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ECONOMICS, EDUCATION, AND POLICY

Case-Series of Nurse-Administered Nitrous Oxide for Urinary Catheterization in Children

Judith L. Zier, MD, FAAP^*, Gloria J. Drake, CRNA, Paul C. McCormick, MD, Katherine M. Clinch, MD, and David N. Cornfield, MD

From the Divisions of *Pediatric Critical Care; and Anesthesiology, Children’s Hospitals and Clinics of Minnesota, Minneapolis, Minnesota; and Department of Pediatrics, Stanford School of Medicine, Stanford, California.

Address correspondence to Judith L. Zier, MD, Children’s Respiratory and Critical Care Specialists, 2545 Chicago Ave. S, Suite 517, Minneapolis, MN 55404. Address e-mail to judy.zier{at}childrensmn.org.

Abstract

BACKGROUND: Children undergoing urologic imaging studies requiring urethral catheterization experience considerable discomfort and psychological distress. Nitrous oxide sedation may mitigate these detriments but the requirement for physician administration has limited the applicability of this technique.

METHODS: Registered nurses underwent the nitrous oxide training requirements prescribed for state licensure of dentists and dental hygienists, with special emphasis on pediatric sedation principles. To evaluate the safety of nurse-administered nitrous oxide, we consecutively enrolled all children (ASA PS I–II) sedated for urethral catheterization for urologic imaging in an observational trial designed to identify sedation-related adverse events.

RESULTS: Nitrous oxide was administered on 1018 occasions. There were no major adverse events (apnea, oxygen saturation <92%). Minor adverse events (diaphoresis, nausea, vomiting) occurred in 4% of patients. Eight patients (1%) were described as over-sedated. In 11 (1%) patients, nitrous oxide provided insufficient sedation for completion of urologic imaging.

CONCLUSIONS: Nitrous oxide sedation can be provided by a nurse-administered program in pediatric radiology. Administration of nitrous oxide for pediatric procedures by adequately trained nursing staff with appropriate multidisciplinary oversight may increase children’s access to this sedative/analgesic drug.

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