Valium and ECMO

[bungee]

Hello there all!

First post here with a quick question. I am a Primer for our ECMO program and I was asked a question as to "Why do we not use Valium with neonates while on ECMO?"

Well, I researched some and have not found anything that is contraindicated with neonatal ECMO. Anyone have any ideas?

Thanks

[EricJRN, MSN, RN]

I don't work at an ECMO center, but we generally stay away from diazepam in our neonates. Diazepam and its metabolites have long half-lives and we also worry about the benzyl alcohol concentration in the drug.

[NotReady4PrimeTime, RN]

I agree with what Eric said. We use midazolam and morphine infusions and morphine and lorazepam boluses most often, and sometimes fentanyl for our ECMO patients. I can't honestly remember the last time we used diazepam for anything... not even status epilepticus. We use lorazepam for that. I'll ask your question at work tonight; we just took a baby off the other day, and have another one on, so there will be someone who might know!

[BittyBabyGrower, MSN, RN]

eric is right...it is the benzyl alcohol in it (it acts as a preservative), that is containdicated in neonates under 6 months old. We use ativan or versed for sedation.

[NotReady4PrimeTime, RN]

I polled the ECMO specialists in our unit on Friday night. One of them has used diazepam when she worked in Salt Lake City, but nowhere else. She thought it was likely physician preference or institutional practice. The infant we have on pump right now is getting midazolam and morphine, with lorazepam for breakthrough. I asked some physicians. They both said the same things... delayed onset of effect and long half-life make it a poor choice. No one mentioned the benzyl alcohol, but for me that's a good enough reason not to use it.

[elizabells, BSN, RN]

We barely sedate our ECMO kids in my NICU at all. Usually have Versed ordered q3 PRN to start, and move up to morphine from there with occasional Fentanyl if the morphine doesn't help. I generally have to butt heads with the docs to get better sedation - each and every time. In our unit it's considered okay for the baby to be awake and even moving a bit as long as the ETT and cannulae aren't endangered. I have never had a child on ECMO on any kind of sedative or analgesic drip.