conscious sedation in New outpatient Clinic

[laureena40]

Hi; I have been a RN for 20 + yrs. I was a CVICU RN and an EP procedural RN who did Conscious Sedation in a hospital setting. I took a new job as an IR RN in a new wound and vascular clinic. The IR doctor is doing arterial stents, TPA, procedures, etc. The Director of Operations is an RN and training me. She told me that if I just give Versed during the procedure I do not necessarily need to place the patient on O2 because "a patient can have 02 toxicity". The cases I have been in so far, the IR doc has just given between 0.25mg-0.5mg of Versed but no fentanyl. I have never done sedation this way. I always placed my patient on 02 and had a defib in the room. We have an AED outside of the room but suction and code cart in the room....I don't know what to do. The RN training me wont listen to new ideas and suggestions cause she thinks she is right no matter what. And both MD's trust her completely. Anyone every heard of such a thing? Any suggestions for me? Thanks

[herring_RN, ASN, BSN]

The following link has the advice our board of nursing. It includes the policies and position statement of the following professional organizations:

* "AORN Recommended Practices for Monitoring the Patient Receiving Intravenous Sedation," Association of Operating Room Nurses, Inc., 2170 S. Parker Road, Denver, Colorado, 80231. Telephone [phone].

* "Position Statement on the Role of the Registered Nurse in the Management of Patients Receiving IV Conscious Sedation for Short-Term Therapeutic, Diagnostic, or Surgical Procedures" (endorsed by 23 professional associations). American Nurses Association, 600 Maryland Avenue S.W., Suite 100 West, Washington, DC 20024-2571. Telephone [phone].

* "Qualified Providers of Conscious Sedation," American Association of Nurse Anesthetists, 222 South Prospect Avenue, Park Ridge, Illinois 60068. Telephone [phone].

CONSCIOUS SEDATION

... In administering medications to induce conscious sedation, the RN is required to have the same knowledge and skills as for any other medication the nurse administers. This knowledge base includes, but is not limited to: effects of medication; potential side effects of the medication; contraindications for the administration of the medication; the amount of the medication to be administered.

The requisite skills include the ability to: competently and safely administer the medication by the specified route; anticipate and recognize potential complications of the medication; recognize emergency situations and institute emergency procedures.

Thus the RN would be held accountable for knowledge of the medication and for ensuring that the proper safety measures are followed.

National guidelines for administering conscious sedation should be consulted in establishing agency policies and procedures.

The registered nurse administering agents to render conscious sedation would conduct a nursing assessment to determine that administration of the drug is in the patient's best interest.

The RN would also ensure that all safety measures are in force, including back-up personnel skilled and trained in airway management, resuscitation, and emergency intubation, should complications occur.

RNs managing the care of patients receiving conscious sedation shall not leave the patient unattended or engage in tasks that would compromise continuous monitoring of the patient by the registered nurse.

Registered nurse functions as described in this policy may not be assigned to unlicensed assistive personnel.

The RN is held accountable for any act of nursing provided to a client. The RN has the right and obligation to act as the client's advocate by refusing to administer or continue to administer any medication not in the client's best interest; this includes medications which would render the client's level of sedation to deep sedation and/or loss of consciousness...

https://www.rn.ca.gov/pdfs/regulations/npr-b-06.pdf

[alwaysnforever]

Are these patients hooked up to monitoring with a BP cycling regularly?

We do conscious sedation at times in my ICU, and do not automatically hook pts up to 02 just because they are being sedated. If the 02 starts to fall, then we hook them up. 0.25-.5 of versed is a pretty small amount and I think most patients would be okay without supplemental 02. I also think that its sufficient for the defib/crash cart to be just on the unit, not in the room.

On a side note, I think it's interesting the providers use just versed. I'm used to seeing versed and fentanyl, or fentanyl by itself.

[Triddin]

I also wouldnt give a patient o2 for conscious sedation unless they needed it. We keep out crash cart inv the ward, not the room and are frequently monitoring bp throughout. We also tend to prepare phenylephrine in case the patient requires it.

[JKL33]

Can't answer your questions, really, but what you are describing is anxiolysis/minimal sedation, not moderate (formerly known as conscious) sedation. In the circumstances you've described, no I would not apply oxygen "just because."

[DextersDisciple, BSN, RN]

This all sounds so bizarre. Moderate sedation at my job means Versed

and fentanyl. Everyone gets put on the monitor with the cuff cycling q5mins. I also toss a NC on but don't turn on the O2 until they need it. Saves a lot of time and frustration from trying to finagle one on with sterile drapes and other wires around. And we usually give 1mg verses per dose. Occasionally we'll do 0.5mg. Code cart isn't in the room but it's nearby.

[AnnieOaklyRN, BSN, RN, EMT-P]

Honestly that is a very low dose of versed, assuming you are working on adults! It would be extremely unlikely that that minute amounts, without additional medications would cause hypoxia. Technically that iant even conscious sedation.

Annie