chloral hydrate

[wen51]

Our facility has determined that chloral hydrate sedation for kids does not fall under our conscious sedation policy. However, no one on that committee can give me any references to back up their decision. I am concerned that JCAHO will ask for our references in determining that policy. I have searched several places and it seems all I can find is that chloral hydrate is considered conscious sedation. How are you all dealing with this. Our policy calls for the physician to be present for sedations, but in our facility we often do EEG's without a physician present and we do use chloral hydrate. Are we putting ourselves at risk--this has been done for many years now without any problems. Thanks. Wenny

[CHUBBY]

I think its a very legitimate concern about JCAHO requesting references- since restraint use and concious sedation are their two focus points this time around. If your policy calls for a MD to be present during concious sedation and you're doing EEG's using chloral hydrate I'd err on the side of being anal-retentive and ask that a doc be present.

Cite your references lisitng chloral hydrate as "concious sedation". You can also contact places where they do alot of pediatric procedures regarding their policies(i.e., Childrens Hospital of Phila. ,etc.) to pic their brains . I'll ask around to see what the general concensus is. I'll get back to you as soon as I find out.

[This message has been edited by chubby (edited 08-26-98).]

[CB]

We use chloral hydrate all the time in our ED to do pediatric CT scans. We also got nailed big time on our last JACHO inspection regarding our conscious sedation policy and we had to make sure that our Conscious sedation paperwork was uniform thru out the facility. However, I still have a lot of concerns regarding the use of chloral hydrate in our ED....Our conscious sedation policy states that the patient must return to 'baseline' before they are d/c'd from the ED....this means that the jumping up and down kid who came to our ED should leave as a jumping up and down kid after conscious sedation. But...this does not always happen. We give some kids chloral hydrate and they are 'out to lunch' for hours and hours but we routinely let them go home with parents in this condition. It could literally take many, many hours for the kid to wake up but it is my feeling that if we follow conscious sedation policy to the letter that these kids should stay in our ED until they are fully awake and back to baseline. I work 7p-7a and the problem comes when this time of day is normally bedtime for kids and then the choral hydrate is added. Makes for a very heavily sedated kid. It would be hard to keep all these kids in the ED as they would be taking up bed space so my feeling is that they should then be admitted as Day Surgery/SPU patients in order to be monitered until they are fully alert again and back to baseline. It seems as if we treat chloral hydrate differently than we do other conscious sedation drugs and allow these kids to go home in their sedated state. I am uncomfortable with this and have ask the unit director to look into whether we need to keep these kids for extended periods of time but have gotten no answers. My son was bitten by a dog several years ago and received a DPT(demerol, phenergan, thorazine) cocktail in order to do his facial repair. He got the shot approx. 1700 and was still barely arousable the next morning. I was allowed to take him home which was ok with me but for the untrained average joe it's a different story. Any experience anyone can share regarding this issue would be of great help. What do other hospitals do? Great subject to discuss!!!

[CHUBBY]

To CB- I agree with you 100%. What if the child was discharged, appropriately, by hospital policy, then vomited and aspirated during the night?? Our facility doesn't really handle peds. We recently had a 7 year with a displaced buckle fx to the wrist. The ortho res. wanted to do concious sedation in the ER- the mom insisted he be done in the OR (good for her). The Anesthesia group didn't feel comfortable with peds airways -so he was sent to a sister facility that does peds. Chubby

[IrisT]

Our facility developed a Pediatric Procedural sedation policy last year. The wording is any agent, by any route used during an invasive, manipulative, and constraining procedure to control behavior is considered procedural or conscious sedation. By the nature of the long half-life of the drug...it is very dangerous airway wise to maintain stability. Once sedated for EEG, a delineated RN accompanies the child from Peds Unit for procedural mointoring and recovery. Our policy requires the "immediate availability of a physician" for those CT/MRI/EEG cases. ED doc is in house 24/7. I can send you a copy of policy.e-mail: [email protected]

Also look to American Academy of Pediatrics for AAP Position Statement on Conscious Sedation and any reference by Dr. Charles Cote, the guru of peds sedation. Link to jcaho.org for 2000 sedation uppdate on standard. Iris Trahan RN CCRN