Sedation for pediatric diagnostic imaging: use of pediatric and nursing resources as an alternative to a radiology department sedation team.
OBJECTIVE
To develop a pathway to provide safe, effective, and efficient sedation for pediatric diagnostic imaging studies using non-radiology personnel.


METHODS
A multidisciplinary team considered manpower and training requirements and national sedation standards before designing a sedation pathway, which included scheduling, pre-sedation history and physical, medication protocols, and monitoring. Oral and IV medication protocols were developed based on patient age and weight. Sedation delays were defined as >15 min (IV) or >30 min (PO) from start of sedation to start of imaging. A sedation failure resulted in an incomplete diagnostic imaging study. Failure rates of 124 sedations before and 388 sedations after the pathway were compared.


RESULTS
The sedation failure rate for 7 months prior to pathway initiation was 15% (19/124). In the first 25 months after pathway initiation, failures were significantly reduced to 1.5% (6/388) ( P<0.0001). Three (50%) of the six failures after pathway initiation were long examinations (>55 min). Deviation from the recommended medication protocol accounted for most of the 115 delays. Only minor adverse events were seen (12/388, 3.1%).


CONCLUSIONS
Implementing a pediatric sedation pathway significantly decreases the sedation failure rate. Pediatric residents and nurses can safely, effectively and efficiently sedate pediatric patients for routine diagnostic imaging procedures without the need for a radiology department sedation team in a department with a small-to-moderate volume of pediatric patients.
Ruess
Lynne
L
Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA. Lynne.Ruess@amedd.army.mil
O'Connor
Stephen C
SC
Mikita
Cecilia P
CP
Creamer
Kevin M
KM
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002697:Chloral Hydrate / Q000008:administration & dosage; D016292:Procedural Sedation / Q000379:methods* / Q000451:nursing* / Q000592:standards; D003952:Diagnostic Imaging / Q000379:methods* / Q000451:nursing* / Q000592:standards; D005260:Female; D006295:Health Resources; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007223:Infant; D007275:Injections, Intravenous; D008297:Male; D010348:Patient Care Team / Q000458:organization & administration; D010424:Pentobarbital / Q000008:administration & dosage; D011872:Radiology Department, Hospital; D013997:Time Factors
D006993:Hypnotics and Sedatives; D002697:Chloral Hydrate; D010424:Pentobarbital