Management of Midazolam Administration

Description

• Hypnovel is a clear colourless to light yellow solution, 1mg/ml (=1000 micrograms/ml) in 5ml ampoules (for IV use).
• A more concentrated preparation (15mg/3ml) is also available, but the drug calculator does not use this concentration.

Administration

Slow IV Injection

1. The first dose of midazolam in the non-ventilated baby is to be administered by the doctor/NS-ANP. If no adverse effects, nursing staff may administer subsequent doses.
2. Further dilution is not necessary.
3. Filter prior to administration through a Pall 0.22 micron filter.
4. Administer by slow IV injection over 3-5 minutes.
5. Is compatible with D5W, D10W and NS. Incompatible with IVN, phenobarbitone and ranitidine.
6. Do NOT mix with other drugs, IV solutions, blood or blood products.

Continuous IV Infusion

Administered by a nurse with neonatal IV drug certification.

1. Dilute midazolam immediately prior to use to required strength in D5W, NS.
2. Administer via a syringe pump.
3. Change fluid and tubing every 24 hours.
4. Do NOT administer intra-arterially.

Nursing Considerations

1. Before administering, have oxygen and resuscitation equipment available in case of severe respiratory depression.
2. Monitor and record patient response to medication.
3. Observe site closely for extravasation.
4. Monitor for adverse reactions.
5. Continuous cardiorespiratory monitoring.
6. Monitor BP and oxygen saturation.
7. Assess sedated infant for signs of pain (midazolam does not possess analgesic properties).

Storage

• Store <25°C in narcotic cupboard.
• Discard ampoules after use.
• Diluted solution may be kept up 24 hours at room temperature in concentrations from 15 to 150 mcg/ml.

Selected References