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Nurse-administered propofol sedation for endoscopy: a risk analysis during an implementation phase
J T Jensen1, P Vilmann, T Horsted
1Department of Anesthesiology, Gentofte Hospital, University of Copenhagen, Denmark.
Endoscopy
|August 4, 2011
Summary
Nurse-administered propofol sedation (NAPS) is safe for endoscopic procedures when staff are properly trained. This study validated a structured training program, identifying key risk factors for adverse events during implementation.
Area of Science:
- Anesthesiology
- Gastroenterology
- Nursing Education
Background:
- Nurse-administered propofol sedation (NAPS) is increasingly used for endoscopic procedures.
- A structured training program is essential for safe implementation of NAPS.
- Risk analysis is crucial to identify potential complications.
Purpose of the Study:
- To conduct a risk analysis during the implementation of NAPS.
- To validate a structured training program for endoscopists and nurses administering propofol.
- To assess the safety and efficacy of NAPS in endoscopic settings.
Main Methods:
- A 6-week training program for nurses and a 2.5-hour program for endoscopists were developed, focusing on airway management.
- Data from 1822 endoscopic procedures in 1764 patients were prospectively collected.
- Adverse events, including hypoxemia, airway handling issues, and blood pressure changes, were meticulously recorded.
Main Results:
- Hypoxemia occurred in 4.4% of patients, with higher rates in upper endoscopies (5.7%) versus lower endoscopies (2.9%).
- Assisted ventilation was required in 1.1% of cases, and two patients needed endotracheal intubation.
- Blood pressure changes were noted in 26% of patients; intervention type and staff experience were identified as independent risk factors.
Conclusions:
- The structured training program for NAPS implementation was validated.
- NAPS is a safe sedation method for endoscopic procedures when administered by properly trained personnel.
- NAPS offers significant advantages over conventional sedation for endoscopy.
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