I agree the climate for monitored sedation is changing because of increased
patient safety regulations. I work for a 3 hospital system consisting of a
children's hospital, a level one trauma center w/a pediatric intensive care
and children's ward, and a university hospital. The physicians in the
children's hospital are very reluctant to order monitored sedation, their
statement is they are not "qualified". What does this word "qualified"
mean. In speaking with the level one trauma center peds docs, it means
watching a video on sedation and recovery and being PALS certified. We have
no problem with the trauma center peds docs ordering sedation and being
available for us. We do the PICCs in the treatment room on the unit with
the physicians available and do the sedation ourselves. Everyone on our
PICC team is PALS and ACLS certified. The children's hospital is all
together different. We assess the child's needs for pain control and
anxiety with the parents, nurse and child life. Most of the time, we can
get by without monitored sedation drugs and use morphine and benedryl IV,
along with a topical. This will work even with some toddlers. We have gone
to the OR and placed PICCs when another procedure is being done or spoken
with the anesthesiologist when a child is having a CT or MRI with anesthesia
and they will let us do the PICC while they still have them under. We have
also had the ICU intensivist sedate in the treatment rooms or moved a child
to the ICU in order to accomodate the sedation requirements and use Ketamine
or propofol, which is very nice. We cannot rely on the sedation team for
our procedures. It takes a lot of coordination with pediatrics, but it is
worth a successful PICC.
Good Luck,
Beth Ferguson
Clarian Health Partners
----- Original Message -----
From: "Toshi Holland" <[EMAIL PROTECTED]>
To: <[EMAIL PROTECTED]>
Sent: Friday, April 14, 2006 6:18 PM
Subject: sedation
We are small (about 200 beds) pediatric hospital. We used to do conscious
sedation on the ward but becuase of JCAHO regulations and staffing needs,
all PICCs requiring sedation are done in OR under general anesthesia
except ICU and NICU. Currently we are entertaining an idea of creating a
procedure room where we can do PICCs. I have a few questions for the
group:
Do you have a procedure room for PICC placement?
If so, who orders and administers conscious sedation?
Do you have nursing support for conscious sedation including recovery
period?
What service can you bill to patient?
How many PICCs do you perform per month?
Thank you,
Toshi Holland
Vascular Access Coordinator
Children's Hospital Oakland, CA
