Nurse-administered propofol sedation for endoscopy: a risk analysis during an implementation phase

J T Jensen, P Vilmann, T Horsted, P Hornslet, Uffe Bødtger, A Banning, A Hammering

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

BACKGROUND AND STUDY AIMS: The aim of the present study was to perform a risk analysis during the implementation phase of nurse-administered propofol sedation (NAPS) and to validate our structured training program.

PATIENTS AND METHODS: A structured training program was developed both for endoscopists and for endoscopy nurses who were administering propofol sedation. The nurses' program comprised a 6-week course including theoretical and practical training in airway management, and the endoscopists' program consisted of 2.5 h of theory and a short course in practical airway management. In the implementation phase, data from 1822 endoscopic procedures in 1764 patients were prospectively collected. All adverse events related to sedation were recorded (defined as oxygen saturation < 92%, airway handling, assisted ventilation, need for intubation, change in blood pressure > 20 mmHg).

RESULTS: 78 cases of hypoxemia were documented in 1764 patients (4.4%), in 56/983 upper endoscopies (5.7%) and 22/754 lower endoscopies (2.9%) (P = 0.007). Assisted ventilation was necessary in 19 cases (1.1%) and anesthesiologic assistance was requested 10 times. Two patients required endotracheal intubation. A change in blood pressure was recorded in 451 patients (26%). Independent risk factors were type of intervention and level of experience of the staff performing the sedation.

CONCLUSION: These results were obtained after development of a structured training program both for endoscopists and nurses using propofol for sedation, and can be used as basis for further comparison. NAPS for endoscopic procedures is safe when performed by personnel properly trained in airway handling and sedation with propofol, and has considerable advantages compared with conventional sedation for endoscopy.

Original languageEnglish
JournalEndoscopy
Volume43
Issue number8
Pages (from-to)716-22
Number of pages7
ISSN0013-726X
DOIs
Publication statusPublished - Aug 2011

Fingerprint

Propofol
Nurses
Education
Ventilation
Oxygen

Keywords

  • Adult
  • Aged
  • Anoxia
  • Cholangiopancreatography, Endoscopic Retrograde
  • Clinical Competence
  • Deep Sedation
  • Education, Nursing, Continuing
  • Endoscopy, Gastrointestinal
  • Female
  • Humans
  • Hypnotics and Sedatives
  • Hypotension
  • Male
  • Middle Aged
  • Propofol
  • Risk Assessment

Cite this

Jensen, J. T., Vilmann, P., Horsted, T., Hornslet, P., Bødtger, U., Banning, A., & Hammering, A. (2011). Nurse-administered propofol sedation for endoscopy: a risk analysis during an implementation phase. Endoscopy, 43(8), 716-22. https://doi.org/10.1055/s-0030-1256515
Jensen, J T ; Vilmann, P ; Horsted, T ; Hornslet, P ; Bødtger, Uffe ; Banning, A ; Hammering, A. / Nurse-administered propofol sedation for endoscopy : a risk analysis during an implementation phase. In: Endoscopy. 2011 ; Vol. 43, No. 8. pp. 716-22.
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abstract = "BACKGROUND AND STUDY AIMS: The aim of the present study was to perform a risk analysis during the implementation phase of nurse-administered propofol sedation (NAPS) and to validate our structured training program.PATIENTS AND METHODS: A structured training program was developed both for endoscopists and for endoscopy nurses who were administering propofol sedation. The nurses' program comprised a 6-week course including theoretical and practical training in airway management, and the endoscopists' program consisted of 2.5 h of theory and a short course in practical airway management. In the implementation phase, data from 1822 endoscopic procedures in 1764 patients were prospectively collected. All adverse events related to sedation were recorded (defined as oxygen saturation < 92{\%}, airway handling, assisted ventilation, need for intubation, change in blood pressure > 20 mmHg).RESULTS: 78 cases of hypoxemia were documented in 1764 patients (4.4{\%}), in 56/983 upper endoscopies (5.7{\%}) and 22/754 lower endoscopies (2.9{\%}) (P = 0.007). Assisted ventilation was necessary in 19 cases (1.1{\%}) and anesthesiologic assistance was requested 10 times. Two patients required endotracheal intubation. A change in blood pressure was recorded in 451 patients (26{\%}). Independent risk factors were type of intervention and level of experience of the staff performing the sedation.CONCLUSION: These results were obtained after development of a structured training program both for endoscopists and nurses using propofol for sedation, and can be used as basis for further comparison. NAPS for endoscopic procedures is safe when performed by personnel properly trained in airway handling and sedation with propofol, and has considerable advantages compared with conventional sedation for endoscopy.",
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Jensen, JT, Vilmann, P, Horsted, T, Hornslet, P, Bødtger, U, Banning, A & Hammering, A 2011, 'Nurse-administered propofol sedation for endoscopy: a risk analysis during an implementation phase', Endoscopy, vol. 43, no. 8, pp. 716-22. https://doi.org/10.1055/s-0030-1256515

Nurse-administered propofol sedation for endoscopy : a risk analysis during an implementation phase. / Jensen, J T; Vilmann, P; Horsted, T; Hornslet, P; Bødtger, Uffe; Banning, A; Hammering, A.

