Decision
Pre-procedural preparation complete?
- Airway equipment at bedside
- Cardiopulmonary monitoring (Class I)
- Capnography (Class II)
- Supplemental oxygen (Class II)
- Preprocedural fasting not indicated (Class II)
- At least 1 ACLS/PALS-trained clinician for monitoring (Class III)
No
Consider alternative options:
- Local aesthetics
- Operating room with anesthesia
Background
Pre-procedural Checklist for Procedural Sedation
- Personnel
- Provider performing the procedure
- Individual trained in ACLS/PALS (eg, nurse) primarily responsible for patient monitoring
- Monitoring
- Electrocardiogram monitor
- Blood pressure monitor
- Pulse oximetry
- Capnography
- Sedative/analgesic agent(s)
- Documentation
- Prior to the procedure
- Time out: Patient name, date of birth, medical record number, type of procedure, and location of procedure
- Name, route, site, time of administration, and dosage of all medications
- During the procedure
- Record heart rate, blood pressure, oxygen saturation, and end-tidal CO2 every 5-10 minutes
- Following the procedure
- Identical to those documented during the procedure, until patient awakens; intervals may then be spaced until patient returns to baseline level of consciousness
- Rescue equipment
- Suction
- High-flow oxygen source/supply (eg, bag-valve mask)
- Vascular access equipment (especially if the patient is being sedated with IM medication)
- Airway management equipment (oropharyngeal airway/nasal trumpet, laryngoscopes, endotracheal tubes, laryngeal mask airway, etc)
- Resuscitation medications (rapid-sequence intubation medications, IV fluids, etc)
- Reversal agents (if applicable)
- Defibrillator/transcutaneous pacemaker
Medication Selection