APRN Clinical Leader Nationwide Children's Hospital Columbus, Ohio, United States
Abstract:
Objective: There is little to no data on procedural sedation performed by advance practice registered nurse (APRN) in the pediatric cardiac population. Our objective is to describe the clinical outcomes and safety of trained acute care APRNs providing procedural sedation for the pediatric cardiac population.
Methods: A retrospective chart review was performed from November 2017 through August 2020 identifying neonates with congenital heart disease undergoing procedural sedation in interventional radiology where the sedating provider was an APRN. All APRNs in the cardiac population performing procedural sedation are certified in pediatric acute care and have completed institutional training and credentialing to provide procedural sedation.
Results: A total of 123 neonates undergoing procedural sedation for PICC line placement were studied. The target sedation level of all patients was mild to moderate utilizing the American Society of Anesthesiologists continuum of depth of sedation scale and in accordance with institutional guidelines for sedation credentialing. Of the patients studied 42 had single ventricle anatomy, 19 were mechanically ventilated, 14 on non-invasive positive pressure, 8 on inotropic support, 78 on prostaglandin (PGE) and 1 on antiarrhythmics prior to the procedural sedation. The average age of patients was 4.3 (days) with a range of 1-17 days. Average gestational age (GA) was 38.3 (weeks) with a range of 33-41 weeks GA, and the average weight was 3.3 (kg) with a range from 1.7-5.85 kg.
Adverse events were identified in 3 patients (.02%). One patient with TOF/MAPCAs required bag mask ventilation for apnea then resumed normal effort after receiving versed for a target level of mild sedation. One patient with truncus arteriosus, tracheal malacia and 22q11 deletion experienced apnea required BMV and escalation to NIPPV after receiving Fentanyl and versed for a target level of moderate sedation. A third patient with transposition of the great arteries required a five ml/kg fluid bolus for mild hypotension after receiving a single dose of versed for a target level of mild sedation. There were notably no adverse events with those patients traditionally thought to be high risk for sedation such as those with cardiomyopathy or single ventricle anatomy.
Conclusions: Trained acute care APRNs credentialed in procedural sedation can provide safe sedation for neonates with congenital heart disease with little risk for adverse events. This study was completed with neonates with a variety of congenital heart disease including higher risk sedation patients with single ventricle anatomy, prostaglandin dependency and cardiomyopathy with no increased risk of adverse events.
