What's New at Children's

‘I had a dream – a good dream!’

Children’s of Minnesota introduces an innovative way to help children relax during uncomfortable tests and procedures. It’s nitrous oxide, a crossover from the dentist office.

By Sally Thompson

Several years ago, Children’s physician Judy Zier, MD, waited in her dentist’s office for a routine teeth cleaning to start. She noticed a framed certificate for the dental hygenist’s credentials to administer the gas nitrous oxide.

Nitrous oxide is commonly used in dental offices to help patients through uncomfortable procedures. It’s a sedative that is safe, quick-acting, and mild.

“I thought, if a dental hygienist can give nitrous oxide to patients, why can’t I?” says Zier, a specialist in caring for children in the pediatric intensive care unit at Children’s Hospitals and Clinics of Minnesota. “I knew we could use it for our patients at Children’s.”

Zier pushed ahead with her goal of introducing nitrous oxide at Children’s. She attended a two-day dental course on nitrous oxide at Tufts University in Boston. When Zier brought her knowledge back to Children’s, she discovered an ally.

Mary Kay Farrell, RN, had long believed that nitrous oxide could help children in Children’s radiology department, where she works. She believed it could ease the discomfort of some uncomfortable procedures. “The philosophy for adults of ‘Just buck up and do it’ doesn’t work with children,” Farrell says.


Judy Zier, MD, left, and Mary Kay Farrell, RN.

Nurses help each child feel comfortable with the nitrous oxide mask before the procedure begins.

Together, Zier and Farrell started to tackle the many steps to bring this innovation to Children’s. This included creating training for staff and safety standards, getting equipment, and securing approval from the Minnesota Board of Nursing. Working with them were Denise Rucker, RN, of the radiology department, and Gloria Drake, RN, a Children’s nurse anesthetist who is clinical services director of surgical services and perioperative care.

The group introduced nitrous oxide at Children’s in 2004. This innovation makes Children’s the only nurse-administered nitrous oxide program in the United States.

Nitrous oxide is now used for some procedures at Children’s St. Paul and Minneapolis hospitals and at Children’s West in Minnetonka. Many children receive it when they undergo a radiological test of the urinary system. For this test, a catheter is inserted into the child’s bladder, the bladder is filled, and the child urinates into pads on the X-ray table while images are taken. Other children receive nitrous oxide when they need a needle inserted for an intravenous line or for nuclear medicine procedures involving a catheter and fluids.

Rave reviews from children, families

Reactions from children and families are overwhelmingly positive. After a test ends, children often tell their nurses, “I had a dream—a good dream!” Nitrous oxide not only calmed them, it often erased any memories about the procedure.

For about 10 years Mary Stemper has brought her two daughters to the Children’s – St. Paul radiology department for a bladder procedure. Rachel, now 13, needed the test several times before nitrous oxide was available. Luckily for Lauren, 5, she’s had nitrous oxide for two tests.

“There is absolutely no comparison,” says Mary Stemper. “Having nitrous oxide has made a night and day difference. It makes the whole procedure go more easily. You want that for your child, especially when they have to come back for the test year after year.”

Tests without nitrous oxide were very difficult for Rachel, and she was upset throughout them. “The nurses at Children’s jumped through hoops to work with her, and I know it made their job harder,” Stemper recalls.

In contrast, Lauren sailed through her test earlier this year. “She did have a few tears after the nitrous wore off, but they were tears of relief,” Stemper says. “As a parent, it’s very difficult to put my children through something that is painful or uncomfortable. Nitrous oxide relaxes the situation for everyone involved.”

Katie Estes-Collins echoes the praise for nitrous oxide. Her son, DeShawn, 4, receives treatment for cancer at Children’s. Because his condition is followed carefully, he undergoes a CT scan every three months.

To start the sedative medication so DeShawn will sleep through the scan, an intravenous line—with a needle—must be placed in his arm. This involves “a poke,” as he and his mother call it. DeShawn has experienced this with and without nitrous oxide.

“We can tell him, ‘No one likes a poke.’ But Shawn is 4 years old,” says Estes-Collins. During DeShawn’s latest test, his nurse had him take four deep breaths of nitrous oxide. “Oh, that’s better,” he said. Then, the nurse easily inserted the needle into his arm. When DeShawn awoke, his first words to his mother were, “Mom, I did it on the first try!”

Before nitrous oxide was available, DeShawn was tense and uncomfortable, and a second team of nurses was needed to start the IV. “That just created so much anxiety,” Estes-Collins says. “Nitrous oxide saves us. Now, our anxiety can be focused on the test results and his health, not the test itself.”

Creating positive experiences, from the first time on

Zier and Farrell, the pioneers of nitrous oxide at Children’s, find it extremely rewarding that they’re helping so many children and families. They credit a collaborative team approach, with nurses and physicians working together, in making the program so successful.

Zier says it’s important that each child’s experience with a medical procedure be positive from the first time forward. “We want to make it the least distressing experience possible,” she says. “Some of these children will need to come back and have the procedure every year.”

Beyond her work in nursing, Farrell draws on her own experiences as a survivor of breast cancer. She’s gone through some long, uncomfortable medical procedures without the benefit of sedation or distraction. That strengthened her resolve to improve matters for her young patients at Children’s.

“Ethically, using nitrous oxide is the right thing to do,” Farrell says. “If sedation does no harm and the pain does no good, then don’t make people suffer.”

Children’s Hospitals and Clinics of Minnesota
Children’s Magazine November 2006