Abstract 20
Kaci A. Rainey, RN, BSN, CEN
Christiana Care Health System
Krainey@christianacare.org
Title: Decreasing Sedation for Pediatric Head CT Imaging in the Emergency Department
Objectives (of project and/or presentation):
1. Identify three risks of sedation in the pediatric population.
2. Demonstrate alternative ways to obtain a non-contrast head CT on the pediatric patient.
3. Describe three benefits of using alternative methods instead of sedation.
Introduction OR Rationale: There are many risks associated with sedating pediatric patients in the Emergency
Department. These risks include aspiration, allergic reaction, respiratory depression and even death. When
choosing to sedate a pediatric patient for CT imaging, there is an increased need for 1:1 nursing and physician staff
during initial sedation process, transport to CT, and post sedation assessment. This may result in a prolonged ED
length of stay, increase in cost, increased risk to patient and high anxiety of parent/caregiver. The goal was to
reduce the occurrence of sedating pediatric patients < 3 years old with IM or IV medication to obtain a noncontrast head computed tomography (CT) scan.
Methods: Data was collected for pediatric patients </= 3 years old who received a non-contrast head CT from
September 2011-2012. The data collection revealed 22 total patients. The data showed a 27% sedation rate in this
patient population. Emergency room staff were educated over the course of one year on how to use alternative
non-invasive methods instead of medications for sedation. These teaching methods included swaddling patients
using sheets or a papoose device, using sweet-ease for infants less than 6 months old, applying cervical spine collar
or towel rolls for neck stabilization and encouraging family presence during CT imaging.
Results OR Practice Implications: Data collection from September 2013-2014 for pediatric patients </= 3 years old
requiring a non-contrast head CT was performed including all three Emergency Departments. The post data
revealed 17 total patients. The data reveals a 17% sedation rate in this patient population. The use of sedation in
obtaining a non-contrast head CT was decreased by 10% overall.
Conclusions: Evidenced based practice supports: the use of swaddling with sheet or blanket, tape, and sweet-ease
for younger children and the use of movie projectors, video goggles and a child life specialist is recommended for
older children. Barriers identified were XX ED opened in June 2013 and was not originally apart of baseline data.
The staffing at XX ED represented the same physicians but had additional nursing staff that was not fully educated
on alternative methods described in this project. High staff turnover in all EDs account for difficulty in continuing
education efforts in many hospital systems. A system-wide "culture change" remains a barrier to family presence
in CT.
References:
1. Cote, Charles J. (2014). Guidelines for monitoring and management of pediatric patients during and after
sedation for diagnostic and therapeutic procedures: An update. The Journal of the American Academy of
Pediatrics.
2. Sacchetti, A., Carraccio, C., Giardino, A. & Harris, R. (2005). Sedation for pediatric CT scanning: Is radiology
becoming a drug-free zone?. Pediatric Emergency Care, 21, 5, 295-297.
3. Pappas, J.N., Donnelly, L.F., Frush, D.P. (2000). Pediatric imaging: Reduced frequency of sedation of young
children with multisection helical CT. Radiology, 215, 897-899.
4. Koch, B.L. (2008). Avoiding sedation in pediatric radiology. Pediatric Radiology, 38, 225-226.
5. Khan, J.J., Donnelly, L.F., Koch, B.L., Curtwright. L.A., Dickerson, J.M., Hardin, J.L., Hutchinson, S., Wright, J. &
Gessner, K.E. (2008). A program to decrease need for pediatric sedation for CT and MRI. Applied Radiology, 4, 3033.
6. Horeczko, T. (2012). Deciding whether to use CT scan with trauma: Pediatric minor head trauma in your office,
clinic, or emergency department. Contemporary Pediatrics, 1-6.
Funding Source: None