Sedation of Patients for Nuclear Medicine and Radiographic Procedures

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Sedation of Patients for Nuclear Medicine and
Radiographic Procedures

• Susan Weiss, CNMT
• Radiation Safety Officer
• The Childrens Memorial Medical Center
• Chicago, IL

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Patient cooperation factors

• Age
• Fear
• Comprehension
• Expectations
• Sedation

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Sedation Required

• 1-3 years
• Bone imaging
• SPECT
• Mental Retardation

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Issues

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

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Sedation Goals

• Patient Safety
• Minimize discomfort
• Diminish negative response
• Control behavior
• Control motion

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Conscious Sedation

• A medically controlled state of depressed
  consciousness that
• 1) allows protective reflexes to be maintained
• 2) retains patients ability to maintain patent
  airway
• 3) permits appropriate response to physical
  stimulation.

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Sedation Risks

• Hypoventilation
• Apnea
• Airway obstruction
• Cardiopulmonary arrest

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Facilities and Equipment

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

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Sedation Benefits

• Cooperation
• Limit Motion
• Minimize Discomfort

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Informed Consent

• Prior Notification
• Parent or Legal Guardian
• Documented

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Informed Consent

• Oral
• Written
• Care post-discharge

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Health Evaluation

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

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Health History

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

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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

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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

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Sedative Agents

• Benzodiazepines
• Valium
• Versed
• Barbiturates
• Nembutal
• Opiates
• Demerol
• Fentanyl

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Sedative Agents

• Phenothiazines
• Antihistamines
• Neuroleptics

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Sedation

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

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Midazolam

• Initial dose 0.2-0.3 mg/kg
• Maximum 5 mg
• Supplementary dose 0.1 mg/kg
• Maximum 2.5 mg

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Designated Observer

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

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Discharge Criteria

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

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Discharge Instructions

• Observation and Monitoring
• Dietary restrictions
• 24 hour emergency number

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Documentation

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

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Quality Assurance

• Develop policies
• Formulary
• QA Committee
• Monitoring
• Education