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Guidelines, Statements & Standards

Facts at your fingertips: Review important practice guidelines and the roles and responsibilities nurses play in specific procedures.

Care of the Patient Receiving Conscious Sedation

Guidelines for the Care of the Patient receiving Conscious Sedation

Note: 
This standard should be considered in combination with the procedure specific practical guidelines.
 

Definition 
I.V. Conscious Sedation is produced by the administration of pharmacologic agents.
A patient under conscious sedation has a depressed level of consciousness but retains the ability to independently and continuously maintain a patent airway and respond appropriately to physical stimulation and or verbal command. 

Pre Procedure
The RN will...

Complete the nursing history and assessment for, particularly noting prior response to: IV Sedation (Valium, Demerol, Fentanyl, Versed, etc.)Use of narcotics, benzodiazepines or other analgesic sedative or "social' drugs.

2.   Inform the patient of restrictions related to driving or using equipment requiring clear judgment or quick physical responses. It is advised not to drive for 24 hours.

3.   Advise patients against ingesting alcohol for 24 hours post sedation.

4.   Assure the patient has made discharge transportation arrangements according to hospital policy.

5.   Document findings and inform physician of significant findings. 

Intra Procedure
The RN will  ...

  1. Document medications received by the patient.

  2. Provide and document minimal monitoring of all patients including: BP, pulse, respirations, level of consciousness, temperature and dryness of skin and pain tolerance at the initiation, during and at the completion of the procedure. As indicated by the patient response, assessment may be more frequent.

  3. Monitor O2 saturation and heart rate as determined by continuous pulse oximetry.

  4. Ensure the immediate availability of Emergency Equipment, e.g. Oxygen, oral airway, ambu bag, medication to reverse the effects of narcotics ond benzodiazepines.

Post Procedure 
The RN will  ...

  1. Assess BP, heart rate , respiratory rate depth and effort and level of consciousness on admission to recovery area, after 15 minutes, until stable and at discharge. Post procedure oximetry must be performed until the patients respiratory status is stable or returned to pre-procedure state.

  2. Assess and document unexpected events and post procedure complications as related to sedation and taking interventions as required.

  3. Assist and accompany patient to the bathroom, assess presence of orthostatic hypotension.

  4. Assess gait prior to discharge.

  5. Remove IV access prior to discharge, assess site and document.

  6. Reinforce pre procedure teaching regarding driving, equipment operation and making decisions requiring judgment. The teaching provided should be in written form and a copy given to the patient prior to discharge.

The Registered Nurse functions within the limitations of the provincial licensing body and Institutional policies.

Disclaimer 
The CSGNA
assumes no responsibility for the practices or recommendations of any member or other practitioner or for the policies and practices of any Endoscopy unit.

Bibliography 
American Society of Post Anaesthetc Care Nurses(1991). Position Statement on the role of the registered nurse in the management of the patent receiving conscious sedabon. 
Bailey,R. (1996). Consensus in Endoscopy. Canadian Journal of Gastroenterology. July 10 (4). 237-242. 
Bell,G., McCloy, R., Charlton, J., Campbell, D., Dent, N., Gear, M., Logan, R., Swan, C. (1991). Recommendabons for standards of sedation and patient monitoring during Gastrointestnal Endoscopy. GUT 7 ( 32), 823-827. 
Kidwell, J. (1 991). Nursing care of the patient receiving conscious sedation during gastrointestinal procedures. Gastroenterology Nursing 13 (3) 134-139. 
McCloy, R., Fleisher, D. (1993). Sedation and monitoring for gastrointestinal endoscopy. UK Colloquim International, Ltd. 
Society of Gastroenterology Nurses and Associates Inc. ( 1991).
Position Statement :Responsibilities of the Gastroenterology Registered Nurse related to Conscious Sedation. 
Somerson, S., Husted, C, Sicilia, M. (1995). Insights into Conscious Sedation. American Journal of Nursing. June 26 -32. 
Wansbrough, G. (1 996). Quality Assurance Medicaton Administration Standards. The College of Nurses of Ontario College Communique. November 21 (5) 4 -31.