Cosmetic Surgery Death after RN (not CRNA) Administered Propofol - page 2

As usual, it took a patient death to effect change to a dangerous practice. This is why I, an operating room nurse, am so adament about getting the practice of RNs giving conscious sedation stopped,... Read More

  1. by   stevierae
    Quote from New CCU RN
    There is no post on this from newnurse2003....

    It is on the thread entitled, "Conscious Sedation By OR Nurses--Why Should We?" in this section---
  2. by   New CCU RN
    Aha, I see.. I skimmed through some of that post, however, it became so long that I may have missed it.

    I was wondering if you had any tangible evidence that RN's administering conscious sedation (without a protected airway) results in a negative outcome for the patient. My reasoning is that I would like to mention this topic to my manager, however, I obviously need some evidence.... do you know if studies of this have been done?
  3. by   UCDSICURN
    Conscious sedation has a very specific definition. The patient must be able to maintain their own airway and be arousable. If they cannot maintain a patent airway on their own or they cannot be aroused then you have gone beyond conscious sedation.

    For intubated patients I've used propfol and ketamine and the usual benzo's and narc's. Pretty straight forward. If they aren't on a rate you may need to put them on one and if they're on the dry side you may need a quick bolus handy to ward of hypotension. For an intubated patient you can even head to deeper sedation as long as their pressure can support it. We use ketamine for large/deep dressing changes. They are certainly not responsive after the initial bolus dose.

    For non-intubated patients I've only ever used narc's and benzo's. Most commonly Fentanyl and Versed. I've never had a negative outcome during conscious sedation. Small doses and check the sedation level. Yes I've had sats drop a bit and pressures drift down but nothing supplemental oxygen and a bolus couldn't handle.

    I'm not sure why you feel the need to mention this to your manager. I hope where you're working there is training involved in administering conscious sedation. It's done all the time and with great success. There is and always will be those RN's that do things they shouldn't and do things without knowing, without asking and consequently injure patients. We had a nurse that administered a paralytic on a non-intubated patient so they could stay still for a CT scan. Well, it worked. Needless to say, he was not representative of the standard that is expected of us and rumor has it the state quickly ran his license to the closest shredder.

    Don't be too quick to jump and paint us all with a brush just because of a few incompetent people.

    Donn C.
  4. by   New CCU RN
    Quote from UCDSICURN
    Conscious sedation has a very specific definition. The patient must be able to maintain their own airway and be arousable. If they cannot maintain a patent airway on their own or they cannot be aroused then you have gone beyond conscious sedation.

    For intubated patients I've used propfol and ketamine and the usual benzo's and narc's. Pretty straight forward. If they aren't on a rate you may need to put them on one and if they're on the dry side you may need a quick bolus handy to ward of hypotension. For an intubated patient you can even head to deeper sedation as long as their pressure can support it. We use ketamine for large/deep dressing changes. They are certainly not responsive after the initial bolus dose.

    For non-intubated patients I've only ever used narc's and benzo's. Most commonly Fentanyl and Versed. I've never had a negative outcome during conscious sedation. Small doses and check the sedation level. Yes I've had sats drop a bit and pressures drift down but nothing supplemental oxygen and a bolus couldn't handle.

    I'm not sure why you feel the need to mention this to your manager. I hope where you're working there is training involved in administering conscious sedation. It's done all the time and with great success. There is and always will be those RN's that do things they shouldn't and do things without knowing, without asking and consequently injure patients. We had a nurse that administered a paralytic on a non-intubated patient so they could stay still for a CT scan. Well, it worked. Needless to say, he was not representative of the standard that is expected of us and rumor has it the state quickly ran his license to the closest shredder.

    Don't be too quick to jump and paint us all with a brush just because of a few incompetent people.

    Donn C.

    My concern is that I am seeing propofol used more and more frequently for conscious sedation on a nonprotected airway....
  5. by   gaspassah
    are you from baton rouge? that sounds an awful lot like a situation that happened at a hospital i used to work at.

    Quote from UCDSICURN
    Conscious sedation has a very specific definition. The patient must be able to maintain their own airway and be arousable. If they cannot maintain a patent airway on their own or they cannot be aroused then you have gone beyond conscious sedation.

    For intubated patients I've used propfol and ketamine and the usual benzo's and narc's. Pretty straight forward. If they aren't on a rate you may need to put them on one and if they're on the dry side you may need a quick bolus handy to ward of hypotension. For an intubated patient you can even head to deeper sedation as long as their pressure can support it. We use ketamine for large/deep dressing changes. They are certainly not responsive after the initial bolus dose.

    For non-intubated patients I've only ever used narc's and benzo's. Most commonly Fentanyl and Versed. I've never had a negative outcome during conscious sedation. Small doses and check the sedation level. Yes I've had sats drop a bit and pressures drift down but nothing supplemental oxygen and a bolus couldn't handle.

    I'm not sure why you feel the need to mention this to your manager. I hope where you're working there is training involved in administering conscious sedation. It's done all the time and with great success. There is and always will be those RN's that do things they shouldn't and do things without knowing, without asking and consequently injure patients. We had a nurse that administered a paralytic on a non-intubated patient so they could stay still for a CT scan. Well, it worked. Needless to say, he was not representative of the standard that is expected of us and rumor has it the state quickly ran his license to the closest shredder.

