Attached is the policy we use and our pre-procedure checklist. These are our standard protocols for procedural sedation:
- DURING Sedation (unchanged)
- Assess and document the following information before the first dose, every 5 minutes during sedation/analgesia, and at end of the procedure:
- Level of Consciousness (LOC)
- Vital Signs (Blood Pressure, Heart Rate, Respiratory Rate)
- Cardiac Rhythm
- Oxygen Saturation
- End-Tidal CO2
- Medication administered (dose, route of administration, time, and individual administering the medication)
- AFTER Sedation (unchanged)
- Assess and document the following information every 15 minutes:
- Level of Consciousness
- Airway patency
- Vital Signs (Blood pressure, Heart Rate, Respiratory Rate)
- Cardiac rhythm
- Oxygen Saturation
- End-tidal CO2
IN THE AFTER VISIT SUMMARY:
Moderation sedation discharge instructions will automatically be added to the After Visit Summary (AVS) for all ED patients who have an ED Procedure Note for Procedural Sedation and have Sedation Narrator documentation. ED staff should review these instructions with the patient at discharge.
Lastly, as you all are aware, we should be utilizing the Sedation Narrator for all sedations.
Considerations
- Patient weight -If there is any doubt about the patient's weight, consider reweighing before the start of the procedure.
- Allergy status - Are there any food or medication allergies that could potentially impact the procedure?
- Anesthesia and sedation history - Has the patient had a poor response to anesthesia medications or moderate sedation and analgesia?
- NPO Status - When was the last time the patient ate or drank? What did they consume?
- Recommended fasting periods for patients of all ages are:
- 2 hours - Clear liquids
- 4 hours - Breast milk
- 6 hours - Infant formula
- 6 hours - Non-clear liquids
- 6 hours - Non-human milk
- 6 hours - Light meal*
- 8 hours - Fried or fatty foods, meat
* a light meal typically consists of toast without butter and clear liquids
Time Out
- Before the start of any procedure requiring moderate sedation, a time out should be called and documented.
- The monitoring nurse should use two unique identifiers for patient verification.
Monitoring
It is common for children to pass from the intended level of sedation to a deeper, unintended level of sedation. This makes meticulous monitoring of the patient's vital signs and level of consciousness a priority for the bedside nurse. According to Hospital Policy S105, "Monitoring is at a level consistent with the potential effects of the procedure and/or sedation." (p.7). At a minimum, vitals should be done at least every 5 minutes during the procedure, and at least every 15 minutes after the procedure. These vitals should be compared to several sets of baseline vital signs obtained before the sedation. Vitals should continue to be monitored and recorded post procedure until the patient has returned to their baseline mental status and is able to tolerate POs.
Documentation
The following parameters shall be recorded in the medical record prior to the start of sedation/analgesia, immediately prior to the first dose of sedation/analgesia and during sedation/analgesia at minimum of every 5 minutes, and at the end of the procedure:
Level of consciousness
Respiratory rate
Oxygen saturation
Heart rate • Cardiac rhythm
Blood pressure
End-tidal CO2
Medications administered with dose, time, route of administration and individual administering the medication
Drug reactions, untoward events, interventions
Pearls of Wisdom
- As a rule, the nurse should never administer a medication they are unfamiliar with. Sedatives can have an especially potent effect, and there is great risk for patient harm if they are administered incorrectly. Take a moment to familiarize yourself with the drug in question by utilizing the NYP Formulary/Lexicomp or discuss it with the pharmacist and ordering provider.
- According to the "Medications Approved for Intravenous Push Method of Administration" (P169), both sedatives and analgesia, including Fentanyl, Ketamine, and Versed can be administered by the RN.
- Although medications such as Ketamine can be used for pain, they are typically reserved for moderate sedation in the pediatric emergency department. If the provider's order lacks an indication, do not hesitate to consult with the ordering provider and pharmacist to confirm the order and the rationale for its use.
- The person monitoring the patient during moderate sedation and analgesia cannot be the same person performing the procedure.
- If you have any doubts about the provider performing the moderate sedation, access the online Privilege Inquiry system on the Infonet to check for privileges or credentialing of a provider (MD/NP/PA) prior to a procedure.
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Tara Doherty, MSN, RN, CPEN, TCRN
Pediatric Emergency Nurse
NewYork-Presbyterian/Morgan Stanley Children's Hospital
New York, NY
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Original Message:
Sent: 01-05-2026 04:00 PM
From: Elizabeth Leming, BSN;BA;CCRN
Subject: Procedural Sedation
Hello,
Looking to see if anyone has a pediatric procedural sedation policy or clinical pathway they might be able to share?
With appreciation,
Liz
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Elizabeth Leming BSN;BA;CCRN
Clinical Practice Specialist
Children's Minnesota
St Paul MN
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