Help Reduce Four Complications of Interventional Radiology

WHAT BALANCED SEDATION LOOKS LIKE DURING INTERVENTIONAL RADIOLOGY PROCEDURES

New techniques in interventional radiology (IR) allow patients to have diagnostic and therapeutic procedures without entering an operating room or experiencing general anesthesia. In recent years, the number of IR procedures requiring sedation nearly tripled.4 These procedures can require the administering of multiple sedatives by trained non-anesthesiologists like radiologic and imaging nurses.1

Clinicians in the IR suite are seeing more physiologic variables — and making more complex decisions about sedation.1 Patients tend to be older and sicker, and procedures often require moderate or deep sedation — sometimes for hours at a time.2 Patients that are opioid naïve or have multiple comorbidities may have a higher risk of developing ventilatory complications related to sedation levels.5,6

That’s why IR clinicians are constantly innovating new approaches to sedation. They tailor sedation for each patient to control depth and length — and to actively monitor for adjustments.5 They’re mindful of the amount of sedation given and its effects on the patient’s ventilatory state.

Learn more about how IR sedation is evolving and what that could mean for you and your patients. This blog post explores ways to help you  balance safety and comfort, minimize complications, and improve outcomes in the IR through smart sedation.

Challenge #1: Patients needing IR sedation may have more risk factors

Patients in the IR tend to be older and may have one or more chronic conditions, which may lead to complications during sedation.1,2

For example, a patient with a high BMI may be at increased risk for hypoxia and additional airway maneuvers.7 A wider neck diameter may make it difficult to manage an obese patient’s airway.8

Sedative dosing can also be a challenge for obese patients, because their weight may affect their body’s ability to process drugs.8 Dosing based solely on total body weight may lead to an overdose.8

Related: Explore interventional radiology resources with healthcare professionals.

Challenge #2: The unique IR environment may complicate intraprocedural communication

Consistent communication during procedures may be an issue in IR settings. Surgical draping is necessary to protect everyone in the IR suite, but it can also obscure a patient’s breathing patterns from clinicians.9,10

And, IR clinicians have the additional challenge of working in relative darkness while making incisions of only 2–3 mm.11 Continuous patient monitoring can help compensate for the lack of direct observation of clinical signs.

Related: Learn how capnography can help you manage sedation-related risks. Visit the resource site.

Challenge #3: Sedation is a delicate balance between procedural and patient needs

Some IR procedures require long periods of sedation. For example, a magnetic resonance high-intensity focused ultrasound can last over four hours.3 During this time, patients’ sedation levels can range from moderate to deep — and they must have a protected airway to maintain proper ventilation.3

Other procedures — such as image-guided biopsies — involve minimal sedation.12 But clinicians must carefully monitor patient discomfort and anxiety. High anxiety levels can affect patient cooperation and disrupt workflows.12

Related: See how IR clinicians make decisions about sedation. Watch this video.

Challenge #4: Complications may lead to adverse outcomes and higher costs

How a patient responds to sedation can be difficult to predict. During moderate sedation, some patients may maintain stable breathing and ventilation on their own. But others may slide into a deeper sedative state than intended.14 Oversedation may lead to adverse outcomes, including respiratory depression, apnea, and airway obstruction.3

Respiratory compromise (RC) associated with IR sedation is associated with worse outcomes and higher costs.15 One study showed that patients with RC were 27.1 percent more likely to die, and cost of care was $6,904 more than patients without RC.15

Related: Find out how you can detect and prevent respiratory compromise in the IR. Learn more.

Tools to help balance safety and comfort during IR procedures

Two tools that can help you balance safety and comfort during IR procedures are:

  • Capnography
  • Tailoring sedation levels

Incorporating capnography in IR procedures can help clinicians detect apnea, hypoventilation, and respiratory depression.1 It provides a way to detect RC earlier so you can respond quicker.1 And nearly half of malpractice claims due to oversedation were “preventable by additional (or better) monitoring,” according to a comprehensive review by the American Society of Anesthesiologists.6 Using capnography decreases the odds of oxygen desaturation and assisted ventilation events, leading to better patient outcomes.14

And tailoring sedation levels in the IR suite to accommodate patient preferences and comfort levels can empower your patients.16 One study showed that patients valued the opportunity to choose between no sedation, minimal sedation, and moderate sedation during venous access device placement procedures.16 This kind of shared decision-making about sedation can improve patient satisfaction.16

Related: Watch for these warning signs during minimal, moderate, and deep sedation. View the infographic

Learn how you can make better decisions about sedation and improve outcomes in the IR suite. Visit the site.

