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by Tom Trimble, RN
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| Checklist for Sedated Procedures |
by Tom Trimble, RN |
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N.B.: This document is intended as a memory aid for Qualified staff in preparing for a sedated procedure. It is not a substitute for training or credentialing to provide sedation. Its goal is to promote consistency and compliance with requirements of policy and safety.
Anticipation: Caution Pt. NPO; Ascertain weight; verify meds., allergies, comorbid history, potential airway problems/anesthetic history; Confirm patient will not drive home; Notify Physician
Planning:
Confirm plan to perform sedation; Confirm Airway Plan and Manager (Deep Sedation requires worse case scenario qualified Intubator (ED faculty, designated ED attendings, Anesthesiology only); Confirm adequacy of staff & conditions for proposed procedure; Resuscitation equipment & Code Cart at hand. NPO x 6 hrs (solids) x 2 hrs (clear liquids in modest amount) –if in doubt, reassess plan!Alternative Plans:
Admit patient (short stay) for O.R. or other procedure room. Discharge patient for return as elective procedure (e.g., Ambulatory Surgery). Return to ED after full NPO time period.Typical Cases/Agents:
Short painful procedures requiring
"relaxation" or amnesia (joint and fracture reductions, cardioversion):
Monitoring:
IV Propofol (Diprivan™)
or IV Methohexital
(Brevital™) & analgesic; adding "hematoma block" with fracture
reductions.
Longer procedures with unawareness/amnesia (e.g.,
pediatric wound repair):
IM Methohexital
(Brevital™) or Ketamine (Ketalar™).
Short procedures requiring dissociation,
amnesia, analgesia, and lower risk of airway loss:
IV Ketamine
(Ketalar™).
Longer procedures requiring titrated
analgesia/sedation with patient cooperation or not needing unawareness:
IV morphine/fentanyl
& midazolam/diazepam.
Drug Preparation: Draw drugs (label if >1 agent); Naloxone/Flumazenil in room, if appropriate to agents used.
Patient Preparation: Monitors as above; IV access (available in room if IM sedation only): N.S. (18ga. desirable); allay anxiety; Oxygen for all patients (titrate sPo2 to 95% or greater). Suction/resuscitative equipment functional.
Recovery: Observe & record: LOC/GCS, VS/SpO2, q 15 minutes until baseline; Must be able to lift head/take deep breath to command. Wakefulness should be without verbal slurring or confusion (or to baseline).
Beware: Be wary of potential re-sedation after procedure as stimulus of pain and anxiety removed, especially with multiple agents or doses rapidly absorbed.
Discharge Criteria: Alert or baseline (exhausted children past bedtime may be drowsy if undisturbed but rousable and otherwise stable); able to take po fluids, able to ambulate at baseline; able to void; verbalization at baseline; understands cautions (to baseline). Pain Scale Assessment.
Documentation: Complete Conscious Sedation Record; Revert to regular Nurse’s Notes after Recovery; Log ALL cases in Sedation Log; Procedure Note by physician; QA Voice Line/ Incident Report of indicated cases.
QA Criteria:
"Checklist for Sedated Procedures"
(http://ENW.org/SedationChecklist.htm)
is a webarticle presented by:
Emergency Nursing World ! [http://ENW.org]
©Tom Trimble, RN [Tom@ENW.org]
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