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 Evaluation ASA 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

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+ monthsNo milk or solids 8 hours prior All agesClear 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 = 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