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The aim of sedation guideline is to provide evidence based approach to the sedation of the cardiac patients on the cardiac ward during diagnostic or therapeutic procedures. This guideline is adapted from the NICE clinical guideline, Sedation in under 19s: using sedation for diagnostic and therapeutic procedures (CG112 2010)
This guideline is intended for all healthcare professionals caring for children on the cardiac ward at the Royal Hospital for Children, Glasgow.
All medical and nursing staff caring for patients requiring sedation should be familiar with the guideline
Sedation is performed on patients to reduce fear, anxiety and to minimize movement. On the cardiac ward sedation is often required for children going to theatre, echocardiogram or removal of chest drain. This guideline is based on the NICE recommendations and can be used for children and young people under the age of 19 undergoing diagnostic or therapeutic procedures. The level of sedation used on patients on the ward setting should be minimal to moderate and conducted within hours of 8 am till 6 pm. Deep sedation should be avoided.
Levels of sedation:
The definitions of minimal, moderate and deep sedation used in this guideline are based on those of the American Society of Anaesthesiologists (ASA).
Minimal sedation: A drug induced state during which patients are awake and calm, and respond normally to verbal commands. Although cognitive function and coordination may be impaired, ventilatory and cardiovascular functions are unaffected.
Moderate Sedation: Drug induced depression of consciousness during which patients are sleepy but respond purposefully to verbal commands or light tactile stimulation. No interventions are required to maintain a patent airway. Spontaneous ventilation is adequate. Cardiovascular function is maintained.
Deep sedation: Drug- induced depression of consciousness during which patients are asleep and cannot be easily roused but do respond purposefully to repeated or painful stimulation. The ability to maintain ventilatory function independently may be impaired. Patients may require assistance to maintain a patent airway. Spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained.
Pre sedation assessment, communication and patient information and consent
Health care professionals delivering sedation should have knowledge and understanding of and competency in:
Health care professionals delivering sedation should have practical experience of:
Patient-centred care and consent
Children and young people undergoing sedation and their parents and carers should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. Informed consent should be obtained for sedation as well as the procedure.
Fasting
Before starting sedation, confirm and record the time of last food and fluid intake in the healthcare record.
Fasting is not mandatory for:
Apply the 2-4-6 fasting rule for:
Conscious sedation for Echocardiogram
For children and young people undergoing a transthoracic echocardiogram under sedation, the target level of sedation is classed as minimal to moderate: during which the child or young person will maintain verbal contact with the healthcare professional. Consider EITHER:
Painful Procedures
For children and young people undergoing a painful procedure (for example suture laceration, chest drain removal), when the target level of sedation is minimal or moderate, consider:
Psychological Preparation
Ensure the child or young person is prepared psychologically for sedation by offering information about:
Monitoring
For moderate sedation: continuously monitor and interpret and respond to changes in all of the following:
The patient should have a patent airway throughout the procedure, be able to protect their airway, be haemodynamically stable and be easily aroused if they are sedated to a minimal/ moderate level. If they have any signs of the above then the person giving the sedation needs to be aware that the patient is over sedated and a senior person needs to be contacted or PICU informed perhaps.
After the procedure, continue monitoring until the child or young person:
The patient should have a patent airway throughout the procedure, be able to protect their airway, be haemodynamically stable and be easily aroused if they are sedated to a minimal/ moderate level. If they have any signs of the above then the person giving the sedation needs to be aware that the patient is over sedated and a senior person needs to be contacted or PICU informed perhaps.
Discharge Criteria
Ensure the following criteria are met before the child or young person is discharged:
Logbook entry
Ensure the logbook for sedation for transthoracic echo is completed by the Advanced Nurse Practitioner or Doctor.
Last reviewed: 23 April 2019
Next review: 01 February 2022
Author(s): Natalie Smith
Version: 3
Approved By: Paediatric Clinical Effectiveness & Risk Committee
Reviewer Name(s): Cardiology Consultants