The SedUROscopy Project: Sedation conducted by nurses supervised by the anaesthetist at a Lithotripsy and Endourology Unit in Spain

Abstract

AbstractThe increased demand for simple, yet invasive and sometimes painful urological procedures in our unit, coupled with a relative lack of anaesthetists, prompted the search for appropriate safe alternatives to current practice, so to enable efficient, satisfactory, and safe interventions for patients. In response to this need, the Four‐Phase SedUROscopy Project has been developed, a plan in which identified Urology nurses take on a more active role in the anaesthetic procedure at the Lithotripsy and Endourology Unit. The aim of the project is to establish a specific care model that ensures the safety and satisfaction of patients undergoing minor endourological procedures, whilst also optimizing resources and empowering nurses and their practice. The SedUROscopy Project started with the training of five nurses (Phase 1: Theory). Subsequently, one of the nurses then began her practical course (Phase 2: up to 200 sedations). She carried out 90 sedations in patients in preparation for minor procedures. Remifentanil and Propofol were administrated using Target Controlled Infusion (TCI) pumps. The initial target plasma propofol concentration was 2 μg/ml, and the remifentanil one was 1 μg/ml. Doses were adjusted to achieve the right sedation. ECG, pulse oximetry, non‐invasive blood pressure and end‐tidal CO2 were monitored. Up to 10 different procedures were carried out. There were 37 oxygen desaturation events (41%), however they were solved with chin lift manoeuvres and mandibular subluxation (8.88%), use of Guedel tube (21.1%) and manual ventilation (11.1%). The intervention of the anaesthetist was not required in any of the cases, and all the patients involved in the sample were discharged the same day, free of any anaesthetic problem at all (100%). As the surveys indicated, the levels of satisfaction expressed by both patient and staff performing the technique were high (98%). The sedation performed by trained urology nurses using TCI has resulted in a provision of safe and effective procedures. Likewise, the patients' satisfaction was ensured. In conclusion, this model represents an optimal use of resources: not only because just a single anaesthetist could supervise two operation theatres, but also nurses could control the patients pain due to their knowledge of endourological procedures and the sedation technique.