concious sedation

[canoehead]

Does anyone out there have experience in concious sedation for pediatric patients WITHOUT using IV access? We have a several docs who insist that starting an IV before sedation is counterproductive and they want to go with IM meds.

Specifically I have refused to give ketamine IM in a 3 year old without IV access, but they are referring to more than that specific med. I am used to EKG, sat and BP moniter, O2 and crash cart available and IV access BEFORE starting the procedure.

[mommatrauma, RN]

So, here's the thing- we are a small hospital licensed for 20 beds. I don't know how our ER docs are at intubations, and I'd be willing to bet they might do one every 5 years. I KNOW that I can do peds IV's, but not in an emergent situation, not with parents and doc hovering, and certainly not if the child's BP had just dropped to nothing. We also don't have ready access to anesthesia 24h/day and NO pediatricians. Usually anesthesia is in the OR or they are on call, and in both of those situations would not be able to respond emergently.

Given the staff and our experience, the more I think about it the less OK I am with doing without the line...but am I overreacting? I've had 6 years of pediatrics and am generally OK with kids- but this is giving me the heebie-jeebies. Then again, a doc that I would trust otherwise is saying it's perfectly safe.

Canoe...read this article from emedicine.com...it was just updated in Jan 2005...It may help answer some of your questions and concerns...

Ketamine article

[canoehead, BSN, RN]

Thank you, that was very helpful. I'm going to print it up for work.

[rn29306]

We utilize rectal meds, IM meds (only as last resort) and inhalation meds.

I was just wondering... what kind of inhalational medications are you specifically speaking of?

[rn29306]

Where I work now we mostly use the Brevital simply because of the immersion nightmares in kids with the ketamine..

Come on guys.

Immersion = a dip, to plunge, to dunk under water

Emergence is the word you are looking for..Emergence delirium following the administration of ketamine is characterized by visual, audiotory, proprioceptive and confusional illusions.

[mommatrauma, RN]

Come on guys.

Immersion = a dip, to plunge, to dunk under water

Emergence is the word you are looking for..Emergence delirium following the administration of ketamine is characterized by visual, audiotory, proprioceptive and confusional illusions.

Haha...sorry half asleep typing up that one..didn't realize...sorry about that...

[mommatrauma, RN]

Thank you, that was very helpful. I'm going to print it up for work.

You are welcome...I hope it helps you feel a little more comfortable with using it. Emedicine is a great resource for up to date information..I get a lot of my stuff from there. Good luck.

[MAGIK GIRL]

So, here's the thing- we are a small hospital licensed for 20 beds. I don't know how our ER docs are at intubations, and I'd be willing to bet they might do one every 5 years. I KNOW that I can do peds IV's, but not in an emergent situation, not with parents and doc hovering, and certainly not if the child's BP had just dropped to nothing. We also don't have ready access to anesthesia 24h/day and NO pediatricians. Usually anesthesia is in the OR or they are on call, and in both of those situations would not be able to respond emergently.

Given the staff and our experience, the more I think about it the less OK I am with doing without the line...but am I overreacting? I've had 6 years of pediatrics and am generally OK with kids- but this is giving me the heebie-jeebies. Then again, a doc that I would trust otherwise is saying it's perfectly safe.

i have worked in places that do iv as well as places that do im (currently an ortho hospital with lot's of d.o.'s that use ketamine). i have to admit, i am much more comfortable with iv sedation. i feel the recovery times are quicker.

just wondering, can you get a committee of nurses to represent all of the nursing staff to write some policy for the use of iv? maybe you have tried it already but i find that there is saftey in numbers!

i agree about the other emergency equiptment (o2, crash cart, monitor etc).

good luck though! :)

[sjt9721, BSN, RN]

Canoehead...

You mentioned some of your docs who haven't intubated in a long time. Our facility requires physicians to complete a credentialing process specific to conscious sedation before they can order it. I don't know if that's in the JCAHO standards, but it's something to consider. And...conscious sedation for any age patient is limited to certain departments/areas of the hospital.

As for pediatric c.s without IV access...yep, we do it too: IM Ketamine, oral/rectal Versed, oral chloral hydrate.

:balloons: