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5h3ryL 5h3ryL (Member)

Moderate Sedation Tips

Gastroenterology   (1,951 Views 6 Comments)
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Hello all!

I'm a new endo nurse (

Much much appreciated!

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Every (all two of them, ha ha) facility I have done moderate sedation in required me to take a moderate sedation study course to be "certified".

I hate looking up state guidelines and policies, but I believe it might be a legal requirement per BRN or Endoscopy Nursing, or AORN. You might ask your boss or look for yourself. Or ask the education department....someone in this large teaching hospital should know.

I could give you some advice, but I think you had better clarify if you need to be "certified" before you give moderate sedation?????!!!!! It isn't at all hard, can be done in one day.

I hope at least you have ACLS? I think that is really mandated!

Edited by brownbook

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Thank you for your reply! I do have ACLS and moderate sedation cert isn't required. However, I do have a competency test to take before I can sedate on my own. I guess since I haven't done it, I'm anxious - and being new in a not so awesome team adds stress. Anyway, I will look more into it before I start my intra-op rotation. I just don't feel confident.

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OK, the competency test is all I was referring to. I made it sound fancier that it is.

As long as you study up for the test and know the material you should be fine.

I've been doing moderate sedation for 17 years, never had a problem.....but still do your duty of care for every case. Know where the crash cart is, know where the ambu bag is (does it have all it's parts). Is there a code blue button in the room. Or what number do you call for codes. Know where your narcan is. Know how to open an airway,use an oral airway. I've never had to do any of that stuff, but maybe because I was always prepared in the back of my mind. I think you should never lose a little bit of anxiety in any area of nursing. A little anxiety, what if's, keeps you on your toes.

From the start you might have to remind yourself over and over....that you are NOT to be distracted, NOT assist the tech or MD, your focus is ONLY the patient. I am over exaggerating, sure once you get comfortable with sedating patients, get familiar with the tech, and MD , get your routine down, you can and will, (should), help out turning the patient, putting pressure on the abdomen, etc. You will, or may be, responsible for keeping track of and labeling specimens.

Edited by brownbook

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I find it very odd that you're not required to show a competency prior to performing moderate sedation along with reviewing every year.

Of course know your drugs and a tip that I got was that if ever needed, use the reversal med for the last sedation med you are giving (if there's a reversal med for it, I believe there's no reversal for Brevital and you just have to wait it out and bag the patient if needed, luckily it wears off pretty quickly).

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peak effect of Versed 5 min, peak of Fentanyl, 7 min.  Give with enough time before they start so the med can work, repeat if it isn't enough.  Start with 1mg Versed, 50 mcg fentanyl, and titrate up from there if you're being conservative depending on pt. of course.  They work synergistically together.  Narcan reverses fentanyl (dilute to 40mcg/mL and give 2 mL to start).  Flumazenil reverses Versed (also dilute and titrate).  Give oxygen via nasal cannula throughout the procedure, learn how to do chin lift/jaw thrust.  Forget BVM ventilation, that takes practice/skill and you will be better served giving reversals.  If you absolutely must bag the patient definitely put in an oral airway first, that will greatly increase your chances of success (trust me it's harder than it looks).

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