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Sedation of Patients for Nuclear Medicine and Radiographic Procedures

Sedation of Patients for Nuclear Medicine and Radiographic Procedures. Susan Weiss, CNMT Radiation Safety Officer The Children’s Memorial Medical Center Chicago, IL. Patient cooperation factors. Age Fear Comprehension Expectations Sedation. Sedation Required. 1-3 years Bone imaging

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Sedation of Patients for Nuclear Medicine and Radiographic Procedures

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  1. Sedation of Patients for Nuclear Medicine and Radiographic Procedures Susan Weiss, CNMT Radiation Safety Officer The Children’s Memorial Medical Center Chicago, IL

  2. Patient cooperation factors • Age • Fear • Comprehension • Expectations • Sedation

  3. Sedation Required • 1-3 years • Bone imaging • SPECT • Mental Retardation

  4. Issues • Inadequate Monitoring • Inappropriate dosage • Lack of evaluation • No CPR training • No discharge criteria

  5. Sedation Goals • Patient Safety • Minimize discomfort • Diminish negative response • Control behavior • Control motion

  6. Conscious Sedation A medically controlled state of depressed consciousness that: 1) allows protective reflexes to be maintained 2) retains patient’s ability to maintain patent airway 3) permits appropriate response to physical stimulation.

  7. Sedation Risks • Hypoventilation • Apnea • Airway obstruction • Cardiopulmonary arrest

  8. Facilities and Equipment • Oxygen delivery system • Suction apparatus • Sphygmomanometer and cuffs • Pulse oximeter • Emergency cart • Drugs • Airways • Breathing equipment

  9. Sedation Benefits • Cooperation • Limit Motion • Minimize Discomfort

  10. Informed Consent • Prior Notification • Parent or Legal Guardian • Documented

  11. Informed Consent • Oral • Written • Care post-discharge

  12. Health Evaluation • Health Hx • Review of systems • Vital signs • Physical exam • Physical status evaluation • Weight • Documented

  13. Health History • Allergies • Drug use • Diseases • Pregnancy • Hospitalization • Sedation Hx • Family Hx

  14. Physical Status EvaluationASA Classification Class I Normal healthy patient Class II Mild systemic disease Class III Severe systemic disease Class IV Severe systemic disease- constant life threatening Class V Moribund patient who will not survive without procedure

  15. Pre-Sedation Dietary Restrictions 0-5 Months No milk or solids 4 hours prior 6-36 Months No milk or solids 6 hours prior 36+ months No milk or solids 8 hours prior All ages Clear liquids until 2 hours prior

  16. Sedative Agents • Benzodiazepines • Valium • Versed • Barbiturates • Nembutal • Opiates • Demerol • Fentanyl

  17. Sedative Agents • Phenothiazines • Antihistamines • Neuroleptics

  18. Sedation • Chloral Hydrate, 50 mg/kg • Repeat 1/2 dose

  19. Midazolam • Initial dose = 0.2-0.3 mg/kg Maximum = 5 mg Supplementary dose = 0.1 mg/kg Maximum = 2.5 mg

  20. Designated Observer • CPR trained • M.D., R.N., C.N.M.T. • Primary responsibility • Not imaging technologist • Documents sedation and monitoring

  21. Discharge Criteria • Airway patency • Stable cardiovascular function • Intact protective reflexes • Easy arousability • Responding appropriately • Sits unaided • Adequately hydrated

  22. Discharge Instructions Observation and Monitoring Dietary restrictions 24 hour emergency number

  23. Documentation • Informed consent • Health evaluation • Sedation plan • Administration of sedative • Monitoring • Discharge evaluation • Post discharge instructions

  24. Quality Assurance Develop policies Formulary QA Committee Monitoring Education

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