complication of sedation

8/8/2019 Complication of Sedation

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Complication of

Sedation

Complication of

SedationMohammad Daghistani M.B. B.S., FRCPC

Chairman Anesthesiology Department KAMC-Jeddah NGHA WR.

Mohammad Daghistani M.B. B.S., FRCPCChairman Anesthesiology Department KAMC-Jeddah NGHA WR.


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High risk patients

The elderly

Hepatic disorders

Renal disorders

Respiratory disorders

Cardiac disorders

Drug abusers

Obese patients


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Monitoring

Vigilant monitoring is the key to

prevention of overdose and other

potential complications


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Sedation

Sedation failure:

Could be due to unsuitability of the patient

or

Problems with medications

Excessive sedation

Can be avoided by:

Monitoring level of consciousness(i.e Ramsey score)

Titration of medications


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Respiratory depression &

hypoventilation

Detected by:

Decrease in oxygen saturation

Decrease in rate and depth of respirations

Treatment:

Stimulate patient

Open airway

Give oxygen

If the above steps are unsuccessful,ventilate with ambu-bag. If

the condition does not improve or the patient stops breathing,

intubate.


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Cardiac complications &

hypotension

Treatment: IV fluids

Oxygen

Vasopressors or specificagonists(avoid if possible)


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In conclusion

If patient and medication selection isappropriate and the patient is monitored

adequately, then the incidence of

complications due to

sedation/analgesia will be very low.


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Staff Qualification &

PrivilegingMohammad Daghistani M.B. B.S., FRCPC

Chairman Anesthesiology Department KAMC-Jeddah NGHA WR.


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Sedation policies &

procedure identify:

Special qualifications or skills of staffinvolved in sedation process


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Sedation Provider

Any physician who is privileged.

Anesthesiologists by nature of theirspecialty.

Physician or dentist who is credentialedor privileged.


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The Sedation Provider should

be competent in:

Techniques of various modes of sedation

Appropriate monitoring

Response to complications

Use of reversal agents At least basic life support


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Privileging of non-

Anesthesiologists Valid BLS Certification.

Documented attendance and successful

completion of an approvedSedation/Analgesia Course.

Training curriculum clearly indicating that

competency in providingSedation/Analgesia is part of the

qualification process for his/her degree.


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Privileging of non-

Anesthesiologists Certificates of experience from his/herChairman or previous employer

documenting that provision of

Sedation/Analgesia is part of his/her clinical practice for a minimum of 5yrs.

Attending and passing the Basic

Competency Course provided by theHospital Sedation Committee.


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Privileging of non-

Anesthesiologists Re-evaluation of Privileging on individualbasis is mandated if:

Invalid BLS.

Less than 10 sedation/proceduresper year.

Failure to pass the basic competencycourse provided by the Hospital

Sedation Committee.


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Responsibilities of

Sedation Provider Obtain Consent Evaluate patient prior to procedure

Document the assessment

Refer to Anesthesia Department if needed

Prescribe or administer medications as per his/her privilege

Ensure monitoring of patients progress

Present in procedure area throughout the entire procedure and remainon the premises of recovery area during recovery.

Ensure appropriate discharge of patient.


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Competencies required for

Registered Nurse The nurse is competent in patient

monitoring, drug administration, and

protocols for dealing with emergencysituations

The nurse will have NO other

responsibilities that would leave thepatient unattended or compromise

continuous monitoring.


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Registered Nurse The Nurse is able to demonstrate therequired knowledge of Pharmacology,

and complications related to medications.

Demonstrate monitoring requirementsduring sedation and recovery.

Understand the principles of oxygen

delivery, respiratory physiology, transportand uptake, and demonstrate the ability

to use oxygen delivery devices.


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Registered Nurse Anticipate and recognize potentialcomplications of sedation in relation to

the type of medication being

administered.

Possess the requisite knowledge andskills to assess, diagnose and intervene

in the event of complications or undesired outcomes and to institute

nursing interventions in compliance with

orders.


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Registered Nurse Demonstrate skill in airway management

and resuscitation principles.

The Nursing Education Department willmaintain an educational/competency

validation mechanism that includes

demonstration of the knowledge, skill and

abilities related to the management of

patients receiving sedation/analgesia.


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Privileging for Registered

Nurse The Registered Nurse needs to have avalid:

BLS certificate IV Cannulation workshop

ECG workshop

Sedation and Analgesia workshop


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The Registered Nurse is

Responsible for:

Providing uninterrupted monitoring of thepatients physiological parameters

Assisting in supportive or resuscitation

measures.


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