Conscious Sedation

1
Conscious Sedation

• Jan Bazner-Chandler
• CPNP, CNS, MSN, RN

2
Conscious Sedation

• The use of non-anesthesiologists to manage
  patients receiving sedation has increase over the
  past 20 years.
• State board of nursing issued position statements
  regarding the role of the registered nurse in
  managing conscious sedation.

3
Definition and Goals

• Conscious sedation is produced by the
  administration of pharmacologic agents, by an
  route, that results in a depressed level on
  consciousness but allows the patient to
  independently maintain a patent airway and
  respond appropriately to verbal commands or
  physical stimulus.

4
Patient Selection and Pre-procedural Assessment
5
ASA Patient Classification

• ASA 1 health patient
• ASA 2 Patient smokes and has well-controlled
  hypertension.
• ASA 3 Diabetes, stable angina, takes
  medications.
• ASA 4 Diabetes, angina, CHF, dyspnea, chest
  pain.
• ASA 5 Patient is unstable, but not expected to
  survive without procedure.

6
Monitoring and Equipment

• Oxygen
• Suction
• Airway management
• Monitors
• Pulse oximeter
• Cardiac monitor
• Automated blood pressure device

7
Monitoring Equipment

• Resuscitative equipment / medications
• Ambu bag
• Defibrillator with ECG recorder
• Emergency drugs
• Emergency drug card and ACLS protocols
• PAL protocol

8
Pre-procedure

• Allergies
• Weight to calculate medications
• Recent history and physical
• Baseline vitals with blood pressure and pulse
  oximeter
• Developmental assessment

9
Documentation of Care

• Pre-procedure assessment
• Dosage, route, time, and effects of all
  medications and fluids used.
• Type and amount of fluids administered, including
  blood and blood products.
• Monitoring devices and equipment used.

10
Documentation of Care

• Physiologic data from continuous monitoring at 5
  to 15 minute intervals and following significant
  events.
• Level of consciousness
• Nursing interventions and patients response
• Untoward significant patient reactions and their
  resolution.

11
Notify Medical Doctor

• Rise or fall in systolic pressure 30 mm HG from
  baseline.
• Tachycardia or bradycardia
• Rise or fall in respiratory rate
• Oxygen saturation less than 90 or significantly
  below pre-sedation level.
• Marked decrease in patient responsiveness to
  verbal or painful stimulation
• Signs or symptoms of medication intolerance or
  allergies
• Patient does not meet discharge criteria.

12
Discharge Assessment

• Vital signs to pre-procedural baseline
• Gag reflex / able to swallow
• To pre-procedural level of awareness

13
Discharge Teaching

• Verbal and written discharge instructions.
• Instructions should be initiated in pre-procedure
  phase and repeated in post-procedural phase.

14
Discharge Instructions

• Instructions should cover
• Home medications administration
• Dietary requirements
• Limitations on activity
• Post-procedural care
• Signs and symptoms of complications
• Emergency numbers / physician numbers
• Follow-up appointment

15
Policies and Procedures

• Every practice setting should have policies and
  procedures in place.
• They should be written, reviewed periodically,
  and readily available within the practice
  setting.
• These policies and procedures provide guidelines
  for patient care, minimize risk factors,
  standardize practice, assist staff members, and
  establish guidelines for quality monitoring and
  quality improvement.

16
Competencies

• AORN states that the RN monitoring the patients
  care be clinically competent in the function and
  in the use of resuscitation medications and
  monitoring equipment and be able to interpret the
  data obtained from the patient.