sedation
Provide Sedation ? Here ’ s What You Need to Know About Monitors by Rose Dodson , MS
What makes a device a monitor ? What meets state requirements and my practice needs ?
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While it ’ s generally considered a safe practice , there ’ s a level of mortality accompanying sedation . The standards of monitoring continue to be advanced by professional organizations with the objective of improving care .
Texas regulations 1 on sedating a patient include monitoring the level of consciousness , oxygenation , ventilation , and circulation ; and documentation — a written , time-oriented record of a patient ’ s various vital signs .
In order to determine the type of monitor needed for the sedation provided at your practice , you need to understand what makes a device a monitor and meets state requirements . Of course , you also want the monitor to meet the preferences of your practice .
MONITORING
To be clear , the best monitor can ’ t be purchased and is not a device ; it ’ s the practitioner . It ’ s important to never lose a sense of awareness and to always pay attention to the patient . In fact , over 50 % of each area to be monitored requires the practitioner ’ s senses .
1 Texas Rules and Regulations Administrative Code Title 22 Part 5 Chapter 110
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Level of Consciousness . Practitioners use their senses to monitor consciousness . It involves simply checking for responsiveness to verbal commands . For example , asking the patient , “ Hey , Susie , how are you feeling ?” would prompt a patient to respond . A patient is obviously conscious if they can respond to anything asked of them .
Oxygenation . Here again , practitioners use their senses to look at the color of mucosa and skin to ascertain a certain level of oxygenation . However , a pulse oximeter — a device that measures oxygen saturation in a patient — can also be used .
Ventilation . A patient ’ s breathing can be assessed either through observing chest movements or verbal communication . It can also be assessed through listening to breath sounds , which can often be heard by the practitioner placing their ears downwards toward the patient ’ s mouth or nose . However , a pre-tracheal stethoscope can be used to listen more efficiently . Additionally , ventilation can be determined through use of a capnograph — also known as a CO2 monitor — which measures the level of CO 2 a patient breathes out .
Circulation . Measuring blood flow or cardiac output is done by taking a patient ’ s blood pressure , measuring heart rate , and / or using an electrocardiograph .
Q . What makes a device a monitor ?
By definition , a monitor is used for observing , checking , or keeping a continuous record of something . As a verb , it is “ to watch , check or observe for a special purpose ,” but specifically to “ warn .” A monitor is actually a device intended to warn a practitioner of an ongoing issue .
Diagnostic devices , such as a finger pulse oximeter , a blood pressure measuring device , and a thermometer can typically be found at a dental office . Why couldn ’ t the finger pulse oximeter be simply used every 10 minutes and a reading recorded ?
A . Here are the features that make a simple device a monitor :
Audible and visual alarms . Tones and alarms are an absolute must for a device to be an actual monitor . It eliminates the need for the practitioner and / or staff to continually stare at that pulse oximeter and gives a warning if the reading drops below an acceptable level . During a busy sedation case , a drop in the pulse oximeter tone is an important indicator to bring attention to a potential physiological change .
Automatic blood pressure monitor . An automatic blood pressure device can be set to a specific interval and inflates on its own to record a patient ’ s blood pres-