Colfosceril Palmitate (Synthetic Lung Surfactant Dipalmitoylphosphatidylcho DPPC)

 Action Replaces deficient endogenous pulmonary surfactant and reduces surface tension.

 Indications Prevention of neonatal respiratory distress syndrome (RDS) in infants with birth weight of < 1350 g; treatment of established hyaline membrane disease at all gestational ages. Adult RDS.

 Contraindications Standard considerations.

 Route/Dosage

NEONATES & INFANTS: Intratracheal Prevention 5 ml/kg/installation as soon as possible after birth; second and third doses: approximately 12–24 hr later to infants remaining on mechanical ventilation. Rescue: 5 ml/kg/installation at confirmation of RDS diagnosis; repeat 5 ml/kg 12 hr later (if infant remains on mechanical ventilation).

 Interactions None well documented.

 Lab Test Interferences None well documented.

 Adverse Reactions

CNS: Intraventricular hemorrhage. RESP: Oxygen desaturation; pulmonary hemorrhage, nosocomial pneumonia; apnea; mucous plugs.

 Precautions

Drug should be administered only by trained personnel in closely supervised setting. Pulmonary hemorrhage: Occurred more commonly in infants weighing < 700 g.

 Administration/Storage

• For intratracheal administration only.
• Reconstitute immediately before use, if possible, with Sterile Water for Injection. Do not use solutions that contain preservatives or buffers. Gently swirl or shake suspension before administration.
• Do not use suspensions if persistent large flakes or particles are present.
• Administer by installation into trachea via side port on special adapter of endotracheal tube without interrupting mechanical ventilation.
• Before administering, assure proper placement of ET tube. Recheck during and after administration. If suctioning is required, allow patient’s condition to stabilize before administering. Suctioning should be done before installation and then no less than 2 hr after administration.
• Store unreconstituted powder at room temperature in a dry place.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Determine infant’s weight, because accuracy is important for dosing.
• Maintain continuous ECG and transcutaneous oxygen saturation monitoring during administration; arterial BP monitoring is desirable.
• Maintain continuous bedside monitoring for at least 30 min after administration.
• Perform frequent blood gas monitoring after administration to prevent hypocarbia and hyperoxia.
• If chest expansion improves significantly after administration, reduce peak ventilator inspiratory pressures immediately. Do not wait for blood gas confirmation.
• Do not suction for 2 hr after administration unless airway is obstructed. Be alert for possible mucous plugs. Replace ET tube immediately if suctioning is unsuccessful.
• Monitor heart rate, color, respirations (rate, quality), facial expression, endotracheal tube patency and oximeter during and after administration.
• Continually monitor oxygen and carbon dioxide levels and be prepared to adjust ventilator appropriately.

 Patient/Family Education

• Explain use and benefits of medication and its possible side effects.
• Advise family of infant’s condition and offer frequent updates.

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