Diazepam rectal gel (e.g., Diastat AcuDial) is a specialized emergency rescue medication used to interrupt prolonged, acute convulsive seizures. This benzodiazepine is designed for intermittent use in patients who experience bouts of increased seizure activity, which can progress to a serious condition known as status epilepticus. The goal is to quickly deliver a dose to the systemic circulation through the rectal route, helping to calm the abnormal electrical overactivity in the brain. This guide provides information for caregivers who have received specific instruction, training, and a personalized prescription from a healthcare professional.
Essential Safety and Preparation
Before attempting to administer the medication, the caregiver must first confirm that the patient’s seizure has lasted for the specific duration determined by the physician’s instructions. This prescribed time frame, typically between three and five minutes, is established in the patient’s individualized seizure action plan.
The caregiver must verify the expiration date on the syringe and confirm that the prescribed dosage is correctly displayed and locked on the device. For pre-filled systems like Diastat AcuDial, the presence of a green “ready” band indicates that the syringe has been properly pre-set and locked to the dose prescribed by the doctor.
The person should be gently moved onto their side, facing the caregiver, in a safe location where they cannot fall or injure themselves. Clothing should be loosened, particularly around the neck, and the lower garments should be removed or pulled down to fully expose the buttocks and rectum. Bending the patient’s upper leg forward helps to further expose the rectal area for easier access and proper insertion.
Step-by-Step Administration Guide
The cap must be removed from the rectal tip, ensuring that the protective seal pin attached to the cap comes off completely. If lubricating jelly is provided or recommended, the tip of the syringe should be gently lubricated.
With one hand, the caregiver should gently separate the patient’s buttocks to clearly expose the rectum. The lubricated syringe tip is then gently inserted into the rectum, aiming for the rim of the tip to be snug against the rectal opening. The depth of insertion is guided by the device’s design, ensuring the medication is delivered past the anal sphincter.
Push the plunger fully until it stops to deliver the medication. To ensure the entire dose is administered, the caregiver should count slowly to three while pushing the plunger and continue to count to three while holding the plunger in place.
After the slow count of three, the syringe is slowly removed from the rectum while the plunger is still depressed. Immediately after removal, the caregiver should press the patient’s buttocks together and hold them closed for another slow count of three.
Post-Administration Care and Monitoring
The patient should remain on their side, facing the caregiver, in a secure position. The most common side effect is somnolence, or marked drowsiness, but the caregiver must primarily monitor the patient for signs of respiratory compromise.
While respiratory depression is considered a rare event when the drug is used as directed, it remains a significant concern. The caregiver must closely watch the patient’s breathing rate and depth, noting any changes such as shallow or slowed breathing. A decrease in the respiratory rate is a sign that requires immediate action.
The exact time the medication was administered and the duration of the seizure must be immediately recorded for documentation purposes. The seizure should typically begin to terminate within a few minutes. If the seizure does not stop within the specified window (often five to ten minutes after the dose), or if the patient’s breathing becomes shallow or stops entirely, the caregiver must immediately call the local emergency number.
Expected Side Effects and Subsequent Dosing
Side effects include dizziness, unsteadiness, and incoordination as the medication takes effect. The patient should be kept warm and comfortable.
If a second dose is prescribed for repeated seizure activity, the caregiver must follow the doctor’s specific instructions regarding the time interval, which is usually between four and twelve hours after the first dose.