Imaging Service Sedation for Ultrasound Examinations/ Ultrasound Scheduling

Purpose/ Applicability:  The purpose of this SOP is to describe the process of how sedation will be ordered and administered on patients that are obtaining an ultrasound exam from the imaging service and how the ultrasound schedule in SANDI should be utilized.

Scope: This SOP shall be applied to small animal patients that are having an ultrasound exam by the imaging staff or radiologist using an ultrasound in imaging.

Definition(s):

RIS order requisition- order that is placed in SANDI for the ultrasound examination

Equipment:

• LAC Cubex- located near imaging in the LAC
• SANDI Scheduler

Procedure:

1. The ultrasound schedule will be available for everyone to view in the SANDI scheduler under the service titled “Imaging Schedule”. If you format the scheduler by group by “Type”, you will find the ultrasound schedule at the left hand of the column for each date.
2. Ordering services must have client’s permission for the ultrasound prior to placing the patient on the schedule.
3. The ordering service will need to schedule the patient for an ultrasound using the ultrasound schedule in SANDI.  The patient must be in-house to be placed on the schedule.  The exception to this is the 0930 and 1000 time slots.  Those may be scheduled prior to the patient arriving at the VTH.
4. Patients must be shaved for their exam when they arrive for their ultrasound appointment.
5. Any patient that arrives 10 minutes or more late for their appointment time will have to reschedule.
6. The service that is ordering an ultrasound examination for a small animal patient will place the sedation protocol into the RIS order requisition when they are entering the order for the exam in SANDI.
   1. Someone from the ordering service will bring the patient down for their scheduled appointment time.
   2. If the ordering service believes that the patient will need sedation, then they should sedate the patient prior to the scheduled ultrasound appointment time.
   3. If the ordering service believes that the patient will not need sedation to obtain a quality ultrasound, the imaging tech will start the exam without sedation.
      1. If the patient becomes uncooperative, or too tense for the imaging tech to obtain quality diagnostic images, sedation will need to be given.
      2. To keep the ultrasound schedule on time, medications will have to be obtained from the LAC Cubex.  If it takes too long to obtain the medications, or if the sedation does not work to relax the patient and the appointment timeslot is over, the imaging tech has to right to send the patient back to the ordering service.  The patient will have to be rescheduled for another ultrasound appointment and should have sedation administered when it arrives to imaging for its rescheduled appointment.  The LAC Cubex does not have Methadone.  If Alfaxalone is the prescribed sedation, someone from the ordering service will have to obtain the medication, administer it, and stay with the patient until the exam is completed.
         1. If a technician, intern, resident, or faculty member, from the ordering service, has accompanied the patient to their ultrasound appointment, they will go obtain the sedation from the LAC Cubex.
         2. If only a student from the ordering service has accompanied the patient to their ultrasound appointment, and an imaging student that has received Cubex training is present for the exam the imaging student will go obtain the sedation medication listed on the imaging requisition from the  LAC Cubex. The imaging tech will review what the student has drawn up, prior to it being administered to the patient.
         3. If an imaging student is not present for the ultrasound, the imaging tech will obtain the sedation medication listed on the imaging requisition from the LAC Cubex.

7. The sedation medication will be administered and documented as needed, based on the type of medication that was prescribed.
8. After the patient has reached a comfortable level of sedation, the ultrasound examination and, if needed, aspirates will be completed.
9. Any documentation for the sedation medication will be returned with the patient to their service.