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Discussion

conscious sedation

In the cath lab we are not allowed to give any form of sedation unless the doctor is physically in the room. Even 1mg of Versed or 25mcg of Fent is considered conscious sedation. I think for those very anxious patients, we should be able to relax them a little during prep before the doctor arrives. What is the practice/policy of other labs?

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  • Admin

I think our procedure will have to be modified in the near future to the same as yours. Now the cardiology fellows are two doors down, in their room doing reports etc. Is it the hospital policy or a JCAHO requirement? If it's only policy, perhaps yours could be re-written to reflect procedure and still remain in compliance w/JCAHO. I need to research this one, to be sure.

Any way the pt can receive 5 mg Valium or some Ativan (po) within an hour or so of coming down? That might help, until the card is in the room.

Any other ideas?

I work in CCU, the doctor usually writes orders for whatever meds he wants...before the cath lab comes up for the patients they call ahead of time and ask up to give the pre-op meds usually atarax, ativan, or valium...

  • Admin

"I'm having a thought here, Barbossa." -- Johnny Depp as Jack Sparrow, Pirates of the Caribbean

How about 25mg Benadryl IV or (po)? One of the cards at another facility where I worked used to order the IV dose, no matter what the pt got for sedation.

Just a word of advice to everyone giving Fentanyl, from a former CCL nurse. I've learned in anesthesia school that it can cause sudden chest rigidity that CANNOT be ventilated. The only way to overcome it is to give Succ and paralyze the pt, then intubate. I had no idea about that as an RN giving conscious sedation, but if I had, I would've been much more hesitant to give it. That's a lawsuit waiting to happen!!!

Our policy is the same .... no med given until the doc is in the cath lab. We do, however, give Valium or Ativan on the floor before the patient comes down for the procedure. Many are very anxious and need something to calm their nerves.

NCgirl, thanks for the info on Fentanyl .... never knew that either.

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