2000 OPEN FORUM Abstracts
CONSCIOUS SEDATION PROVIDED BY RESPIRATORY CARE PRACTITIONERS DURING BRONCHOSCOPY IN ADULT PATIENTS:
James T. Shreve BS, RRT, RPFT, Michael Lavery, RRT, James P. Lamberti M.D. Inova Fairfax Hospital, Falls Church, VA
OBJECTIVE: To evaluate the safety of conscious sedation provided by Respiratory Care Practitioners (RCPs) during flexible bronchoscopy. We studied 460 patients between January 1999 and December 1999.
Methods: RCPs were provided additional training and tested for competence in the insertion of intravenous catheters, sedative and analgesic pharmacology, and titration of analgesics and sedatives prior to providing conscious sedation during flexible bronchoscopy. Baseline vital sign measurements were recorded to include level of consciousness using a modified Aldrete Score. Patients were monitored during the procedure with continuous ECG, oxygen saturation, plethysmograph and non-invasive blood pressure measurements every five minutes. Post-bronchoscopy vital sign measurements were monitored until the patient was stable (usually 30-60 minutes after the procedure). Patients received midazolam (Versed) and/or meperidine (Demerol) intravenously under direct physician supervision. A retrospective review was performed to investigate adverse reactions during bronchoscopy with conscious sedation being provided by RCPs.
Results: 96% of the patients completed flexible bronchoscopy without any complications from conscious sedation. 17 adverse reactions to the conscious sedation were noted: Hypoxia = 8 patients, Hypotension = 3 patients, Tachycardia = 0 patients, Bradycardia = 0 patients, Reversal agents used = 4 patients, Unplanned admission to hospital = 2 patients, 1 death not related.
CONCLUSION: RCPs who demonstrate competence in airway skills, patient assessment and monitoring are excellent candidates to provide conscious sedation. These practitioners, with additional training in inserting intravenous catheters, sedative and analgesic pharmacology, can assist in providing safe conscious sedation in accordance with physician direction to the adult patient population during flexible bronchoscopy.