Opioid Safety, Respiratory Compromise

Keeping Patients Safe During Moderate Sedation

There are millions of medical procedures involving conscious or moderate sedation completed each year. In 2002, for example, there were 14.2 million colonoscopies performed. According to the U.S. National Library of Medicine, some of the moderate sedation procedures include:

  • Breast biopsy
  • Dental prosthetic or reconstructive surgery
  • Minor bone fracture repair
  • Minor foot surgery
  • Minor skin surgery
  • Plastic or reconstructive surgery
  • Procedures to diagnose and treat some stomach (upper endoscopy), colon (colonoscopy), lung (bronchoscopy), and bladder (cystoscopy) conditions.

In order to ensure the safety of patients undergoing procedures requiring moderate sedation, in January 2016, the Association for Radiologic & Imaging Nursing (ARIN) issued a Position Statement on Use of Capnography for Patients Who Receive Moderate Sedation/Analgesia.

The ARIN Position Statement seeks to improve the safety of patients through the “early detection of patient progression towards a deeper level of sedation [which] is paramount in preventing a sentinel event.”

To achieve this objective, ARIN recommends the use of capnography during moderate sedation procedures:

ARIN endorses the routine use of capnography for all patients who receive moderate sedation/analgesia during procedures in the imaging environment. This technology provides the critical information necessary to detect respiratory depression, hypoventilation, and apnea, thus allowing the timely initiation of appropriate interventions to rescue the individual patient. [emphasis added] Capnography use is associated with improved patient outcomes. Capnography should be used at all times, regardless of whether sedation is administered by an anesthesia provider or a registered nurse credentialed to administer moderate sedation/analgesia medications.

Capnography enhances a holistic toolbox of standard of care continuous monitoring; and according to ARIN, this suite of monitoring tools includes includes:

  1. Continuously (prolonged without any interruption at any time) monitored heart rate and oxygenation by audible pulse oximetry.
  2. Respiratory frequency and adequacy of pulmonary ventilation are continually (repeated regularly and frequently in steady, rapid succession) monitored.
  3. Vital signs and patient assessment every 5-15 minutes as condition warrants (minimally heart rate, respiratory rate, O2 saturation, blood pressure, and, if indicated, heart rhythm). Vital signs should be monitored after each medication administration and with any significant event.
  4. Age-appropriate assessment of pain and sedation level with vital signs.
  5. EKG is monitored in patients with significant cardiovascular disease when dysrhythmias are anticipated or detected.

To view the ARIN Position Statement on Use of Capnography for Patients Who Receive Moderate Sedation/Analgesia, please click here.

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