Conscious sedation complications Flashcards
iv sedation - types of complication (related to cannulation)
venospasm
extravascular injection
intra-arterial injection
haematoma
fainting
What is venospasm?
disappearing vein syndrome
veins collapse at attempted venepuncture
may be accompanied by burning
associated with poorly visible veins
What is meant by ‘extravascular injection’? give the signs and potential problems
active drug placed into interstitial space
diagnosis
- pain
- swelling
potential problems
- delayed absorption
how to prevent extravascular injection
good cannulation
use a test dose of saline
extravascular injection - management
remove cannula
apply pressure
reassure patient
intra-arterial injection - diagnosis
pain on venepuncture
red blood in cannula
difficult to prevent leaks
pain radiating distally from cannulation site
loss of colour or warmth to limb/weakening pulse
how to prevent intra arterial injection
palpate before attack
avoid anatomically prone sites
Intra arterial injection management
monitor for loss of pulse
- cold
- discolouration
leave cannula for 5 mins post drug
- remove if no problems
- if symptomatic leave cannula in and refer to hospital (procaine 1%)
What is a haemotoma and how can it occur during iv sedation?
outflow of blood into soft tissue
- due to damage of vein walls
can occur at venepuncture due to poor technique
can occur at removal of cannula
- failure to apply pressure
haematoma prevention
good cannulation technique
operator must apply pressure post operatively
take care with elderly
haemotoma treatment
time
rest
reassurance
if severe
- initial ice pack
- moist heat for 20 mins an hour after
after 24 hours
- consider heparin containing gel
fainting during venepuncture - potential causes
anxiety related to venepuncture
worse if starved
prevention of fainting during venepuncture
don’t starve patients
topical skin anaesthesia
position of patient
types of complications - drug related
hyper or hypo responders
paradoxical reactions
over sedation
allergic reactions
hyper responders - briefly describe - give ways to manage
deep sedation with minimal dose
- 1-2mg midazolam
take care with titration
- 1mg increments
- slow titration in elderly
hypo responders - briefly describe and give ways to manage
little sedative effect with large doses
management
- check cannula in vein
- may be due to tolerance - cross tolerance, idiopathic, BZD induced
paradoxical reactions - briefly describe and give ways to manage
appear to sedate normal
react extremely to all stimuli
relax when stimuli removed
management
- check for failure of LA
- do not continue adding sedative
- watch immature teenagers
over sedation - signs and symptoms
loss of responsiveness
respiratory depression
loss of ability to maintain airway
respiratory arrest
over sedation - management
stop procedure
attempt to wake patient
ABC
if no response to stumlation and support
- reverse with flumazenil 200ug then 100ug at minute intervals
- watch for 1-4 hours
management of respiratory depression
check oximeter
stimulate patient
- ask them to breathe
supplemental oxygen
- nasal cannula 2 litres per minute
reverse with flumazenil
loss of airway control or respiratory arrest - how to manage
stimulate patient/assess consciousness
maintain or clear airway
ventilate patient
reverse with flumazenl
consider other medical incident
allergic reactions - management
rare to sedatives
- do not use flumazenil
manage as if not sedated
inhalation sedation - complications
oversedation
patient panics
signs of symptoms of nitrous oxide overdose
patient discomfort
lack of co-operation
giggling
nausea
vomiting
loss of consciousness
