Practical aspects of IV and IHS sedation seminar Flashcards
What are the safety checks required prior to inhalation sedation
- Check the machine is connected properly
- Mask on nose
- each insert is in each pipe
- Valve stops rebreathing waste gasses
-connected to scavenging pipe- wall 45l/min
-Fresh gas hose into nasal hood
- check outlets and connctors have a pin index to only allow oxygen to connect to oxygen etc - Oxygen is going through & oxygen flush button works
- Remove hose & block valve with hand- allow inflation of the bag and ensures valve is working & no holes in the bag
- check no tears in valves by blocking outlet- check the bag fills up - Check scavenging:
- bag after inflation, goes flat - Check air entratment valve - if oxygen fails it allows air through
- Check calibration- turn nitrous oxide to 50%, balance out this dial
- Check the valve doesn’t go higher for 70\% for NO2
- Check if oxygen cuts out- nitrogen goes off & both vials go down
When might inhalation be more appropriate than IV sedation?
High BMI
Stress induced medical conditions e.g angina/ asthma
Social circumstances mean pt cannot have IV e.g no suitable escort
How does IV sedation differ ?
- episode of analgesia
- no pain reflief so must supplement with LA
- More potent
- Stays in the system for 24hrs
What questions does the consent process for IV sedation require?
Reason for sedation
Do they know what it involves
Occupation
Who do they live with
Do they smoke, when did they previously, what did they smoke
Alcohol intake/ drug intake
Why might a high BMI affect sedation
-cant find cannula
- cant take blood pressure
- fat occludes airway
- fat moves up when laying down→ weight on chest may affecting breathing and so oxygen saturations
-hypertension/ hypotension→ pause send off and will get blood pressure taken
How do we safely administer Midazolam to the patient?
- Check the observations before commencement
- Make sure the syringe is firmly attached to the cannula
- Start timer: give 1mg of midazolam (IV slowly & wait to observe the effect)
* 0.5mg for elderly, young or ill - Titrate the dose against the clinical effect→ vary person to person
- Give additional 1mg increments as required
- Wait one minute between each increment → more if concerns
- Be patient, converse with patient throughout
- If little/ no effect→ check cannula site
- ALWAYS flush with saline after the last increment
* Check air bubbles
What post-operative instructions were given and to whom?
To the patient & escort
- Go home with an escort & rest for the remainder of the day
- Pt may experience some difficulty remembering events of today because of the sedation drug, this is normal
- Take normal pain medications- somebody else oversees this to avoid over-dosing
- No drinking alcohol, drive any vehicles or operate domestic appliances for the next 24 hours
- Pt is unable to return to work or make any important decisions for 24 hours or sign any legal documents
What do we check for at the start of this appointment of IV sedation. Why are these things important?
- History to indicate why sedation is required, if it is appropriate
- Advise about the risks therefore the patient is fully informed
- Pt’s expectations of sedation
- what they have eaten prior (need something light)
- Fitness for sedation via a medical history
o BMI cut off 35+
o Pulse, blood pressure, O2 saturations to gather a baseline - ASA Classification for anaesthesiology- see if a anaesthesiologist needs to be present
- Escort is present – not allowed to take public transport, patient will feel drowsy for 24 hours so will need someone to look after them
What are the potential hazards of nitrous oxide for staff and patients?
- Acute Hypoxia, nausea, dizziness
- Chronic side effects can cause severe bone marrow depression
- Haematological effects (pernicious anaemia)
- Neurological
- Reproductive & fertility
- Liver and kidney
- Malignancy
What safety features are incorporated into the equipment for inhalational sedation?
- Oxygen flush: to give patients emergency flush of oxygen which will dilute & interrupt sedation
- Active scavenging system to remove excess gases (rate of 45L/min) e.g nitrous oxide
- Colour coding system for gas tubing/ flow meters (nitrous oxide is blue and white is oxygen)
- Pin index system- correct fixing of gas
- Minimum oxygen of 30% (never at risk of saturation)
- Oxygen fall safe- cannot give 100% nitrous oxide (nitrous oxide cuts out if does)
- Reservoir bag- assists in monitoring the patient’s breathing
- Air entrainment valve: allow the glow of atmospheric air into the system if the gases run out