References:
1. Green KL, Brast S, Bland E, et al. Association for Radiologic & Imaging Nursing Position Statement: Capnography. Journal of Radiology Nursing. 2016 35:1:63–64.
2. Long M, Green KL, Bland E, et al. Capnography monitoring during procedural sedation in radiology and imaging settings: an integrative review. J Radiol Nurs. 2016;35:191–197.
3. Vaessen HHB, Knuttel FM, van Breugel JMM, et al. Moderate-to-deep sedation technique, using propofol and ketamine, allowing synchronised breathing for magnetic resonance high-intensity focused ultrasound (MR-HIFU) treatment for uterine fibroids: a pilot study. J Ther Ultrasound. 2017;5:8. doi: 10.1186/s40349-017-0088-9.
4. Nagrebetsky A, Gabriel RA, Dutton RP, Urman RD. Growth of nonoperating room anesthesia care in the United States: A contemporary trends analysis. Anesth Analg. 2017;124(4):1261–1267.
5. Johnson S. Sedation and analgesia in the performance of interventional procedures. Semin Intervent Radiol. 2010;27(4):368–373.
6. Bhananker S, Posner K, Cheney F, Caplan R, Lee L, Domino K. Injury and liability associated with monitored anesthesia care: a closed claims analysis. Anesthesiology. 2006;104(2):228–234.
7. Wani S, Azar R, Hovis CE, et al. Obesity as a risk factor for sedation-related complications during propofol-mediated sedation for advanced endoscopic procedures. Gastrointest Endosc. 2011;74(6):1238–1247.
8. Aberle D, Charles H, Hodak S, O'Neill D, Oklu R, Deipolyi AR. Optimizing care
for the obese patient in interventional radiology. Diagn Interv Radiol. 2017;23(2):156–162.
9. King JN, Champlin AM, Kelsey CA, Tripp DA. Using a sterile disposable protective surgical drape for reduction of radiation exposure to interventionalists. AJR Am J Roentgenol. 2002;178(1):153–157.
10. Renu B, Jyoti S. Should end-tidal carbon dioxide monitoring be mandatory for surgeries under spinal anaesthesia? Indian J Anaesth. 2018;62(2):147–148.
11. Tsetis D, Uberoi R, Fanelli F, et al. The provision of interventional radiology services in Europe: CIRSE recommendations. Cardiovasc Intervent Radiol. 2016;39(4):500-506.
12. Jo YY, Kwak HJ. Sedation strategies for procedures outside the operating room. Yonsei Med J. 2019;60(6):491–499.
13. Birchard KR. Transthoracic needle biopsy. Semin Intervent Radiol. 2011;28(1):87–97.
14. Saunders R, Struys MMRF, Pollock RF, Mestek M, Lightdale JR. Patient safety during procedural sedation using capnography monitoring: a systematic review and meta-analysis. BMJ Open. 2017;7(6):e013402. doi: 10.1136/bmjopen-2016-013402.
15. Urman RD, Moucharite M, Flynn C, Nuryyeva E, Ray CE Jr. Impact of respiratory compromise in inpatient interventional radiology procedures with moderate sedation in the United States. Radiology. 2019:182455. doi: 10.1148/radiol.2019182455.
16. Chittle MD, Oklu R, Pino RM, et al. Sedation shared decision-making in ambulatory venous access device placement: Effects on patient choice, satisfaction and recovery time. Vasc Med. 2016;21(4):355–360.

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TOPIC: Microstream™ Capnography, Procedural Sedation

About the Author

Martina Blaho

Martina Blaho RN, BSN is a senior market development clinical specialist at Medtronic.

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