In: Endoscopy, Vol. 43, No. 8, 08.2011, p. 716-22.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Nurse-administered propofol sedation for endoscopy

T2 - a risk analysis during an implementation phase

AU - Jensen, J T

AU - Vilmann, P

AU - Horsted, T

AU - Hornslet, P

AU - Bødtger, Uffe

AU - Banning, A

AU - Hammering, A

N1 - © Georg Thieme Verlag KG Stuttgart · New York.

PY - 2011/8

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N2 - BACKGROUND AND STUDY AIMS: The aim of the present study was to perform a risk analysis during the implementation phase of nurse-administered propofol sedation (NAPS) and to validate our structured training program.PATIENTS AND METHODS: A structured training program was developed both for endoscopists and for endoscopy nurses who were administering propofol sedation. The nurses' program comprised a 6-week course including theoretical and practical training in airway management, and the endoscopists' program consisted of 2.5 h of theory and a short course in practical airway management. In the implementation phase, data from 1822 endoscopic procedures in 1764 patients were prospectively collected. All adverse events related to sedation were recorded (defined as oxygen saturation < 92%, airway handling, assisted ventilation, need for intubation, change in blood pressure > 20 mmHg).RESULTS: 78 cases of hypoxemia were documented in 1764 patients (4.4%), in 56/983 upper endoscopies (5.7%) and 22/754 lower endoscopies (2.9%) (P = 0.007). Assisted ventilation was necessary in 19 cases (1.1%) and anesthesiologic assistance was requested 10 times. Two patients required endotracheal intubation. A change in blood pressure was recorded in 451 patients (26%). Independent risk factors were type of intervention and level of experience of the staff performing the sedation.CONCLUSION: These results were obtained after development of a structured training program both for endoscopists and nurses using propofol for sedation, and can be used as basis for further comparison. NAPS for endoscopic procedures is safe when performed by personnel properly trained in airway handling and sedation with propofol, and has considerable advantages compared with conventional sedation for endoscopy.

AB - BACKGROUND AND STUDY AIMS: The aim of the present study was to perform a risk analysis during the implementation phase of nurse-administered propofol sedation (NAPS) and to validate our structured training program.PATIENTS AND METHODS: A structured training program was developed both for endoscopists and for endoscopy nurses who were administering propofol sedation. The nurses' program comprised a 6-week course including theoretical and practical training in airway management, and the endoscopists' program consisted of 2.5 h of theory and a short course in practical airway management. In the implementation phase, data from 1822 endoscopic procedures in 1764 patients were prospectively collected. All adverse events related to sedation were recorded (defined as oxygen saturation < 92%, airway handling, assisted ventilation, need for intubation, change in blood pressure > 20 mmHg).RESULTS: 78 cases of hypoxemia were documented in 1764 patients (4.4%), in 56/983 upper endoscopies (5.7%) and 22/754 lower endoscopies (2.9%) (P = 0.007). Assisted ventilation was necessary in 19 cases (1.1%) and anesthesiologic assistance was requested 10 times. Two patients required endotracheal intubation. A change in blood pressure was recorded in 451 patients (26%). Independent risk factors were type of intervention and level of experience of the staff performing the sedation.CONCLUSION: These results were obtained after development of a structured training program both for endoscopists and nurses using propofol for sedation, and can be used as basis for further comparison. NAPS for endoscopic procedures is safe when performed by personnel properly trained in airway handling and sedation with propofol, and has considerable advantages compared with conventional sedation for endoscopy.

KW - Adult

KW - Aged

KW - Anoxia

KW - Cholangiopancreatography, Endoscopic Retrograde

KW - Clinical Competence

KW - Deep Sedation

KW - Education, Nursing, Continuing

KW - Endoscopy, Gastrointestinal

KW - Female

KW - Humans

KW - Hypnotics and Sedatives

KW - Hypotension

KW - Male

KW - Middle Aged

KW - Propofol

KW - Risk Assessment

U2 - 10.1055/s-0030-1256515

DO - 10.1055/s-0030-1256515

M3 - Journal article

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VL - 43

SP - 716

EP - 722

JO - Endoscopy

JF - Endoscopy

SN - 0013-726X

IS - 8

ER -