[DeterminedOne]

Hello fellow rad nurses! Have a question I'd like the group to address - Do any of you have docs/radiologists that do angios without any conscious sedation??
I work with a variety of doctors - radiologists, cardiologists, and a vascular surgeon - all who do angios. The vascular guy allows us to give sedation to all of his patients; one of the radiologists never gives sedation, but he does keep the site numbed with Lido and his patients never complain. However - we just started doing cardiac caths and our cardiologist does not use sedation. First case he did was a right and left heart cath and I was very uncomfortable when he sized up to an 8 FR sheath. It was obvious the patient had a lot of discomfort. This particular cardiologist is new to our facility (in fact - he is new to our country) and I did ask one of the other cardiologists in the group to discuss giving conscious sedation with him. Seems to me we are not providing a consistent standard of care for all our patients. Any advise - suggestions on how to address this? By the way - I really enjoy this site and would love to see more postings and discussion!!

[NurseGirlKaren]

It all depends on the doc/procedure/pt's comfort. Some of our docs always call out for sedation when they walk in the room; others just wait and see how the pt's doing. As long as the pt's comfortable, I'm ok with not giving them sedation. If the doc refuses to let them have sedation if they really needed it, then I would have a problem. For example, if a pt is known to have sleep apnea and is comfortable during the procedure, then I'd be happy to not give them sedation!

It all just depends on the circumstances. Hope this helps!

[dianah]

Most of our caths and angios are done with mild sedation and local anesthesia, mild sedation being 1-2mg Versed at beginning of case, possibly with 25-50mcg Fentanyl added. Pts are generally very comfortable (we monitor them continually for comfort) during case. Our conscious sedation protocol, written by the anesthesia dept, stipulates that it becomes conscious sedation if we have to titrate doses to maintain a level of sedation required for the exam. Most cases we do try to stay with mild sedation. As NurseGirlKaren wrote, it does depend on the case and the pt as to what is used and how much. The cardiologist whose pts are uncomfortable may not be giving enough local anesthesia, or not over a wide enough area, or the pts may benefit from use of a longer-acting local anesthetic agent (eg, Marcaine). The one or two mg of Versed usually helps "take the edge off."

[dspring]

I see both in out lab. Our Vascular Dr. and Cardiologist want them zonked, and our Rads give a little happy juice, and lots of Lido, and they get along just fine.

[RadRN2]

We're about the same as everyone else here. Probably around 85% of our IR cases receive some Versed/Fentanyl combination, varies according to pt anxiety/pain/type and discomfort of procedure. Our rads pretty much leave it up to the RN's to give appropriate sedation/analgesia which is great because I think we have a much better feel for it during the case. Generally, the quicker diagnostic cases, especially neuro angios are lightly sedated so we can better moniter LOC. Longer, more painful procedures like PTC and vertebroplasty receive heavier doses. We also pre-dose our vertebroplasties with Toradol.

[CCL"Babe"]

We almost always do valium and sometimes dilaudid. We tried Versed, but our MDs didn't like the fact that patients didn't remember their procedures or what was said to them. A couple of times we had some patients wake up during long procedures with versed and try and get off the table. Only one MD uses versed routinely in combo with dilaudid. If our patients have a history of sleep apnea we get a bipap machine from resp therapy or ask the patient to bring in theirs. It is very rare that we don't sedate our patients. Most of them are pretty anxious when they hit our sheets.

[RadRN2]

Now that's interesting -- we like Versed BECAUSE of the amnesiac effect! You're the first I've seen use Dilaudid routinely, is there specific reasons for that preference?

[CCL"Babe"]

We use dilaud usually for pain management, in small increments. We give dilaudid for chest pain during PTCA/stents and other invasive procedures. Many patients complain about the tables -back pain etc. Some people are just plain resistant to valium or versed, but a little bit of dilaudid puts them in a comfortable place. The one MD that uses Versed routinely always orders 1mgm of versed and 1mgm of dilaudid.

I think our MDs get tired of answering the same questions repeatedly after sedating the patients with Versed. Often the patients do not see the doctor again. We have PAs who follow the patients once they leave the lab. The patients didn't remember seeing the doctors after the procedures and would get ******, demanding to see them.

When we do conscious sedation on any of our TEEs and cardioversions we do versed and Demerol. Usually in the lab we only give demerol for the shakes.

[dspring]

Toradol preop for vertebroplasty? Have you seen much difference with it. Toradol is one of my favorite drugs for kidney stone pain. I've seen grown men cry with 10 of morphine, and give them 30 of toradol and boom they are ready to walk out the door.

[RadRN2]

We have one guy who gives Toradol 30 mg pre-procedure and another one who gives the same only post-procedure. The "pre" guy does alot more vertebroplasties than the other one, but I do think his pts do better than the "post" Toradol.