Reply To: Intranasal Versed

  • Jennifer Nordin

    October 3, 2019 at 9:48 am
    • Midazolam  
    • Dose:
      • 1-5 months – 0.2mg/kg (single dose) 
      • 6 months – adolescents – 0.2-0.3mg/kg (up to max total dose 0.5mg/kg or 10 mg)                   
    • Administration:
      • Give ½ dose in each nostril using atomizer (MAD) device.    
        • May pre-medicate with IN lidocaine 2% to decrease irritation and subsequent agitation. *See Below*                   
      • Onset = 3.5 – 7.5 minutes                              
      • Duration = 23 minutes                               
      • Peak time = 10 minutes                              
      • ½ Life (IV) = 2.9 – 4.5 hours                              
    • Monitoring Guidelines:                                              
    • If given as single agent, LOC, HR, RR, O2 Sat prior to administration. BP for patient’s > 3 yrs or per patient condition if <3 yrs. Frequent reassessment advised after administration. Per patient condition, may consider VS after 15min. Continuous CR and Sat monitor not required with single agents, except for patient’s under 1 year.                                             
    • If given with a benzodiazepine or other sedative medication, including subsequent fentanyl doses, place on CR and Sat monitor, and follow sedation protocol.                                             
  • Discharge Home Criteria                
    • Awake and alert without painful stimulation – easily arousable if sleeping               
    • > or = to 30 minutes since last dose administered
    • Individual providers may elect shorter observation time at their own discretion when clinically indicated, (i.e selected cases when patient condition necessitates further treatment elsewhere).  Provider must ensure patient safety at time of discharge, clearly document patient status and that risk mitigation strategies were discussed with caregivers.                
    • Instructions to family include possible altered mental status for up to 4.5 hours.
  • ——————————
    Jennifer Nordin, RN
    Leawood, KS
    United States
    Original Message:
    Sent: 10-03-2019 08:40 AM
    From: Amanda Marino
    Subject: Intranasal Versed

    Does anyone have a policy regarding the administration/use of intranasal Versed prior to procedures (IV starts, NG placements) they would be willing to share? It would be greatly appreciated. 

    Very Respectfully,

    Amanda J. Marino BSN, RN, CPN
    Naval Medical Center Portsmouth
    Inpatient Pediatrics – Hematology & Oncology

    Amanda J. Marino BSN, RN, CPN
    Naval Medical Center Portsmouth
    Inpatient Pediatrics – Hematology & Oncology