Stepwise sedation is safe and effective for the insertion of central venous catheters.

BACKGROUND The introduction of a central venous catheter in haemodialysis patients is an unpleasant procedure for the patient. Intravenous sedation is accepted practice in complicated endoscopic procedures but not often used in haemodialysis patients. METHODS We developed a protocol for the use of stepwise sedation in these patients with the use of midazolam and fentanyl. RESULTS Stepwise sedation with midazolam and fentanyl was used in 155 procedures. No or minor movements were observed in 94% of 154 procedures. 88% of the 155 procedures were graded as very easy or easy. No or only very slight recall of the procedure were noted in 86% of 133 procedures. Only in 7% of 132 procedures were the patients able to recollect most of the procedure. No, or only a small amount of pain was recollected in 93% of 131 procedures. The most important complication was a slight decrease in oxygen saturation in 23 procedures. In the second part of the study we compared the effects of sedation with midazolam alone versus the combination of midazolam and fentanyl for the introduction of Tesio catheters. Amnesia, ease of procedure and the recollection of pain were equivalent. Oxygen desaturation occurred significantly less often with the use of midazolam alone. CONCLUSION We conclude that stepwise sedation is effective and safe in haemodialysis patients and leads to a complete amnesia for the procedure.