Conscious sedation

[MrsK1223]

I just wondered if anyone thinks conscious sedation should be something that special training is given to a nurse or just another part of medication administration? The unit I have started in uses conscious sedation and I will be getting "while I'm working" training on conscious sedation but its very informal and nothing specific given on the medications used, just give this or that..of course they know what they are doing but I just feel very uneasy at this point which is early in the game, about doing conscious sedation and all that it entails. To me its very serious with all the potential complications but doesn't seem like a big deal to the ones who have been there a while. What do you think?:)

[Tweety, BSN, RN]

What type of unit to do work in? ICU?

I think outside of ICU and the ER, it's not a good idea to ask the nurses to do the conscious sedation. It takes too much time and monitoring out of one's shift. It's too risky.

[dianah, ASN]

At our facility (and with strong pressure from the State) conscious sedation may only be given by RNs who have passed a yearly competency (written exam and having one case proctored by an Anesthesiologist), and C.S. can only be given in designated areas of the hospital (so named in the Conscious Sedation Policy, written by the Dept of Anesthesia) -- ER, ICU, Perioperative Services (GI Lab), Cath Lab, Radiology/Angio, Cardiac Diagnostics (for TEEs). There must be a written policy that clearly outlines who may give, what makes them competent to give (re: your original question/comment: how do you know the other nurses "know what they're doing"?), when they may give (not if the ASA is 4 or higher), how it may be given (dosages and reversal agents), etc. Check out the other posters' suggestions/links. Good luck!

[SmilingBluEyes]

Yes, where I work, we do have to achieve competency in conscious sedation procedures. AND we are required to have ACLS also because we do circulate our own csections, tubals, manual removal of placental fragments, occasional D and C's, and other procedures that require differing forms of anesthesia and yes, conscious sedation. All the places I know of do require annual competencies including what our role is in caring for patients under conscious sedation.

[mosrnc]

You might want to check with your board of nurisng for any restrictions on conscious sedation administration. Some states are considering it.

[kaycee]

We use CS quite frequently in the ER, and as others have said we have a yearly competency. There must be a physician and an ACLS certified nurse doing the procedure as well as resusitation equipment in the room or very near by.

[plumrn, BSN, RN]

This is a stupid question, but I have to ask. One of our orthopedic surgeons in the past, injected Valium IV (5mg) to momentarily put a pt to sleep, in order to pull their dislocated hip back into place. He did this on the med/surg floor! Isn't this considered conscious sedation?

He did this so fast; just called for someone to bring a vial of Valium to the room, and then injected it before we really knew what was going on. The pt was out for about 30 secs, then was awake, but groggy for a little while. Of course, a nurse stayed with the pt until she was well awake.

Shouldn't he have taken the pt to OR, or at the least had a CS trained nurse at bedside w/ a crash cart right there?

[webbiedebbie]

One hospital where I worked 8 years ago (postpartum) did conscious sedation for procedures on the floor. I was very uncomfortable with this and felt I needed further training. They didn't think so.

I am returning to that hospital (postpartum) and found out that they don't do it on the floor anymore. Any procedures that use it are done in L&D now.