1. Conscious (IV) Sedation
 Intravenous sedation is defined as a medically controlled state
of depressed consciousness with or without analgesia that:
• allows protective reflexes to be maintained,
• retains patient’s ability to maintain a continuously
independent patent airway, and
• permits appropriate response by the patient to verbal
command or physical stimulation
 Intravenous sedation and analgesic agents are to be given in
small incremental doses that are titrated to the desired end-
points of sedation and analgesia

2. Conscious Sedation (continued)
 Groups of drugs used for this purpose include:
 Sedatives • Benzodiazepines
 Hypnotics • Antihistamines
 Anti-anxiety • Narcotics
 The pharmacologic agents’ intended uses are for short-term
therapeutic, diagnostic, or surgical procedures
 Sufficient time must elapse between doses to allow the effect
of each dose to be assessed before subsequent drug
administration
 IV Fentanyl is not administered by nurses at WCMC

3. Conscious Sedation (Competency)
 Physicians and CRNA’s managing the care of patients
receiving intravenous sedation for a procedure must be
competent to manage complications related to the
administration of Intravenous sedation
 Anesthesiology credentials physicians and CRNA’s
 Patients receiving sedation and analgesia for a procedure
(such as endoscopy, cardioversion, heart cath, placement of
chest tube, etc.) are given the medication and monitored by
a registered nurse (RN) who has demonstrated current
competency in the administration of Intravenous sedation

4. Conscious Sedation (Competency)
Current competency for RNs includes:
 Knowledge of anatomy and physiology
 Successful completion of ACLS and BLS courses
 Knowledge and skills to assess, diagnose, and intervene in the
event of complications or undesired outcomes, and ability to
institute intervention in compliance with orders (including
standing orders);
 Administration of sedation and analgesic agents: to include
physiological and desired effects, medication
uses, dosages, routes and speed of
administration, contraindications, recognition and
management of adverse or side effects, and use of drug
antagonists

5. Conscious Sedation (Competency)
The RN must:
 Understand the principles of oxygen delivery, respiratory
physiology, oxygen transport and uptake, & demonstrate
ability to use oxygen delivery devices;
 Demonstrate the knowledge of legal ramifications of
intravenous sedation and analgesia and/or monitoring
patients receiving sedation and analgesia, including the RN’s
responsibility and liability in the event of an untoward reaction
or life-threatening complication;
 Assess total patient care requirements during sedation and
analgesia and recovery

6. Conscious Sedation (Staffing)
 Staffing during intravenous and deep sedation for
procedures always includes one RN and one MD at a
minimum
 Additional staff is obtained as indicated according to the
acuity of the patient procedure and potential response to
the medications administered
 The RN monitoring the patient does not engage in any
other tasks that would compromise the ability to assess and
monitor, care for patient, intervene as needed, and be in
constant attendance

7. Conscious Sedation (continued)
 Physiologic measurements include, but are not limited to:
• Respiratory rate
• Oxygen saturation
• Blood pressure
• Cardiac rate and rhythm
• Level of consciousness
• Level of sedation
 The RN administers the prescribed medication under the direct
supervision of the physician
 In the instance a qualified registered nurse is unavailable to
administer the agent, the physician is responsible for
administering the agent

8. Conscious Sedation (Medications)
 The pharmacological agents used to produce Intravenous
sedation/analgesia during procedures include these selected
benzodiazepines and opiates, but are not limited to:
• Valium (diazepam)
• Versed (midazolam) Benzodiazepines
• Ativan (lorazepam)
• Morphine
• Demerol (meperidine) Opiates
 These selected medications are dose and patient dependent and
are usually titrated to the desired effect

9. Conscious Sedation (Equipment)
The following equipment is readily available when
administering conscious sedation.
 Supplemental oxygen and accessibility of delivery
devices (nasal cannula, venturi mask, non-rebreather
mask, bag-valve-mask-device, intubation equipment )
 Crash cart with available defibrillator, emergency
medications, airway adjuncts, and the ability to provide
100% oxygen
 Benzodiazepine Antagonist (Romazicon) and Opiate
Antagonists (Narcan) readily available
 Monitors for noninvasive or invasive blood pressure;
continuous cardiac rhythm and pulse oximetry

10. Conscious Sedation (Pre-procedure)
Before the procedure there is a history and physical completed
by the physician.
 Exception: in emergent situations, an acceptable history and
physical for the procedural purpose may be limited to major
significant conditions requiring intervention
 Patients should be NPO 6 hours prior to administration of
sedation if procedure is elective
 Medications may be given with 30ml of water or less if ordered
 The patient will have continuous intravenous access prior to
the administration of any sedation/analgesia agent and until
the patient meets discharge criteria

11. Conscious Sedation (Pre-procedure)
Nursing assessment is to include, but is not limited to
 Procedure to be performed
 Complete vital signs
 Pulse oximetry
 Level of consciousness
 General physical assessment
 Allergies with reaction
 Current medication
 Time of last PO intake (should be fasting at least 6 hours is elective)
 Past medical history

12. Conscious Sedation (Intra-procedure)
Assessment and documentation is to include:
 Time procedure began and completed
 Medications along with assessment of
effects of medication
 Cardiac rate and rhythm, respiratory
rate, blood pressure, and pulse oximetry
must be documented at regular intervals
during the procedure (a minimum of every
15 minutes and PRN as the condition
requires)

13. Conscious Sedation (Intra-procedure)
Monitoring continuously throughout the procedure:
 Continuous pulse oximetry with visual and auditory displays
 Level of consciousness (LOC) documented every 15 minutes
 Use of supplemental oxygen
 Hypersensitivity reactions
* Documentation is required for intervention needed to support
any of the above parameters - the physician must be notified of
significant deviations, including adverse effects of medication

14. Conscious Sedation (Post-procedure)
Assessment and documentation is to include:
 Activity, oxygenation (to include pulse
oximetry), circulatory, and LOC, every 15 minutes until
sedation/analgesia score = 9 or above
 When the sedation/analgesia score is 9 or above, patient
may be transferred to another unit unless the patient is to be
discharged from the hospital
 Hence, the patient must be monitored for at least one hour
and have a responsible party to drive patient home
 When an antagonist is administered, the patient must be
monitored for two hours from the last dose of the antagonist

15. Conscious Sedation (continued)
 Additional and more frequent monitoring is dictated by
patient condition or at the discretion of the physician, and
may be unit-specific
 Assess and document safety precautions with side rails up
and in place
 Prior to discontinuing post-operative monitoring, the
patient’s vital signs must be stable as compared to baseline
pre-procedure readings
 If the patient is to be discharged post procedure written
discharge instructions pertaining to post sedation home care
are provided