Pediatric Sedation: Using Secondary Data to Describe Registered Nurse Practice in Radiology

Comparison of sedation using pentobarbital or chlorpromazine in pediatric non-invasive imaging procedures: A before and after study.: Comparison of sedation using pentobarbital or chlorpromazine in non-invasive imaging procedures

BACKGROUND

Sedation is often required for pediatric medical imaging procedures to ensure compliance and image quality. Recommendations for pediatric sedation exist, but there are currently no guidelines for the choice of the sedative drug.

OBJECTIVE

To compare the efficacy and adverse events of per os pentobarbital with intravenous chlorpromazine in children undergoing diagnostic imaging procedures. We hypothesized that the efficacy of per os pentobarbital would not be inferior to that of intravenous chlorpromazine, that safety would be similar, and that patient acceptance would be higher.

MATERIAL AND METHODS

A pilot study (before and after study methodology) was performed. The sedation of 247 children with intravenous chlorpromazine or oral pentobarbital was evaluated for 6 months successively (independently by two radiologists, both blinded to the sedation technique). The primary outcome was sedation success as defined by an acceptable image quality. Secondary outcomes were induction time, length of hospital stay, adverse events, parental satisfaction and potential factors associated with failure of pentobarbital sedation.

RESULTS

The sedation success rate of per os pentobarbital was found to be not inferior to that of intravenous chlorpromazine (83 % vs 90 %, p < 0.01). Mean length of hospital stay was shorter with per os pentobarbital. Despite the higher incidence of agitation during recovery with per os pentobarbital, parents expressed a preference for it. Per os pentobarbital failed more often in children older than 5 years.

CONCLUSION

Per os pentobarbital may be an effective alternative to intravenous chlorpromazine, especially in children under 5 years of age.

The Use of Intranasal Dexmedetomidine and Midazolam for Sedated Magnetic Resonance Imaging in Children: A Report From the Pediatric Sedation Research Consortium

OBJECTIVE

The objective of this study was to describe the use of intranasal dexmedetomidine (IN DEX) for sedated magnetic resonance imaging (MRI) examinations in children. The use of IN DEX for MRI in children has not been well described in the literature.

MATERIALS AND METHODS

The Pediatric Sedation Research Consortium (PSRC) is a collaborative and multidisciplinary group of sedation practitioners dedicated to understanding and improving the process of pediatric sedation. We searched the 2007 version of the PSRC database solely for instances in which IN DEX was used for MRI diagnostic studies. Patients receiving intravenous medications were excluded. Patient demographics, IN DEX dose, adjunct medications and dose, as well as procedure completion, complications, interventions, and monitoring providers were analyzed.

RESULTS

A total of 224 sedation encounters were included in our primary analysis. There were no major adverse events. Most sedations (88%) required no intervention. Registered nurses were the monitoring provider in over 99% of cases. The median (interquartile range) dose of dexmedetomidine was 3 (2.5-3) mcg/kg. Adjunctive midazolam was used in 219/224 (98%) of the cases. All procedures were completed.

CONCLUSIONS

This report from the PSRC shows that IN DEX in combination with midazolam is an effective medication regimen for children who require an MRI with sedation.

Differences in Pediatric Non-Interventional Radiology Procedural Sedation Practices and Adverse Events by Registered Nurses and Physicians

PURPOSE

The purpose of this study was to determine differences in sedation-related adverse events according to the type of provider monitoring and delivering sedation.

DESIGN AND METHODS

A retrospective, cross-sectional, correlational design using secondary data from the Pediatric Sedation Research Consortium database was used for this study.

RESULTS

A sample of 36,352 cases (0-14 years of age) sedated and monitored for diagnostic radiology procedures by three types of providers (registered nurses [RNs] alone, physicians (MDs) alone, or registered nurse + physician [RN+MD sedation teams]) were compared. Patients sedated by RNs alone or MDs alone had lower odds of unanticipated adverse events (odds ratios 0.46 and 0.53, respectively; p<0.0001) compared with RN+MD sedation provider teams.

CONCLUSIONS

Team skills may be an important competency for RN+MD sedation teams in the non-interventional radiology setting.

PRACTICE IMPLICATIONS

This study can inform clinicians, administrators, and quality-improvement managers of the differences in adverse event outcomes of pediatric radiology procedures when RN+MD teams provide sedation compared with RNs or MDs alone.

Procedural Sedation Practice: A Review of Current Nursing Standards

Although administration of procedural sedation is a common practice among nurses, at present a unified consensus statement on Registered Nurse (RN) sedation core competencies or a consistent way in which RN sedation practice is regulated in the United States is lacking. In this article, the topic of RN sedation is discussed and includes current sedation standards by the American Society of Anesthesiologists and the Joint Commission. Examples of current regulations from State Boards of Nursing throughout the United States are also reviewed. Three major controversies related to RN sedation practice exist: variation in Board of Nursing regulation, lack of research on RN sedation practice, and lack of a national standard for RN sedation. Recommendations to address each of these areas are provided to inform regulators and nurse educators about current standards and knowledge gaps in sedation care. Strategies to improve sedation research in order to advance practice in this area are also discussed.