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

Abstract

Children, often require sedation for procedures due to their developmental level and difficulty complying with positioning. There are few studies that describe nurse sedation practices or adverse events. Studies of pediatric sedation care have small sample sizes that are inadequate to detect adverse events. This study reports practices and outcomes of sedation delivered to children from infancy up to 14 years of age, that were monitored only by registered nurses (RNs) during diagnostic radiology procedures drawn from a sample of 12,584 cases from the Pediatric Sedation Research Consortium (PSRC) database. There were 727 adverse events (5.78%). However, no deaths, cardiac arrests, intubations or aspirations were reported in this sample. The most common adverse event was inadequate sedation/agitation/delirium 196 (155.8/10,000) and desaturation below baseline for greater than 30 seconds 173 (138/10,000). Further research comparing sedation practices and outcomes by type of providers, including nurses, are necessary to improve practice.

Utilização De Barreiras De Segurança No Preparo De Drogas Vasoativas E Sedativos/Analgésicos Em Terapia Intensiva Pediátrica

“…As Unidades de Terapia Intensiva Pediátrica (UTIP) se caracterizam por serem locais com assistência de maior complexidade, permitindo a realização de terapias que incluem o uso de drogas vasoativas e sedativos/analgésicos (1) . As drogas vasoativas apresentam como principal função melhorar a perfusão tissular e fornecer oxigênio aos órgãos vitais (2) , enquanto os sedativos são utilizados para reduzir o desconforto e a ansiedade nos procedimentos realizados e diminuir a assincronia ventilatória durante o uso de ventilador mecânico (3) . Os analgésicos possuem a função de diminuição e prevenção da dor do paciente decorrente do estado clínico crítico (4) .…”

Improving Quality and Safety Through Use of Secondary Data: Methods Case Study

“…The PSRC is a consortium of more than 30 sites that prospectively collect data on pediatric sedation cases in at least one area or specialty within their organization (Cravero et al, 2006). Descriptive data on RN sedation provider practices obtained from the PSRC have previously been reported (Crego, 2014).…”

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

“…Current research on RN-provided sedation is limited, primarily consisting of single-site studies describing the implementation and outcomes of RN-led sedation services, or outcomes of RN-administered medication protocols in a single setting such as a radiology or endoscopy unit (Crego, 2013). Outcomes of RN-provided sedation have not been compared to physician non-anesthesiologist sedation providers (MD), or to RN-MD teams that monitor and deliver sedation.…”

“…Several studies using PSRC data have examined outcomes according to sedation provider. In one study of 41,392 pediatric diagnostic radiology sedation cases, 31% received sedation and were monitored by only an RN during non-interventional diagnostic radiology procedures (Crego, 2013). An adverse event rate of 5.78% was reported for these patients; adverse events included minor complications (e.g., intravenous access) or major complications (e.g., unexpected need for bag-valve-mask ventilation) (Crego, 2013).…”

“…In one study of 41,392 pediatric diagnostic radiology sedation cases, 31% received sedation and were monitored by only an RN during non-interventional diagnostic radiology procedures (Crego, 2013). An adverse event rate of 5.78% was reported for these patients; adverse events included minor complications (e.g., intravenous access) or major complications (e.g., unexpected need for bag-valve-mask ventilation) (Crego, 2013). In comparison, a prior study by Cravero et al (2006) found a 5.3% incidence of minor and major complications in 30,037 sedation cases with MD and advanced practice sedation providers (physician assistants and nurse practitioners) for a variety of procedures.…”