Complication of IV sedation Flashcards
What are the complication of venous cannulation?
venospasm extravascular injection Intrarterial injection haematoma fainting
What is venospasm?
Veins collapse when venpuncture is atempted
What may venospasm be accompanied by?
A burning sensation and poorly visible veins
How do you manage venospams?
Need to spend time dilating veins
Use an efficiet technique
Ask pateint to wear gloves or soak hands in warm water before attempting
What happens when there has been an extravascular injection?
The active drug is placed into the instertitial space
How can you tell is there has been an extravascular injection?
pain and swelling noticed
What are the problems if there has been an extravascular injection?
There is delayed absorption
How do you prevent an extravascular injection?
good cannulation technique and use a test dose of saline
How do you treat an extravascular injection?
remove the cannula and apply pressure
How do you diagnose in intra-arterial injection?
pain on injection radiation distal from site and red blood appears in the cannula, loss of colour and warmth in the limp
T/F when there has been an intra-arterial injection, it is difficult to prevent leaks from ocurring?
T
How do you manage intra-arterial injection?
Prevention: avoid anatomically prone sites eg anterior cubital fossa and palpae before entering
Monitior for loss of pulse, leave the cannula in situ for 5 mins post drugs and then if there are no problems then remove the cannula however if there are symptoms then need to refer to hospital
What is a haematoma?
This is when there is extravastion of blood into soft tissues due to damage in the vein walls
When can heamatomas occur?
due to venepuncture as a result of poor tecnhqie and on removal of the cannula when there has been failure to apply pressure
In which groups of pateints are heamatomas more common in?
the elderly
how do you treat a severe haematoma?
Initial ice pack and then palce moist heat for 20 mins on to the site after 24 hours. can also consider heparin gel
What is fainting?
Sudden and temporary loss of consciousness resulting from a reduction in blood flow to the brain.
What can precipiate a faint?
starvation
anxiety
Consider topical skin anaesthetic
What could you do before IV sedation with people anxious of needles?
Use inhaltional sedation first
How can people respond to the IV drugs?
Hyper responders Hypo-responders Paadoxical reactions Oversedation Allergic reaction
What happens to patients that are hyper responders?
They go into a deep sedation when there has been a minimal dose
How can you manage hyper responders?
need to titrate drug slowly using 1mg increments
What happens to pateints that are hypo responders?
they experience little sedation with large doses of drug
What can cause hypo responders?
cannula not in the vein
cross tolerance
BZD induced
What are signs of a paradoxical reaction?
The pt appears to sedate normally but they react extremely to all stimuli and relax when stimuli removed
What should you stop doing in patients showing signs of paradoxical reactions?
need to stop adding drugs
What happens when people have been oversedated?
there is loss of repsonsiveness
respiratory depression
loss of abilty to maintain airway
respiratory arrest
How do you manage oversedation?
ABC
if patient does not respond to stimulation then reverse sedation with flumazenil 200micrograms and then 100mircrogrmas at minute intervals. need to watch for an our
How do you manage respiratory depression?
check the oximeter and stimulate the pateint, provide supplemtnal oxygen 2 littered per min and reverse with fluamzanil
How common are allergic reactions to the drugs used in sedation?
Rare! do not give flumazenil
How do you manage sexual fantasy?
Ensure that always someone in room with you
What are the complications of RA?
Oversedation
Patient panics
What are the signs go NO overdose?
Patient discomfort Lack of co operation Mouth breathing Giggling Nausea Vomiting LOC
How do you treat NO overdose?
Decrease NO concentration by 5-10%
DO NOT REMOVE NOSE PIECE
What happens if you remove the nose piece in someone having NO overdose?
Diffusion hypoxia
