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

• SPECT

• Mental Retardation

Issues

• Inadequate Monitoring

• Inappropriate dosage

• Lack of evaluation

• No CPR training

• No discharge criteria

Sedation Goals

• Patient Safety

• Minimize discomfort

• Diminish negative response

• Control behavior

• Control motion

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.

Sedation Risks

• Hypoventilation

• Apnea

• Airway obstruction

• Cardiopulmonary arrest

Facilities and Equipment

• Oxygen delivery system• Suction apparatus• Sphygmomanometer and cuffs• Pulse oximeter• Emergency cart

–Drugs–Airways–Breathing equipment

Sedation Benefits

• Cooperation

• Limit Motion

• Minimize Discomfort

Informed Consent

• Prior Notification

• Parent or Legal Guardian

• Documented

Informed Consent

• Oral

• Written

• Care post-discharge

Health Evaluation

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

Health History

• Allergies• Drug use• Diseases• Pregnancy• Hospitalization• Sedation Hx• Family Hx

Physical Status EvaluationASA Classification

Class I Normal healthy patientClass II Mild systemic diseaseClass III Severe systemic diseaseClass IV Severe systemic disease-

constant life threateningClass V Moribund patient who will

not survive without procedure

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

Sedative Agents

• Benzodiazepines–Valium–Versed

• Barbiturates–Nembutal

• Opiates–Demerol–Fentanyl

Sedative Agents

• Phenothiazines

• Antihistamines

• Neuroleptics

Sedation

• Chloral Hydrate, 50 mg/kg

• Repeat 1/2 dose

Midazolam

• Initial dose = 0.2-0.3 mg/kg

Maximum = 5 mg

Supplementary dose = 0.1 mg/kg

Maximum = 2.5 mg

Designated Observer

• CPR trained

• M.D., R.N., C.N.M.T.

• Primary responsibility

• Not imaging technologist

• Documents sedation and monitoring

Discharge Criteria

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

Discharge Instructions

Observation and Monitoring

Dietary restrictions

24 hour emergency number

Documentation

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

Quality Assurance

Develop policies

Formulary

QA Committee

Monitoring

Education