    Don't be too quick to jump and paint us all with a brush just because of a few incompetent people.

    Donn C.
  6. by   deepz
  7. by   NurseasPatient
    Quote from New CCU RN
    Aha, I see.. I skimmed through some of that post, however, it became so long that I may have missed it.

    I was wondering if you had any tangible evidence that RN's administering conscious sedation (without a protected airway) results in a negative outcome for the patient. My reasoning is that I would like to mention this topic to my manager, however, I obviously need some evidence.... do you know if studies of this have been done?
    I am proof that a person should not receive Propofol without an airway- from anyone! Woke being told "you stopped breathing" in MRI. Scared the crap outta me & my husband whom the Nurse went to waiting room & told "your wife stoped breathing." Hubby told me later that "the whole bunch looked pretty freaked out!" I remembered they were acting strange but was still pretty fuzzy from the whole deal. He did not tell me right at first as he said "you looked scared enough" I wrote here & asked questions about Propofol, rec'd many replies- thank you all! After doing some reading I find that a person died having cosmetic surgery under this med?! I was told an anesthesiologist was present & was actually introduced to him. Regardless of who was there- it is terrifying to me that I was in that tube without being intubated & wonder how long it took them to figure out I was not breathing! Those people told me they do about 10 patients per day with this drug the same way. Thank God the outcome was not as bad as it could of been. Some have asked "Why does a person getting an MRI need sedation?" Try 2 vascular surgeries & 40+ Dr's visits in one year, not to mention numerous CTs, MRIs - you name it. I have got to the point that I cry simply at the mention of a MRI- never had any prob. with any kind of test before now. Valium wore off in the MRI previous to this one & I really lost it in the tube. I understand lots of folks have a prob. with MRIs. I think my issue is more hard to lay there so long with those infernal non-stop shooting sounds coming at my head while I am attached to this contraption by my head. Obviously they are going to have to find an alternative to this last crash test dummy trick for future MRIs that I am sure to have... Thank you all for your insight into this very scary med which is probably a good med when used in the right setting under the right conditions.
  8. by   Pete495
    Just so you know, they do have OPEN MRI now, which will eliminate most of your anxieties. Not all facilities are up to date with the equipment however, so the sites are often spread out. In your case, I would travel the extra distance I had to get to one, that is if your insurance will pay for it.
  9. by   TinyNurse
    I know that some states use diprovan routinely for conscious sedation admin by the RN , others it must be admin by the MD. This is a very interesting post.
  10. by   sjt9721
    Quote from UCDSICURN
    Conscious sedation has a very specific definition. The patient must be able to maintain their own airway and be arousable. If they cannot maintain a patent airway on their own or they cannot be aroused then you have gone beyond conscious sedation. (edited by sjt9721)
    Donn C.
    I agree. Propofol, even in procedural doses, is NOT considered conscious sedation. If propofol is being used, the patient is 'deeper' and does not meet the definition of conscious sedation.

    Conscious sedation agents such as narcotics and benzodiazipines have reversal agents that are readily available during procedures. And properly trained RNs can assess for and administer these medications. Sedation using propofol does not meet the definition of "conscious" and should be left up to those with anesthetic administration credentials.
  11. by   suzanne4
    The post that you are responding to today is two years old.

    Please look at the dates that a thread was posted if pulling it up from the archives.

    Thanks in advance.......................:angel2:
  12. by   NurseasPatient
    First let me say thanks for the info. I am aware that OPEN MRIs are available in some areas. I had traveled 12 hours from my home to see this specialist & to have the tests he ordered in the facility it was ordered in.
    I would imagine if they had an open MRI they would of offered it as I'm sure (very sure now) that it is certainly a safer alternative to anesthesia.
    The oncologist suggested sedation- due to my anxiety over both being diagnosed with malignant cancer (that has killed nearly ever ancestor of one side of my family) & the many tests & tortuous procedures I have endured this year. I as an LPN (not claiming any great knowledge of medicine) am aware of the dangers of anesthesia but sure did not think that anyone who is supposed to know alot more about it than me would be so RETARDED as to give me a med that would cause me to stop breathing while in a tube not intubated. I guess in the future I will ask more questions before letting them use just anything. One of my greatest lessons this year? If you don't know a little bit about medicine you are pretty much screwed & sometimes even if you do you still are. I don't mean to come off as sarcastic - honestly I don't- but sometimes things are not as simple as "have an open MRI" I felt safe in having it there under anesthesia & it was necessary that it be done there so the Dr. could quickly review the results with the me.
    My insurance pays for MRI wherever I chose to have one. Thankfully it is excellent insurance & in the future before having an MRI I will be sure to discuss all avenues of anesthesia/sedation/open MRI etc so this never happens again. I've certainly got enough trying to kill me without anesthesia helping.
    Thanks again.
  13. by   SigmaSRNA
    Quote from New CCU RN
    NOOOOO Way.... not all ICU patients are trached or intubated........ we often do procedures requiring conscious sedation on non-intubated patients... cardioversions, TEE's, scopes, etc.
    I think he meant the patients in the ICU on propofol infusions.

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