Need your professional opinions!

  1. One of our GP's has started ordering Ketamine for minor procedures on children in the ER (laceration suturing), and this seems to me to be a workplace safety issue (floor nurses not up to speed on anesthesia meds and proper monitoring, side effects, half-life, etc., not to mention the staffing issue that we have with the extended monitoring needed) putting their licenses at risk, as well as the patient safety risk due to the above nursing limitations.
    This just seems too risky...am I being too much of a worrier? (Our CRNA HATES this, and will not even speak to us about it.)
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  2. 13 Comments

  3. by   yoga crna
    Read the package insert on Ketaimine. It is categorized as an "anesthetic". Unless you are a CRNA, have education and certification in anesthesia, you should not be administering it. Patients have been known to aspirate and die under ketamine. Also, it has many side effects such as increasing secretions, icreasing intracranial pressure and is a powerful hallucinogenic.

    GPs should not be ordering or administering it unless they have anesthesia privileges.

    Tell your supervisor and ask risk management people to get a written document from the hospital's malpractice carrier that they will cover all claims related to non-anesthetist RN employees administering anesthesia. Even if they would give you such a document, I still wouldn't do it.
    YogaCRNA
  4. by   PediERRN
    Ketamine given for suturing and other minor procedures is actually not considered anesthetic doses - only sedation. We use it very heavily in our ED and it works great! We only give small doses and the recovery time is quick. The package insert should include dosaging for anesthesia and sedation now.
  5. by   CRNA, DNSc
    Bottom line is that what you are doing would fall under Moderate/Deep Sedation and you should be credentialed to give such sedation. JCAHO will nail your hide to the wall with out credentials.!!!!
  6. by   yoga crna
    I agree with with CRNA, DNSc and suggest you look at the ASA Standards for Sedation. They clearly state that sedation is a continuum and that the person administering the sedation MUST be able to handle a patient in a deeper level, which amounts to general anesthesia, if you are doing deep sedation.

    Those of you non CRNAs who are giving sedation need to understand the very fine line between conscious and unconscious sedation. I do sedation frequently in my practice and I know how even a very small dose of a sedative drug can cause loss of airway control in some patients. This is serious business. I have seen nurses fret about "putting their license on the line" for inane things, but don't hesitate to perform functions outside the scope of their education and experience. I know I am on a soapbox here, but honestly how many of you students really understood the physiology of pulse oximetry before you went to anesthesia school and could correlate the readings to the oxygen hemoglobin dissociation curve?

    Getting off my soapbox for now.
    YogaCRNA
  7. by   zudy
    yoga crna, you can jump on your soapbox any time around me. Having worked in ED for over 18 yrs I have had too experience with drs not wanting to bother to take a pt to OR, and wanting the ED nurses to over sedate, then recover pts in ED. I have had drs complain because I refused to do conscious sedation without RT there to manage the airway. Our pts deserve to be safe.
  8. by   New CCU RN
    Originally posted by yoga crna
    I agree with with CRNA, DNSc and suggest you look at the ASA Standards for Sedation. They clearly state that sedation is a continuum and that the person administering the sedation MUST be able to handle a patient in a deeper level, which amounts to general anesthesia, if you are doing deep sedation.

    Those of you non CRNAs who are giving sedation need to understand the very fine line between conscious and unconscious sedation. I do sedation frequently in my practice and I know how even a very small dose of a sedative drug can cause loss of airway control in some patients. This is serious business. I have seen nurses fret about "putting their license on the line" for inane things, but don't hesitate to perform functions outside the scope of their education and experience. I know I am on a soapbox here, but honestly how many of you students really understood the physiology of pulse oximetry before you went to anesthesia school and could correlate the readings to the oxygen hemoglobin dissociation curve?

    Getting off my soapbox for now.
    YogaCRNA

    Yoga,

    I totally agree with you as far as RN's administering anesthetic agents. We put patients under conscious sedation quite often in my ICU and if the doc wants to use a questionable drug, I ask them to push it and make them stay on the unit until I feel comfortable the patient is fully recovered. So you are absolutely correct in that point....there is a fine line if the patient isn't tubed, I am quite weary. The majority of the nurses I work with are the same way. However, I'd ask you to give RN's a little credit here, pulse oximetry and the oxygen hemoglobin dissociation curve??? I personally as an RN (not even SRNA yet) fully understand it.
  9. by   PediERRN
    I absolutely agree - I like the newer term procedural sedation. Conscious sedation I have always considered to be a misnomer. If you want them conscious, why are you sedating them???
  10. by   gwenith
    AHHHH..... Here in Australia we don't HAVE CRNA's SRNA's ETC. We just go for it....... It is considered part base nursing knowledge to be able to care for a patient under light sedation.

    Can't see the hu hu myself.
  11. by   London88
    Gwenith,

    There is a major hu hu with light sedation which can quickly become deep sedation. Without going into the specifics a not too bright nurse in my unit was not able to tell when a patient who was over sedated was loosing his airway. The patient respiratory arrested, extended his MI owing to decreased O2, and now appears to have anoxic encephalopathy. I am not saying that RNs are not qualified to handle light sedation, however when experience is lacking this is the end results!
  12. by   KSCRNA
    What state do you live in?

    Some states allow a physician to delegate any portion of their responsibility to another whom they deem properly educated to handle the responsibility. Unfortunately they do not define educated. When a nurse or janitor for that matter takes on these responsibilities they no longer are working under their licensure, but are under the physicians license. Therefore, a state board of nursing can not take any action against the individual if there is a bad event. However, the nurse needs to know there there can still be civil penalties, i.e. law suits.

    When using anesthetic drugs, know your pharmacology, physiology and AIRWAY management.
  13. by   gwenith
    As I said - it is considered part of our base knowledge, BUT we are expected to notify the senior nurse on for that shift in that ward and if staffing is not adequate to keep a close watch on the patient tehn it is up to the nurse manager to ensure that we have enough. Light sedation would not be carried out in ward except under special circumstances in any event. BUT as I said we do not have the CRNA ans SRNA here so we HAVE to cover . A basic difference if care - we seem to have a broader area of responsibility and job description than elsewhare. Mind yo I am not saying htat is is good - it just is how things are over here.
  14. by   no-pain
    We also need to remember that each individual medical center has policy and procedures in which they follow. Some may not have the autonomy others do and visa-versa.

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