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The Caffeine challenge: “Dew” you believe it works?
Session Abstracts
JOURNAL OF RADIOLOGY NURSING
apply the art. Measurement of the effectiveness of this combination of art and science requires a sound documentation tool. Documentation of sedation is not restricted to nursing alone. It is multidisciplinary, involving information from the patient, the family, the physician directing the sedation, and hospital departments such as health information and quality management. To develop this type of documentation tool, duPont Hospital for Children formed an interdisciplinary committee in 2001. The Sedation Task Force expanded an existing form to meet the safety and quality requirements of the Joint Commission on Accreditation of Healthcare Organization’s (JCAHO) standards on sedation. The resulting Sedation Assessment and Flow Sheet requires documentation of the health history, the physician’s evaluation of the patient immediately before sedation, a sedation medication order, and the nurse’s charting through the entire process until discharge. In addition, the form is printed with a carbon copy, which is submitted to the quality management department for analysis and quarterly reporting. This documentation tool received favorable comments during a recent JCAHO survey. It has provided a wealth of information for ongoing process improvement and a detailed history of sedation at this hospital.
Pediatric Sedation: Evolution of Nursing Practice Cindy Sanders, MSN, RN, Laura Wagner, BS, RN Children’s Healthcare of Atlanta, Atlanta, GA
Results:
# of patients enrolled # of positive responses % of positive response Complications
PO Caffeine 82 69 84% 0
IV Caffeine 114 67 59% 0
IV+PO Caffeine 7 7 100% 0
Total 203 143 70% 0
Conclusion: Administration of caffeine is effective in managing paradoxical hyperactivity to IVPB in children. The best results were in the small subgroup that received both oral and IV therapy. Further investigation is required to determine whether combined oral and IV therapy is warranted and whether confounding factors such as blood sugar and caffeine intake at home inhibit the effectiveness of this treatment.
Colonography
The art and science of pediatric sedation is truly an evolutionary process. Ongoing changes with regard to JCAHO standards, institutional requirements, medication availability, and other considerations have led to many modifications in nursing practices in radiology. The presenter provided findings gathered during a benchmarking study conducted two years ago and then replicated this year. The participants in the study were nurses in radiology departments providing large amounts of pediatric sedation. Analysis of these findings was presented as it related to medications administered, credentialing of staff, percentages of patients sedated, and other factors. Additionally, the role of sedation services in radiology was discussed as it related to changes in registered nurse practice.
The Caffeine Challenge: ‘‘Dew’’ You Believe It Works? Michelle Niewinski, BSN, RN, Theresa Schultz, RN, Kevin Baskin, MD, Robert Towbin, MD, Robin Kaye, MD The Children’s Hospital of Philadelphia, Philadelphia, PA Background: Paradoxical hyperactivity is an idiosyncratic reaction to intravenous pentobarbital (IVPB) sedation characterized by extreme inconsolable irritability and hyperactive behavior, similar to that seen in attention deficit hyperactivity disorder. Paradoxical reactions are more often seen during the recovery phase but can occur during induction. Stimulants are known to increase concentration and improve self-control in hyperactive children. Objective: In an IRB-approved prospective study, the presenters evaluated the effectiveness of a stimulant, caffeine, in treating paradoxical hyperactivity to IVPB sedation in children.
54
Methods: From April 2001 to December 2002, children sedated with IVPB for diagnostic imaging and interventional procedures were eligible for enrollment. IVPB was given either as a single agent or in combination with midazolam or midazolam and fentanyl citrate. Caffeine was administered either orally, IV, or combined. A positive response was recorded if symptoms (agitation, crying, or hyperactivity) decreased within 40 minutes of caffeine administration. Response time was characterized as immediate (within 10 minutes), early (11-20 minutes), late (21-30 minutes), delayed (31-40 minutes), absent (>41 minutes), or unknown (no time or response recorded).
Colleen Sasso, BSN, RN, CRN Department of Veterans Affairs, San Francisco, CA Colon cancer is the second leading cause of cancer deaths among men and women in the U.S., and 93% of cases occur in people age 50 and over. Most colon cancers can be prevented if precursor colonic polyps are detected and removed. But recent studies demonstrate that fewer than 40% of the people who should be screened do so on a regular basis. Reasons for this are many, but the most prominent is that they are uncomfortable with some of the tests, especially colonoscopy. CT colonography (virtual colonoscopy) was introduced in 1994 and is being evaluated as a promising new tool for colorectal cancer and polyp detection that might encourage more patients to undergo screening. CT colonography uses data acquired from helical CT images and combines these with sophisticated software to generate two- and threedimensional views of the colon. This presenter discussed current screening tools for colorectal screening, benefits and techniques of CT colonography, and future direction of this promising screening modality.
