Equipment 8-396 - Intranasal (IN) Device

CMH EMS & MIH Protocols

Scope of Practice:

Emergency Medical Responder

Emergency Medical Technician

Advanced Emergency Medical Technician

Registered Nurse

Paramedic

Note: EMR, EMT, and AEMT may only use IN device for Narcan administration for suspected narcotic overdose causing respiratory depression when they are unable to ventilate.

Indications:

Contraindications:

If IV access can be obtained, IV is preferred medication route.

Precautions:

Mucous, blood, and vasoconstrictors reduce absorption.

Minimize volume, maximum concentration:

1/3 ml per nostril is ideal, 1 ml is max.
Use both nostrils to double surface area.

Procedure:

Select correct medication at a high of a concentration as possible. Divide the dose between the two nares.

Confirm orders, dosage, and expiration.

Check patient allergies.

Remove and discard the green vial adapter cap.

Pierce the medication vial with the syringe vial adapter.

Aspirate the proper volume of medication required to treat the patient (an extra 0.1 ml of medication should be drawn up to account for the dead space in the device).

Remove (twist off) the syringe from the vial adapter.

Attach the Mucosal Atomization Device (MAD) to the syringe via the luer-lock connector.

Using the free hand to hold the crown of the Head stable, place the tip of the MAD snugly against the nostril aiming slightly up and outward (toward the top of the ear).

Briskly compress the syringe plunger to deliver half of the medication into the nostril.

Move the device over to the opposite nostril and administer the remaining medication into that nostril.

Observe patient for effects.

Citations:

Protocol 9-010 - References
Borland, Bergesio, Pascoe, Turner, & Woodger, 2005.
Finn, et al., 2004.
Holsti, et al., 2007.
O'Donnell, et al., 2013.
Teleflex Incorporated, 2013.

Change Log:

Date	Link to previous version	Description of change
11/11/13	pdf	Added comment that IV route is preferred.
07/04/20		Renumbered the section to allow for future additions.
08/07/20	pdf	Added content (without substantive modification) from old Section 8-130 - Intranasal (IN) Device.
06/11/21	pdf	Moved to emsprotocols.online
12/01/21		Updated link to Zofran.
12/01/21		Updated link to Versed.
03/19/23		Changed links for Narcan.
03/20/23		Changed link for Fent.

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