UWHC Sedation Policy #8.38 defines the minimum standard of care for all adult patients receiving sedation for procedures throughout the hospital and clinics.
Patients "at-risk" include any patient meeting one or more of the following criteria:
- The patient is unable to handle secretions without aspiration.
- The patient is unable to maintain a patent airway independently (excludes mechanically ventilated patients).
- The patient has severe systemic disturbance or disease, which limits activity.
- The patient has:
- Received opioids, benzodiazepines, or initiated therapy with any CNS depressant within the past 6 hours
- Begun extended release opioids or received methadone or intraspinal/epidural narcotics within the past 24 hours, or
- Begun opioids via an implantable pump within the past 72 hours.
- The sedative drug is administered IV regardless of drug or dose used.
- The sedative drug dose administered requires sedation monitoring per UW Health guidelines (see Appendix A of policy 8.38).
- Two or more sedative drugs are administered concomitantly or sequentially such that there is an overlap in the duration of action, which places the patient at increased risk for airway compromise.
According to these guidelines, examples of patients "at-risk" include patients:
- Who require q 2 hour suctioning
- Who will receive IV morphine or midazolam
- Who are receiving opioids for pain management or benzodiazepines as part of their treatment regimen
- Who have a history of COPD, sleep apnea or morbid obesity
For high-risk patient populations, consultation with an anesthesiologist is desirable. Characteristics of patients that may be inappropriate for moderate sedation include:
- Patient has cardiac and /or respiratory status that makes risk of cardiac or pulmonary compromise likely.
- Patient's mental status makes assessment of level of awareness, pain and response to medications difficult.
- Patient has had previous adverse experience with sedation.
- Patient is allergic or sensitive to sedative and/or analgesic agents.
- Patient is allergic to products that may be used during the procedure
(e.g., Latex products or iodine).
- Patient has a baseline Modified Aldrete score less than 8.
If you have questions about whether medications used in your clinical area qualify as sedation, please talk with your section chief or supervisor. Yopu may also consult UWHC Policy and Procedure #8.38.
Procedures with Sedation
Sedation occurs in settings throughout the institution. This includes general and critical care patient care units, Ambulatory Procedure Center, operating rooms, radiology suites and clinics.
Common adult procedures performed with sedation include (but are not limited to):
- Bone marrow biopsy
- MRI and imaging procedures
- Insertion of venous access device
- Chest tube insertion
- Invitro fertilization
- Cardiac catheterization
- Breast biopsy
- Removal of cardiac sheaths
- Placement of a PD catheter
Sedation provided inside the hospital is supported by the Blue Cart Team, which can be reached at 2-0000.
All off-site locations must be approved for administration of moderate sedation. Any physician providing sedation off-site must have current ACLS certification including advanced airway management skills. In the event of an off-site emergency, activate EMS services via 911.