Administering Medications through the Nasal Cavity | Loyola Medicine
Tuesday, April 18, 2017

Emergency Departments Administering More Medications through the Nasal Cavity

Loyola University Medical Center emergency room

MAYWOOD, IL –  Administering medications through the nose as an alternative to injections or IVs is becoming increasingly popular in emergency departments and ambulances, according to a paper by Loyola Medicine pharmacists.

The intranasal route “is easy, fast and noninvasive,” emergency department pharmacist Megan A. Rech, PharmD, MS, and colleagues write in the journal Annals of Emergency Medicine.

To administer a medication through the nose, a nurse or physician attaches a device called an atomizer to a syringe. The device then is placed in the patient’s nostril. When the syringe plunger is pushed, a fine mist of medication covers the inside surface of the nose, providing a shortcut to the brain.

The intranasal route requires no needles, is less painful than IVs or injections and minimizes the spread of infectious diseases. For certain patients, including children, the elderly and the obese, the intranasal route also can deliver a medication to the bloodstream more quickly than an injection.

In some patients, IVs and injections are difficult to administer. A patient may be seizing or combative. An IV drug user may have collapsed veins. A child may be afraid of needles. A patient may be wearing multiple layers of clothes. Or it may be difficult and time consuming to obtain an intravenous line.

The review article by Rech and colleagues examined intranasal administration of five common medications used in emergency departments: midazolam (used to tranquilize and sedate children and treat seizures in children and adults); fentanyl (for pain relief); naloxone (for opioid overdoses); ketamine (to induce anesthesia) and dexmedetomidine (to sedate and relieve pain in children).

Previous research has found that, when administered intranasally, midazolam is effective for procedural sedation, anxiety and seizures and fentanyl is safe and effective for managing acute pain. The intranasal route also appears to be an effective alternative for naloxone for opioid overdose. The research to date is less clear on the roles for intranasal ketamine and dexmedetomidine.

The intranasal route has several disadvantages. It’s more expensive than IVs and the dose may not be large enough, especially for adults. It cannot be used in certain situations, such as nasal defects or cocaine use that restricts blood vessels. It may irritate nasal membranes and leave an unpleasant taste in the back of the throat.

The paper is titled, “When to Pick the Nose: Out-of-Hospital and Emergency Department Intranasal Administration of Medications.”

In addition to Rech, other co-authors are Loyola emergency room physician Brian Barbas, MD; Loyola pharmacists Whitney Chaney, PharmD, BCPS and Elizabeth Greenhalgh, PharmD, BCPS; and Charles Turck, PharmD, BCPS of ScientiaCME of Highland Park, Illinois.

About Loyola Medicine and Trinity Health

Loyola Medicine, a member of Trinity Health, is a quaternary care system based in the western suburbs of Chicago that includes Loyola University Medical Center (LUMC), Gottlieb Memorial Hospital, MacNeal Hospital and convenient locations offering primary and specialty care services from 1,877 physicians throughout Cook, Will and DuPage counties. LUMC is a 547-licensed-bed hospital in Maywood that includes the William G. and Mary A. Ryan Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, Illinois's largest burn center, a certified comprehensive stroke center and a children’s hospital. Having delivered compassionate care for over 50 years, Loyola also trains the next generation of caregivers through its teaching affiliation with Loyola University Chicago’s Stritch School of Medicine and Marcella Niehoff School of Nursing. Gottlieb is a 247-licensed-bed community hospital in Melrose Park with 150 physician offices, an adult day care program, the Gottlieb Center for Fitness, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park. MacNeal Hospital is a 374-bed teaching hospital in Berwyn with advanced inpatient and outpatient medical, surgical and psychiatric services, advanced diagnostics and treatments. MacNeal has a 12-bed acute rehabilitation unit, a 25-bed inpatient skilled nursing facility, and a 68-bed behavioral health program and community clinics. MacNeal has provided quality, patient-centered care to the near west suburbs since 1919.

Trinity Health is one of the largest multi-institutional Catholic healthcare systems in the nation, serving diverse communities that include more than 30 million people across 22 states. Trinity Health includes 92 hospitals, as well as 109 continuing care locations that include PACE programs, senior living facilities and home care and hospice services. Its continuing care programs provide nearly 2.5 million visits annually. Based in Livonia, Mich., and with annual operating revenues of $18.3 billion and assets of $26.2 billion, the organization returns $1.1 billion to its communities annually in the form of charity care and other community benefit programs. Trinity employs about 129,000 colleagues, including 7,800 employed physicians and clinicians. Committed to those who are poor and underserved in its communities, Trinity is known for its focus on the country's aging population. As a single, unified ministry, the organization is the innovator of Senior Emergency Departments, the largest not-for-profit provider of home health care services—ranked by number of visits—in the nation, as well as the nation’s leading provider of PACE (Program of All Inclusive Care for the Elderly) based on the number of available programs.