Evidence-based Nursing Case for Selection of Appropriate Sedative Therapy in Pediatric Bone Marrow Biopsy

ABSTRACT

Purpose: This case study aimed to provide a optimal sedation guidelines for pediatric patients receiving Bone Marrow Biopsy and Aspiration. Methods: The PICO format was used to develop a clinical practice question. A systematic search was carried out in PubMed, EMBASE, CINAHL, Cochrane, RISS and practice guidelines of professional association. In total, 157 articles were screened, and eight articles were selected in this study. Four reviewers independently extracted data and assessed quality. Study findings were summarized and evaluated the quality of evidence using SIGN and GRADE. Results: The SIGN grade for Ketamine-Midazolam seda-tion was "A", which was applied to clinical practice from August 2020, and a comparative study was conducted. Ketamine-Midazol-am-Pethidine (KMP) sedations used from March to July 2020 and Ketamine-Midazolam (KM) sedations used from August to Decem-ber 2020. Both groups achieved successful sedation in all cases, therefore the need for additional sedative medication (KM=1.04 ver-sus KMP=1.01, p=.978) was similar. Pain frequency (KM=5.9% versus KMP=9.0%, p=.531) and lowest saturation level (KM=97.97 versus KMP=97.6, p=.173) were equivalent between the two group. Conclusion: Ketamine-Midazolam sedation can provide an ap-propriate level of sedation and reduce adverse events in children undergoing bone marrow aspiration and biopsy.