Seizing child recieving IN treatmentTherapeutic Intranasal Drug Delivery

Needleless treatment options for medical problems

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Home Therapy for seizures using intranasal midazolam:

Indications - To deliver topical seizure medications to the nasal mucosa for the treatment of status epilepticus

NOTE: You can now have your doctor prescribe midazolam in prefilled syringes. All you will need to do at that point is connect the atomizer and deliver the correct dose for your child

Prefilled syringes of medication:

Based on extensive research and community use, prepackaged midazolam in the 5mg/ml dosing would certainly seem appropriate for use by properly trained families and BLS providers - and this packaging would surely help improve the ease of use. See this PDF file for the information on other prepackaged medications: Carpuject medications  In situations where the entire volume might not be appropriate (smaller child), the syringe can have a indelible mark or piece of tape applied by the clinician or pharmacy at the appropriate dosage so the parent/provider knows how much to give. Just be sure to purchase the proper dosing (concentrated).

Carpuject of midazolam (has a Luer attachment for a needle or atomizer)

Carpuject of midazolam

Preparation and practice before any seizure:

 

Always store the syringe(s), needle or needleless vial adapter, atomizer tip(s) and medication bottle together in the same place where you can easily access them.

Full kit photo including syringe, atomizer, needle and drug vial should be stored in same place in home

Before you ever need to use the medication, be sure you are knowledgeable regarding the amount (volume) of medication you will administer to the seizing person. That way when the time comes and you are anxious, you will not make a mistake in administering the correct dose.

o        It is a very good idea to take the syringe(s) and have the doctor or nurse use a permanent marker to draw a line around the barrel of the syringe indicating the TOTAL volume of drug you will need to treat the patient.

o        Be sure they account for the 0.1 ml of medication that will remain within the syringe and atomizer tip at the end of the procedure (dead space).

§        For example, if you need to administer 1.2 ml of medication to the patient, you will need 1.3 ml in the syringe at the start of the procedure.

o        Use a syringe and some water (in place of the medication) and follow the procedural directions for a practice trial so you are comfortable when the time arrives.

Unless seizures occur on a weekly basis, do not store the medication pre-drawn up in a plastic syringe – this may lead to the active medication leaching out of the fluid into the plastic and result in inadequate medication effect on the patient. You should draw the medication up at the time it is needed.

Midazolam Dosing chart

Patient age

(years)

Weight

(kg)

IN Midazolam volume in ml*

5mg/ml concentration

 Volume        Dose (mg)

Neonate

  3  kg

0.3 ml             0.6 mg

<1  yr

  6  kg

0.4 ml             1.2 mg

1  yr

10  kg

0.5ml              2.0 mg

2  yr

14  kg

0.7 ml             2.8 mg

3  yr

16  kg

0.8 ml             3.2 mg

4  yr

18  kg

0.9 ml             3.6 mg

5  yr

20  kg

1.0 ml             4.0 mg

6  yr

22  kg

1.0 ml             4.4 mg

7  yr

24  kg

1.1 ml             4.8 mg

8  yr

26  kg

1.2 ml             5.2 mg

9  yr

28  kg

1.3 ml             5.6 mg

10  yr

30  kg

1.4 ml             6.0 mg

11  yr

32  kg

1.4 ml             6.4 mg

12  yr

34  kg

1.5 ml             6.8 mg

Small teenager

40  kg

1.8 ml             8.0 mg

Adult or full-grown teenager

> 50 kg

2.0 ml            10.0 mg

 

* This volume is based on the calculated dose PLUS 0.1 ml dead space in the device (the amount of medication that will remain within the syringe and atomizer tip and therefore will not be delivered to the child). The total volume is then rounded off to the next highest 0.1 ml. Slightly higher doses may be appropriate at the lower range of volume (in smaller children) due to measurement difficulties and possible under dosing which may not stop the seizure. 

In some children a higher dose (0.3 mg/kg) may be more appropriate

To calculate your child’s weight in kg, divide their weight in pounds by 2.2.

Procedure:

  1. Pull the plunger of the syringe back until the black seal is at the mark on your syringe.
    • For example if you are supposed to draw up 1.0 ml of medication, pull the plunger back to the 1 ml mark of the syringe - the syringe will now have 1 ml of air within it.
    • Syringe plunger pulled back to fill with air prior to connecting to the vial.
  2. Pop the protective plastic cap off the bottle of Versed (midazolam) or lorazepam.
    • Pop cap off the midazolam vialPop cap off the vial completely - second picture
  3. Connect the syringe (twist or slip) to the needle or needleless access device and puncture the rubber seal of the medication bottle vial.
    • Puncture vial rubber seal with needle on syringe
  4. Tip the bottle up-side down so the syringe is on the bottom and the bottle rubber seal faces down.
  5. Compress the syringe plunger – injecting air into the bottle vial.
    • Inject air into the vial and tip it upsidedown
  6. Pull the plunger back and allow the syringe to fill with medication (look inside the bottle to see that the tip of the needle is within the liquid drug, otherwise you will just draw the air back out). Draw up the proper volume of medication required to treat the patient.
    • Aspirate correect volume of drug out of the vial into the syringe
  7. Twist off/remove the syringe from the needle/needleless device
    • Disconnect syringe from needle
  8. Attach the atomizer tip via Luer lock mechanism – this product twists into place.
    • Slip Luer is also effective as long as the tip is firmly seated on the syringe tip
    • Connect atomizer tip to syringeTwist or slip atomizer tip onto syringe snugly
  9. Using your free hand to hold the crown of the head stable, place the tip of the atomizer snugly against the nostril aiming slightly up and outward (towards the top of the ear).
    • Hold head and spray half of the medication into one nostril
  10. Briskly compress the syringe plunger to deliver half of the medication into the nostril.
  11. Move the device over to the opposite nostril and administer the remaining medication into that nostril.
    • Spray other half of medication into second nostril

 

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