Interventional Radiology: A Case Study

In my department Interventional Radiology (IR), nursing staff administers moderate sedation to patient who are undergoing minimally invasive procedures. Interventional Radiology (IR) follows the anesthesia guidelines for administering moderate sedation. The guidelines do not limit the amount of medications that are administered, if the drugs are being ordered by a supervising physician. Most, patients receive doses of fentanyl up to 100 mcg, starting with 25mcg to 50 mcg to start, and versed up to 2 mg starting with 0.25 mg to 50 mg. We have a physician new to our department who ordered higher doses of medications than what our staff is comfortable with as starting doses of the medications. This physician was routinely ordering oral agents pre-procedure and he would order Benadryl be

The staff and myself got the patient on the CT table, on the monitor, and on oxygen. The physician came to CT for the procedure he ordered starting sedation doses of 2 mg versed and 100 mcg of fentanyl, I told this physician I felt the doses should start at 1 mg versed and 50 mcg of fentanyl, and then we can always give more. He insisted the doses he ordered be administered. I was not comfortable with the order, but I administered the medications as ordered. The patient quickly developed snoring respirations, he was maintaining a good oxygen saturation, but I know he was on the brink of decompensating. I was concerned he would not be able to maintain his own airway, he was over sedated. The physician and the CT staff were in the control room waiting for me to step out of the CT room so they could do the preliminary CT scan and start the biopsy. I refused to leave the CT room until I felt comfortable with the patient’s respiratory status. Once the biopsy was over I discussed with the physician that I would never administer a dose so high at one time for any