Save a Life with Rectal Diazepam

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Save a Life with Rectal Diazepam

• Rachel Gallagher, RN, CPNP, NCSN
• DPI School Nurse Consultant
• [phone]
• Rachel.gallagher_at_dpi.wi.gov

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Prevalence

• 1.5 million Americans active epilepsy
• 325,000 children (up to age 14) have active
  epilepsy (EPA, 2006)
• 300,000 per year newly recognized seizure

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Data

• 90 of seizures last less than 2 minutes
• The longer the seizure, increases the likelihood
  of long term complications and mortality
• 42,000 people die every year due to status
  epilepticus
• 3.8 to 7 billion per year in inpatient cost

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Goal of Seizure Management

• The time of seizure onset to initial treatment is
  critical in attaining seizure control and timely
  administration of effective seizure treatment is
  essential to preventing neuronal damage and
  permanent cerebral injury (Bleck, 1999).
• Prompt treatment prevents status epilepticus and
  decreases mortality or death(Pellock, 2004)

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Definition Acute Repetitive Seizures (ARS)

• Child with a history of recurrent seizure
  activity with periodical episode of repetitive
  seizure activity.
• Characteristics
• Severe
• Predictable, consistent in presentation
• Historically distinct from other seizure activity
• Onset and progression is recognizable
• Patient may recover between seizure
• Constellation of activity recurrent, serial,
  cluster, crescendo seizures

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Definition Status Epilepticus (SE)

• Continuous seizure activity or intermittent
  seizure activity lasting 30 minutes or more with
  a return to consciousness (Bleck, 2002).
• Seizure activity lasting 5-10 minutes
  (Lowenstein, 1999 DeLorenzo, 1999)
• 126,000 to 195,000 estimated cases per year of
  Status Epilepticus 42, 000 deaths each year in
  U.S.
• Time to treatment (5-10 minutes) dictates outcome
  of SE emergencies

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What is needed prior to administration of
rectal diazepam?

• Medical provider authorization or order
• Parent authorization or order
• Verification of correct dosage
• Window
• Green ready band
• Training
• Knowledge Medication On-Line Training and
  webcast
• Return demonstration of physical skill

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When do I give the rectal diazepam?

• Medical provider and parent authorization
• Length of time of seizure activity

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What do I need to have available to give rectal
diazepam?

• Watch
• Gloves
• Prefilled syringe with rectal diazepam gel
• Lubricant
• Blanket and other materials to maintain privacy

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Procedure

• 1. Time seizure and determine need to administer
  medication.
• 2. Have another adult call 911.
• 3. Confidentially remove clothing from buttock
  and drape.
• 4. Push up on cap with thumbs to remove cap.
• 5. Lubricate the tip by inserting it into
  lubricant.
• 6. Move the student to side-lying position,
  facing you with upper leg forward exposing
  rectum.
• 7. Separate the buttock to expose the rectum.

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Procedure continued

• 8. Insert the syringe gently into the rectum
  until the rim is snug against the rectal opening.
• 9. Push the plunger in slowly counting to three
  until the plunger stops.
• 10. With syringe still in rectum count to three.
• 11. Remove syringe and immediately hold buttock
  together and count to three again, to prevent
  leakage of medication.

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Procedure Continued

• 12. Monitor seizure and respiratory effort.
• 13. Begin CPR as needed.
• 14. Notify school nurse and parent.
• 15. Keep student on their side.
• 16. Note time.
• 17. If not already done, call 911.

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• Demonstration
• The three threes

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• Practice

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• Questions regarding administration of rectal
  diazepam in your school district can be directed
  to your school nurse or administrator.
• Questions regarding this training webcast can be
  directed to
• Rachel Gallagher, RN, CPNP, NCSN
• DPI School Nurse Consultant
• [phone]
• Rachel.gallagher_at_dpi.wi.gov