Conscious Sedation Jan Bazner-Chandler CPNP, CNS, MSN, RN
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.
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.
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.
Monitoring and Equipment • Oxygen • Suction • Airway management • Monitors • Pulse oximeter • Cardiac monitor • Automated blood pressure device
Monitoring Equipment • Resuscitative equipment / medications • Ambu bag • Defibrillator with ECG recorder • Emergency drugs • Emergency drug card and ACLS protocols • PAL protocol
Pre-procedure • Allergies • Weight to calculate medications • Recent history and physical • Baseline vitals with blood pressure and pulse oximeter • Developmental assessment
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.
Documentation of Care • Physiologic data from continuous monitoring at 5 to 15 minute intervals and following significant events. • Level of consciousness • Nursing interventions and patient’s response • Untoward significant patient reactions and their resolution.
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.
Discharge Assessment • Vital signs to pre-procedural baseline • Gag reflex / able to swallow • To pre-procedural level of awareness
Discharge Teaching • Verbal and written discharge instructions. • Instructions should be initiated in pre-procedure phase and repeated in post-procedural phase.
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
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.
Competencies • AORN states that “the RN monitoring the patient’s 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.”