Bedside surgery with no sedation

  1. I witnessed a very sad incident yesterday. My elderly client was undergoing an EGD/ PEG tube placement, and received no sedation or pain management during the procedure. I was in a difficult situation (still a student). The nurse assisting the Gastroenterologist asked how much medication to give the patient, and he said casually "Don't worry about it." This patient was in the ICU because she had just experienced a stroke and was not able to communicate, so she wasn't a typical anxious surgical client - nevertheless her HR was in the 160s during the surgery and her BP went to 192/87. After the procedure her face was red and there were some tears from her eyes. This patient broke my heart - after the procedure my nurse preceptor and I brought her 2mg Versed and 4mg Morphine, which calmed her significantly.

    Why would a surgeon not allow sedation/pain management for such a procedure? How would you have handled this situation?
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  2. 33 Comments

  3. by   Marie_LPN, RN
    This is extremely sad, because i know that this is not the only incidence of this. I haven't seen it for myself (yet), but i've heard the rumors at work.

    I can't fathom why a surgeon would do that. I mean, if the pt. was their own child, it's pretty safe to say they would give meds immediately.

    If this situation were to happen, i'd report it even if it mean my license or my job. No one should ever have to be subjected to such treatment.:angryfire

    I'm glad that you and your nurse preceptor were there to give her some comfort.
  4. by   jnette
    :stone I'm shocked.

    Speechless.
  5. by   URO-RN
    My nephew had to undergo a procedure such as the one above w/out any anesthetic. I was not there. His mom was. He had suffered a severe head injury and had been airlifted from San Juan to Miami. This procedure took place there. I don't know all the details, just that the docs said he could not receive anymore anesthetic. :uhoh21:

    Beats the heck out of me...????
  6. by   SHAMROCKY
    I have been an ICU nurse for years and can't tell you the number of times I've witnessed this (mostly by the residents). I find myself being a pt advocate on a daily basis. I always say, "What kind of pain/sedation can I give before you start?" 9 times out of 10 they are incapable of starting any procedure w/out the nurse there holding their hand so they won't mind waiting for you to step out to get the drugs!
    I've also caught many of them starting to put in a central line or art line w/out using any Lidocaine.
    My hospital also has the lovely rule that anyone who intubates a pt. has to be "deep sedation certified". This is very frustrating especially for the night shift because more often than not the doc sent to tube the pt. isn't "certified" to push the drugs needed prior to intubating. I've seen a couple of pts. intubated with no sedation whatsoever! Makes me furious!!!
  7. by   URO-RN
    Quote from Jo Anne
    My nephew had to undergo a procedure such as the one above w/out any anesthetic. I was not there. His mom was. He had suffered a severe head injury and had been airlifted from San Juan to Miami. This procedure took place there. I don't know all the details, just that the docs said he could not receive anymore anesthetic. :uhoh21:

    Beats the heck out of me...????

    To any CRNA's:

    Maybe because of his severe head injury?.... Just curious.
  8. by   jewelcutt
    Unfortunately, residents and surgeons don't know the field of anesthesia, how to give it, what options are available. All they have is narcotics, sedatives for procedures where patient's aren't tubed, besides the fact that their concern is getting procedure done. I often wonder if it is just ignorance but I used to see a lot of docs giving inadequate sedation/pain medicine for procedures. This is where it gets tricky though, going beyond conscious sedation is deep sedation in whick a nurse is not allowed to manage, this is where the patient is at high risk for apnea, etc. and I don't think the docs want to cross that line. I personally believe procedures like this should either be done in the OR or with an anesthesia provider at the bedside where they can administer the appropriate medicine to make the patient comfortable. These procedures don't fall in the category of "emergencies" and don't necessitate anyone being cut open without pain medicine and sedation at the least. I'm very sorry that you witnessed this incident but it should motivate you to be a strong patient advocate. I know being new or inexperienced is difficult but you just have to learn to protect your patients and let the doc know that this is unexceptable.
  9. by   miloisstinky
    It ALL comes down to patient advocacy. I believe that to be our number 1 responsibility. I would get the incident documented, even anonymously. Atleast get a paper trail started, he/she will only do it again and again, unless someone atleast brings attention to it.
  10. by   curleysue
    That is very shocking! I am glad to hear that versed and morphine were given after the procedure but it would of been so much better if that could have been given before the procedure. What is the use after? Yah, I guess it calmed her down but I think that is so cruel.

    What is wrong with the medical professionals? I think they all need a dose of their own medicine. Don't you agree. Some sort of painful procedure they all must endure during med school or residency that would give them a new appreciation for what its like!

    I was in a situation like that. I was in a car accident with a collapsed lung. I was intubated and really aware of what was going on even though I was sort of in and out of it. I remember them having to put in a central line (this was before my port) and I remember the resident saying no to the lidocaine cause he thought "she is too croggy she won't remember or feel a thing" Excuse me? I felt everything and I too had my heart rate go up into the 160s plus the fact that I was thrashing a bit to try to let them know that yah, I am feeling this. It was awful. Course I was in and out of it so I don't remember all of it but I do remember him saying that and the nurse disagreeing saying "can't I give her something?"

    Oh well. I don't know what can be done to help out those residents and doctors who are so lax about sedation or pain meds. Its really really bad! Although the pain medication being the 5th vital sign is now starting to get some real recognition but still needs work in a lot of institutions!

    I pray for every patient that doesn't get treated right. Curleysue
  11. by   AmiK25
    I'm sorry but as a nurse, there is no way I would let me patient undergo a PEG placement without any analgesia/sedation! We have to be patient advocates!
  12. by   Kiwi
    The nurse had asked the doctor if the patient could have meds - should I have just given them?
  13. by   Pete495
    If you had something on your medication record, such as a little morphine at least, than yes, I would have given it. But that's just me. Others might disagree, but the prn pain medicine is there for a reason as far as I am concerned. I don't need to ask the doctor if I can give it if it is there for a reason. It's part of nursing duties.
  14. by   traumaRUs
    Unbelievable. I too have had docs try to start procedures w/o adequate sedation/analgesia. Never gonna happen when I'm around. Being a patient advocate is what its all about!

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