(DOES INCLUDE MODERATE SEDATION PRIVILEGES)

Transcription

1 CAROLINAS HEALTHCARE SYSTEM CAROLINAS MEDICAL CENTERS - CHARLOTTE (Carolinas Medical Center, Carolinas Medical Center-University and Carolinas Medical Center Pineville) DEEP SEDATION WITH ANESTHESIA SPECIALTY OF EMERGNECY MEDICINE AND PEDIATRIC EMERGENCY MEDICINE DELINEATION OF PRIVILEGES (DOES INCLUDE MODERATE SEDATION PRIVILEGES) I. EMERGENCY MEDICINE PHYSICIANS - CREDENTIALS REQUIRED: Applicant must submit the following: 1. Provide documentation of board certification in Emergency Medicine or Pediatric Emergency Medicine or documentation of successful completion of an Accreditation Council for Graduate Medical Education (ACGME) or American Osteopathic Association (AOA) accredited residency training program in Emergency Medicine or fellowship training in Pediatric Emergency Medicine; AND 2. Provide documentation from the Director of his/her residency/fellowship training program in Emergency Medicine or Pediatric Emergency Medicine that the candidate is proficient in performing Adult and/or Pediatric deep sedation within the past twenty-four (24) months OR 2. Successful completion of an approved continuing education and proctoring program overseen by the Chairmen of the Anesthesia and Emergency Medicine Departments. II. EMERGENCY MEDICINE PHYSICIANS AND PEDIATRIC EMERGENCY PHYSICIANS - CRITERIA FOR MAINTENANCE OF PRIVILEGES: 1. The Practitioner must perform ten (10) cases over a twenty-four (24) month period to be eligible to reapply for Deep Sedation Privileges. Documentation of procedures performed and the results of Quality Assessment and Improvement Committee outcomes will be reviewed at the time of the Practitioner s reappointment OR 2. Successful completion of the deep sedation tutorial from the Specialty of Anesthesiology and successful test score.

2 Page 2 I hereby apply for privileges to perform * ADULT Deep Sedation with Anesthesia at the following Facilities: X Carolinas Medical Center q Carolinas Medical Center-University q Carolinas Medical Center- Pineville Medicines and Dosing Guidelines have been approved by the Medical Staff of the above listed facilities for Deep Sedation with Anesthesia. Propofol Dosing Guidelines for Adult Deep Sedation Drug Dose Onset Duration Propofol Propofol Injectable Emulsion should be administered only by persons trained in the administration of general anesthesia and not involved in the conduct of the surgical/diagnostic procedure IV Bolus Dosing mg/kg mg/kg every 3 5 min IV Infusion Dosing mcg/kg/min for 3-5 minutes mcg/kg/min 40 seconds 1 3 minutes 3 5 minutes 5 7 minutes

3 Page 3 I hereby apply for privileges to perform * PEDIATRIC Deep Sedation with Anesthesia at the following Facilities: X Carolinas Medical Center q Carolinas Medical Center-University q Carolinas Medical Center-Pineville Medicines and Dosing Guidelines have been approved by the Medical Staffs of the above listed facilities for Deep Sedation with Anesthesia Propofol Dosing Guidelines for Pediatric Deep Sedation Children under 5 years of age are not eligible for propofol sedation by an emergency medicine or pediatric emergency physician. Drug Dose Onset Duration IV Bolus Dosing 40 seconds 3 5 minutes mg/kg mg/kg every 3 5 min Propofol Propofol Injectable Emulsion should be administered only by persons trained in the administration of general anesthesia and not involved in the conduct of the surgical/diagnostic procedure Recommend draw up Propofol 1mg/kg in syringe and infuse slowly (i.e. over 3-5 minutes) as some patients will be adequately sedate at doses of 0.25mg/kg and many patients will not require the entire 1mg/kg to reach adequate sedation. Titration stops when level required achieved and then may be reinitiated when level of sedation wanes. 1 3 minutes 5 7 minutes IV Infusion Dosing mcg/kg/min for 3-5 minutes mcg/kg/min Rarely needed or recommended for nonintubated sedation in the emergency department unless period of sedation will be prolonged.

4 Page 4 Pediatric Propofol Dosage and Administration (Procedural sedation): - Can be used alone or with an opiate since it provides amnesia but no analgesia. - Should be used with ETCO2 Capnography. - Pre-dose of IV lidocaine or fentanyl prior to Propofol may be reasonable to decrease burning. For painful procedures utilization of fentanyl at usual dose for pain through IV that you are going to give the Propofol through is reasonable (Propofol is not an analgesic). If only using the fentanyl for Propofol injection related pain than 1 ug/kg typically used. It is ideal to use blood pressure cuff for 1 minute after giving the narcotic for maximum effect. If not a painful procedure, lidocaine may be used to decrease Propofol injection related pain: Pre-dose with preservative free 1% lidocaine: Pt s Wt (Kg s) ml s (1%) Lidocaine ml NS Total ml Vol With either fentanyl or lidocaine predose: 1. While occluding the brachial artery, elevate the arm to a vertical position and maintain pressure for two minutes. Adequate occlusion of the brachial artery will be evidenced within a short period of time by increasing blanching of the hand and a lack of a pulse over the radial artery. 2. Inflate blood pressure cuff above systolic pressure. Maintain tourniquet pressure continuously. 3. Check patency of IV with small amount of saline prior to injecting medication. Inject slowly over a couple minutes to prevent leakage under the tourniquet. Let cuff down >1minute later. I have attained the level of competency required to administer the above requested drugs for deep sedation with anesthesia through the following training and/or experience: Training in emergency medicine, years of practice, seminars, reading, conferences, education modules

5 Page 5 I attest that I have read the Policy and Clinical Practice Guidelines for the Use of Propofol for Deep Sedation with Anesthesia and agree to abide by this Policy and the Clinical Practice Guidelines. Signature 7/2/14 Stephen Colucciello Emergency Medicine Print Name Specialty Chief, Department of Anesthesiology, Carolinas Medical Center Chief, Department of Anesthesiology, Carolinas Medical Center-University Section Chief, Section of Anesthesiology, Carolinas Medical Center-Pineville Approval by the Medical Executive Committee: Carolinas Medical Centers-Charlotte 05/15/2014 Board of Commissioners 06/10/2014