5-3 INTRANASAL MEDICATION ADMINISTRATION

General Information:

• The Mucosal Atomization Device (MAD) can be used for the administration of Fentanyl, Midazolam, and Nalaxone in the event an IV has not or cannot be initiated.
• Prior to using the intranasal route of administration, inspect the patient’s nostrils for significant amounts of blood or mucous discharge.  The presence of these will limit the medication absorption.  Suctioning the nasal passage prior to delivery and/or alternative delivery options should be considered.
• Always deliver half of the medication dose up each nostril.
• Do not use more than 1 ml of medication per nostril.  If a higher volume is required, apply it in two separate doses allowing a few minutes for the initial amount to absorb.
• Be aware that there is approximately 0.1 ml of dead space in the MAD.  It is important to make allowances for this dead space when calculating the volume to be administered.
• May only be used with medications within the scope of practice of the individual administering the medication

Indication:

• Available route of administration available for specified medications when:
  • Intravenous (IV) access is unavailable or impractical
  • Rapid onset of medication is desired
  • Intra-osseous (IO) placement is not indicated

Procedure:

1. Using a 1 ml or 3 ml syringe and needle, draw the appropriate amount of medication into the syringe.
2. Remove the needle and place the MAD tip onto the syringe.  The MAD is a Luer lock device and twists into place.
3. Use 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 (toward the top of the ipsilateral ear).
4. Briskly compress the syringe plunger and deliver approximately half of the medication.
5. Move the device over to the opposite nostril and administer the remainder of the medication as before.
6. If an amount greater than 1 ml per nostril is needed, wait 2 – 3 minutes and administer the remaining medication.
7. Monitor ECG, Vital Signs (BP, HR, RR, SPO₂)
8. Evaluate the effectiveness of the medication, if the desired effect has not been achieved, consider repeating and/or changing route of administration