How to give intranasal midazolam using a nasal atomizer. Midazolam is a prescription medication
used to quickly stop seizures. This video explains how to give Midazolam when it
comes in a glass vial. It is given as a mist into the nose using a device called a mucosal
atomization device.You may also hear it called a nasal atomizer, an M.A.D or a MAD. Give your
child this medication exactly as your child's healthcare provider or pharmacist tells you to.
This medication should only be given when your child needs it. Midazolam is often used to stop
a long seizure or a cluster of seizures. Speak to your child's health care provider or pharmacist
about when you should give this medication to your child. Why is midazolam being given through
the nose? When the medicine is sprayed into the nose, it is quickly absorbed through the
inner surface of the nose, directly into the blood. This works quickly to stop a seizure.
To prepare the dose you will need: a mucosal, atomizer device, or MAD, a lure lock syringe,
a needle, a vial of Midazolam, alcohol wipes, a piece of tape to mark the amount you will withdraw,
and a sharps container. Before starting you may find it helpful to mark the syringe with tape
or a marker at the level where the medication needs to be drawn up to.
Your child's health care provider or pharmacist will tell you the volume of medication your child
needs and what level this is in milliliters or mLs. Note that an extra 0.1 mil of medication should
be drawn up to account for the amount of liquid medication that will remain in the neck of the MAD
after administering the dose. For example, if the dose is 0.5 mLs of medication,
0.6 mLs needs to be drawn up. It is important that you check with your pharmacist or other
health provider for the exact volume of extra medication to draw up before giving the dose.
There are different models of MADs and the volumes may vary.
First, you will need to drop the Midazolam from the vial. Fill the syringe with air by pulling
the plunger of the syringe back until the top of the plunger reaches the marked level.
Check to make sure the medication is Midazolam. That it has the correct dose and that it hasn't expired.
Remove the protective plastic cap off the vial of medication
and wipe the top of the vial with an alcohol swab.
Connect the needle to the syringe and twist to secure.
Remove the needle cap and stick the needle through the rubber seal of the medication vial.
Push on the plunger of the syringe to inject air into the medication vial
and flip the vial upside down. And while holding down the plunger, look
into the vial to make sure the tip of the needle is in the liquid medication.
If it is not, adjust the level of the needle so the needle tip is fully in the liquid.
Pull back on the plunger and allow the syringe to fill with medication.
Draw the medication until it reaches the marked level.
If you notice a large air bubble in the syringe, tap the syringe to bring the bubbles to the top,
flip it back over, inject all the medication back into the vial and restart again.
When you have the correct amount, remove the needle from the vial. Replace the needle cap and twist off
the needle tip from the syringe. Safely dispose the needle tip into the sharps container. Now you are
ready to give your child Midazolam using the MAD. Attach the mad to the syringe and twist to secure.
Examine the inside of your child's nose. Look for large amounts of mucus or blood that may prevent
absorption of the medication into the nose and remove it if possible. Hold the top of your child's
head as still as possible and place the MAD into the nostril. The tip of the MAD should rest snugly
against the inside of the nostril and should be aiming up and outwards. Push down on the syringe
plunger forcefully to expel the medication as a mist into the nostril in one rapid dose.
If pushed too slowly, medication might not turn into a mist and may not work as effectively.
Make sure the child is lying down in the recovery position.
There is a maximum dose that can be given per nostril. If your healthcare provider has advised
you to split the dose, please do so. Midazolam usually starts working within five minutes.
Your child's healthcare provider may decide that it is safe to repeat a dose of Midazolam.
You should only repeat a dose if instructed to do so by your child's healthcare provider. If you need to
repeat a dose the 0.1 mil of medication remaining in the device should be discarded first. With the
MAD attached, pull back on the plunger to fill the syringe with air. Then push down on the plunger
forcefully to push the remaining medication out of the device. Repeat a few times to make sure all
medication is pushed out, then follow the earlier instructions to draw and administer the next dose.
The device may be washed and reused by the same child. Remove the MAD from the syringe.
Wash your hands and the device with mild soap and water. You can use a syringe to rinse the
MAD and let it air dry. Once everything is dry, place them into a safe storage container.
You may want to write down when the vial was first opened. Once opened, a vial of Midazolam
can continue to be used for up to 28 days. After 28 days, the vial must be discarded even if there
is still some Midazolam remaining. Take your expired Midazolam to your pharmacy for disposal.
Make sure you always have enough Midazolam to last through weekends, holidays and vacations. You may
want to prepare a travel pack of the medication to keep in your purse or at your child's school.
It should include all the necessary supplies such as: the medication, the MAD device, a needle,
syringe, the alcohol swabs, etc. Call your pharmacy at least two business days in advance if you are
running low in Midazolam, as not all pharmacies will carry this medication on a regular basis.
The vial of Midazolam must be kept in a dry and clean place at room temperature away from
sunlight. Do not store it in the fridge, bathroom or kitchen. Keep it out of your child's sight
and reach and locked up in a safe place. Some families use a safe storage container.
Write down when the vial was first opened. Discard the open vial after 28 days.
Check with your pharmacist about the best way to throw away medications. Some possible side effects
of Midazolam may make your child drowsy, dizzy, less alert, hyperactive, irritable or grumpy.
Most of the following side effects are not common, but they may be a sign of a serious problem.
Call 9-1-1 or take your child to the nearest emergency department if your child has any of the
following side effects: trouble breathing, shortness of breath, severe weakness, difficulty waking up,
chest pain or pressure, slurred speech, confusion or seizures that do not stop. If your child takes
too much Midazolam call your local poison center. Midazolam should not be given to your child unless
it has been prescribed to them by their health care provider. Make sure you give this medication
to your child exactly as you have been told to by your child's health care provider or pharmacist.
Remember, they are available to answer any of your questions about your child's medications.
Key points. Intranasally means given through the nose using a mucosal atomization device or MAD.
Check with your pharmacist or other health provider for the exact volume of extra medication
to draw up before giving the dose. There are different models of MADs and the volume may vary.
Be careful to give the medicine only as directed by your child's healthcare provider.
Take open vials of Midazolam back to the pharmacy for disposal
after 28 days. It may seem overwhelming at first but with practice, this does get easier.