PICC is a Four Letter Word: The Development of a Vascular Access Team Nancy Costa, BSN, RN, CRNI, Elizabeth Ferguson, BSN, RN, CRNI Methodist Hospital, Indianapolis, IN A pilot program was developed in 1997 to study the safety and feasibility of establishing a specially trained team of nurses to
www.radiologynursing.org
JUNE 2004
JOURNAL OF RADIOLOGY NURSING
apply the art. Measurement of the effectiveness of this combination of art and science requires a sound documentation tool. Documentation of sedation is not restricted to nursing alone. It is multidisciplinary, involving information from the patient, the family, the physician directing the sedation, and hospital departments such as health information and quality management. To develop this type of documentation tool, duPont Hospital for Children formed an interdisciplinary committee in 2001. The Sedation Task Force expanded an existing form to meet the safety and quality requirements of the Joint Commission on Accreditation of Healthcare Organization’s (JCAHO) standards on sedation. The resulting Sedation Assessment and Flow Sheet requires documentation of the health history, the physician’s evaluation of the patient immediately before sedation, a sedation medication order, and the nurse’s charting through the entire process until discharge. In addition, the form is printed with a carbon copy, which is submitted to the quality management department for analysis and quarterly reporting. This documentation tool received favorable comments during a recent JCAHO survey. It has provided a wealth of information for ongoing process improvement and a detailed history of sedation at this hospital.
Pediatric Sedation: Evolution of Nursing Practice Cindy Sanders, MSN, RN, Laura Wagner, BS, RN Children’s Healthcare of Atlanta, Atlanta, GA
Results:
# of patients enrolled # of positive responses % of positive response Complications
PO Caffeine 82 69 84% 0
IV Caffeine 114 67 59% 0
IV+PO Caffeine 7 7 100% 0
Total 203 143 70% 0
Conclusion: Administration of caffeine is effective in managing paradoxical hyperactivity to IVPB in children. The best results were in the small subgroup that received both oral and IV therapy. Further investigation is required to determine whether combined oral and IV therapy is warranted and whether confounding factors such as blood sugar and caffeine intake at home inhibit the effectiveness of this treatment.
Colonography
The art and science of pediatric sedation is truly an evolutionary process. Ongoing changes with regard to JCAHO standards, institutional requirements, medication availability, and other considerations have led to many modifications in nursing practices in radiology. The presenter provided findings gathered during a benchmarking study conducted two years ago and then replicated this year. The participants in the study were nurses in radiology departments providing large amounts of pediatric sedation. Analysis of these findings was presented as it related to medications administered, credentialing of staff, percentages of patients sedated, and other factors. Additionally, the role of sedation services in radiology was discussed as it related to changes in registered nurse practice.
The Caffeine Challenge: ‘‘Dew’’ You Believe It Works? Michelle Niewinski, BSN, RN, Theresa Schultz, RN, Kevin Baskin, MD, Robert Towbin, MD, Robin Kaye, MD The Children’s Hospital of Philadelphia, Philadelphia, PA Background: Paradoxical hyperactivity is an idiosyncratic reaction to intravenous pentobarbital (IVPB) sedation characterized by extreme inconsolable irritability and hyperactive behavior, similar to that seen in attention deficit hyperactivity disorder. Paradoxical reactions are more often seen during the recovery phase but can occur during induction. Stimulants are known to increase concentration and improve self-control in hyperactive children. Objective: In an IRB-approved prospective study, the presenters evaluated the effectiveness of a stimulant, caffeine, in treating paradoxical hyperactivity to IVPB sedation in children.
54
Methods: From April 2001 to December 2002, children sedated with IVPB for diagnostic imaging and interventional procedures were eligible for enrollment. IVPB was given either as a single agent or in combination with midazolam or midazolam and fentanyl citrate. Caffeine was administered either orally, IV, or combined. A positive response was recorded if symptoms (agitation, crying, or hyperactivity) decreased within 40 minutes of caffeine administration. Response time was characterized as immediate (within 10 minutes), early (11-20 minutes), late (21-30 minutes), delayed (31-40 minutes), absent (>41 minutes), or unknown (no time or response recorded).
Colleen Sasso, BSN, RN, CRN Department of Veterans Affairs, San Francisco, CA Colon cancer is the second leading cause of cancer deaths among men and women in the U.S., and 93% of cases occur in people age 50 and over. Most colon cancers can be prevented if precursor colonic polyps are detected and removed. But recent studies demonstrate that fewer than 40% of the people who should be screened do so on a regular basis. Reasons for this are many, but the most prominent is that they are uncomfortable with some of the tests, especially colonoscopy. CT colonography (virtual colonoscopy) was introduced in 1994 and is being evaluated as a promising new tool for colorectal cancer and polyp detection that might encourage more patients to undergo screening. CT colonography uses data acquired from helical CT images and combines these with sophisticated software to generate two- and threedimensional views of the colon. This presenter discussed current screening tools for colorectal screening, benefits and techniques of CT colonography, and future direction of this promising screening modality.
PICC is a Four Letter Word: The Development of a Vascular Access Team Nancy Costa, BSN, RN, CRNI, Elizabeth Ferguson, BSN, RN, CRNI Methodist Hospital, Indianapolis, IN A pilot program was developed in 1997 to study the safety and feasibility of establishing a specially trained team of nurses to
www.radiologynursing.org
JUNE 2004