Download Transesophageal Echocardiography (TEE) Procedural Sedation

Transesophageal Echocardiography
(TEE) Procedural Sedation
Purpose
To provide guidelines that promotes safety and best practice for
patients receiving conscious sedation for a Transesophageal
Echocardiography Procedure.
Description:
Conscious Sedation:
Increasingly patients are receiving short-term conscious sedation and analgesia for invasive diagnostic
procedures. Advantages of conscious sedation and analgesia include a short rapid recovery, early
ambulation, and the preference for patients to experience light sleep while maintaining adequate
cardio-respiratory function and the ability to respond to verbal or tactile commands. It is impossible to
predict individual responses to sedation, therefore specific post procedural monitoring of each patient is
required.
Sedation Levels (ASA – American Society of Anesthesiologists)
ASA Levels of
Sedation
Minimal
(anxiolysis)
Responsiveness
Normal response
to verbal stimuli
Airway
Unaffected
Spontaneous
ventilation
Cardiovascular
function
Unaffected
Unaffected
Moderate
(conscious
sedation)
Purposeful
response to verbal
or tactile
stimulation
No intervention
required
Adequate
Deep
General
Anesthesia
Purposeful
response after
repeated or painful
stimulation
Intervention may
be required
May be inadequate
Unarousable even
with painful
stimulation
Usually
maintained
Usually
maintained
Most common
level for the
performance of
a TEE
Policy
Staff Responsibilities:
 Must be able to differentiate the different levels of sedation
 Full explanation must be provided to patient with time to answer questions
 Must acquire written consent to proceed with test
 Patient safety and comfort a priority
 Emergency equipment (crash cart) in direct proximity of the room
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Intervention often
required
Frequently
inadequate
May be impaired
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Must know how to activate a code blue
Appropriate staff present during the procedural sedation
Vital signs are monitored and documented by a dedicated and qualified staff member
Must document all medications given (name, dose, time and effect)
Must be aware of and able to identify adverse reactions
Must be able to assess for airway patency and able to identify life-threatening arrhythmias
CPR certification maintained (BCLS)
The regulated health care professional (RN, Anesthetist Assistant) responsible for monitoring of the
patient during and after the procedure may not leave the patient unattended at any time; they cannot
assist with any procedure that distracts them from the monitoring of the patient
Monitoring includes: observing skin color, level of consciousness, rate and depth of respiratory rate
Patients are at a higher risk of respiratory depression within 5 to 20 minutes after receiving IV
sedation
Oxygen saturation monitor on throughout
Cardiologist performing the test is responsible for sedation dosage and writing the order for
administration
Should start with the lowest dose of sedation and repeat to achieve patient comfort
Cardiologist performing the test must be made aware of the patient’s status throughout the test
Staff should always be aware of length of test and patient comfort level
Appropriate recovery time with continuous monitoring and IV site, until patient stabilized
If Flumazenil or Naloxone required to reverse the effects of the sedation, the patient should continue
to be monitored for an additional 2 hours
Patient must be discharged with an accompanying adult who takes responsibility for them
Recovery:
To assess the recovery status of the patient after discontinuation of the sedation.
Example:
Aldrete Score
Score
Respirations
Oxygen saturation
2
Able to take a deep
breath and cough
Maintains > 92% on
room air
Consciousness
Fully awake
Circulation
B/P +/- 20 mmhg
pre test
Able to move all
extremeties
Activity
1
Dyspnea/shallow
breathing
Needs oxygen
inhalation to
maintain > 90 %
Arousable on
calling
B/P +/- 20 to 50
mmhg pre test
Able to move 2
extremeties
0
apnea
Saturation < 90% even with
supplemental oxygen
Not responding
B/P +/- 50 mmhg pre test
Able to move 0 extremeties
The Aldrete score should be completed every 15 minutes until the patient reaches a score of 8 to 10 prior
to discharge.
There are different scoring methods available on line:
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Modified Observers Assessment of Alertness
Ramsey Score
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