1. Implementing paediatric procedural sedation in emergency departments-2013
General principles of paediatric sedation
Gerry Silk
Paediatric Nurse Consultant
Title - xxx
Speaker’s name etc

2. What this presentation will cover
Why is paediatric sedation used in EDs?
What is procedural sedation?
Key to safe and successful sedation
Goals of paediatric procedural sedation in ED
Types of procedures where sedation is used
Possible adverse events of sedation
Clinical governance arrangements
Choosing the type of sedation
Staff
Preparation of the child and parent
Standardised processes

3. Why is paediatric sedation used in ED?
Over 300,000 children present to Victoria’s 40 EDs each year
Many of these children require a procedure while in ED to assist with diagnosis or treatment
Sedation is used to reduce the child’s fear, anxiety and distress associated with the procedure and to maximise the chances of procedural success

4. What is procedural sedation?
A technique of administering sedative or dissociation agents to induce a depressed consciousness that allows the child to tolerate unpleasant procedures while maintaining cardio-respiratory function
Various types of sedation, this program is about use of nitrous oxide and Ketamine
Various levels of sedation eg minimal, moderate or deep
Procedural sedation DOES NOT provide analgesia
Analgesia needs to be managed separately 4

5. Key to safe and successful sedation
Ensure the patient requires the procedure and this can occur in your ED
Ensure child is suitable for selection
Choosing the type of sedation
Staff are trained & credentialed and there is a team approach
Child and parents participate in sedation episode
Standardised processes

6. Goals of paediatric procedural sedation
Minimise physical discomfort, pain or distress for children undergoing a procedure
Maximise the potential for amnesia
Maximise the chances of procedural success
Ensure patient safety
Allow the child to return to their pre- sedated state as quickly as possible
Respect the rights of the child and family

7. Types of procedures where sedation is used
Laceration repair
Fracture reduction
Foreign body removal
IV cannulation
Burn/ wound management
Joint relocation

8. Possible adverse events of sedation
Hypoxia
Airway obstruction
Hypoventilation/Apnoea
Aspiration
Hypotension
Bradycardia
Prolonged or excessive sedation
Allergic reaction
Drug interaction
Emergence phenomena
Unscheduled admission
Inadequate or failed sedation

9. Clinical governance arrangements
Responsibility for each health services to:
decide what procedures can be performed in its health service and in ED
ensure policies and procedures are in place associated with that procedure

10. Policies and procedures
Appropriate polices for paediatric procedural sedation in ED should include:
What procedures can be performed in ED?
Who can perform these procedures?
Where the procedure can be performed?
What sedation agents can be used?
Who can administer the sedation agent?
When can it occur – hours of the day?
What authorisation is required?
What approach is used to engage the child and family in the procedure?

11. Assessing suitability for sedation
Use of a risk assessment and record form

12. Choosing the type of sedation
Decrease the need for sedation
Pharmacological strategies
Non pharmacological strategies
Age of the child
Exclusion criteria
Type of procedure
Staff capability and availability

13. Staff Trained in paediatric life support
Staff trained and credentialed in sedation
Correct mix of staff to carry out the procedure and sedation
Team approach

14. Preparing the child and parent
Build trust and rapport with the child and parent
Explain the procedure and sedation to the child and parent
Gain permission from parent for the procedure and sedation
Use age appropriate language and distraction techniques
Appropriate positioning of the child

15. Standardised processes
‘Right patient’, ‘right procedure’ ‘right time’
Parent information and consent
Fasting times
Location
Equipment
Sedation agent calculation and documentation
Monitoring the child pre, during and post procedure
Recognition and management of any adverse events
Discharge criteria and follow up
Documentation (sedation record)

16. Questions