tumescent anesthesia tumescent anesthesia | allnurses

tumescent anesthesia

  1. 1 Was wondering if a RN with no certification in anesthesia, can administer tumescent anesthesia for lipo if trained by the physician. I am unsure if this is within the scope of practice of a RN in NJ and unable to find any info on the BON website. Any info is appreciated
  2. 17 Comments

  3. Visit  GHGoonette profile page
    0
    I admit, I had never heard of this technique until I read your question. It's been a long time since we had a plastic surgeon at our hospital lol.

    After looking it up, I would have said that the dosages involved might make the procedure a bit risky, although on the whole, the text articles deny this. Like you, I saw nothing regarding the qualifications required to perform it.

    FORTUNATELY I remembered a thread regarding sedation which ran some time ago, and I looked it up. Here's a link which might answer your question:

    http://www.aana.com/Resources.aspx?id=24804

    The article contains a section dealing specifically with RNs administering sedation and analgesia.
  4. Visit  NRSKarenRN profile page
    0
  5. Visit  foraneman profile page
    2
    Quote from sleepy1010
    Was wondering if a RN with no certification in anesthesia, can administer tumescent anesthesia for lipo if trained by the physician. I am unsure if this is within the scope of practice of a RN in NJ and unable to find any info on the BON website. Any info is appreciated
    CRNAs and Anesthesiologists do not administer tumescent anesthesia generally. It essentially is local anesthesia but in a diluted volumes and usually over a wise ares of tissue. The large volume and potential for vascular injection makes local anesthesia toxicity a concern. Of equal concern is perforation of structures with the bowel being the most common. WHY an RN would want to administer it i don't know, but this is probably a question the board of nursing has not specifically considered, since it likely has never been asked (not many surgeons would want a third party to do this for them), and you may have to contact them for a formal opinion.
    jitomim and Maevish like this.
  6. Visit  wtbcrna profile page
    2
    Quote from sleepy1010
    Was wondering if a RN with no certification in anesthesia, can administer tumescent anesthesia for lipo if trained by the physician. I am unsure if this is within the scope of practice of a RN in NJ and unable to find any info on the BON website. Any info is appreciated
    I am wondering if the RN position entails just providing moderate/IV sedation for tumescent anesthesia. That would be more in line with normal RN duties.
    Maevish and BigPappaCRNA like this.
  7. Visit  sleepy1010 profile page
    0
    Thank you all very much for your responses...i think my best bet wil be to email the board.... to foraneman and wbtcrna...i beleive that I would be required to actually mix the lido and epi, and inject it into the pt before laser liposuction...
  8. Visit  foraneman profile page
    2
    Quote from sleepy1010
    Thank you all very much for your responses...i think my best bet wil be to email the board.... to foraneman and wbtcrna...i beleive that I would be required to actually mix the lido and epi, and inject it into the pt before laser liposuction...
    As a CRNA, I would REFUSE TO do it if that gives you some idea how I view the added liability so that the surgeon can be lazy. mixing it is fine...injecting..no way. You WILL eventually perforate a bowel. many surgeons have.
    Maevish and subee like this.
  9. Visit  manuelporras profile page
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    This seems to be an old and resolved thread ... anyway this is what i found

    Tumescent Lipo
  10. Visit  liponurse profile page
    1
    I am an RN practicing in California and have been injecting, or "infiltrating" tumescent local anesthetic (aka very dilute, large volume, local anesthetic) for almost 25 years. In California, nurses may perform standardized procedures with adequate training, on going evaluation, supervision, and a physician's order. Scope of Practice varies state by state.

    Since the time I began infiltrating local anesthetic at the office based surgery center where I work, we have employed and trained about 15 nurses to perform this task. Best guess estimate is that we have infiltrated well over 10,000 patients, with not one (repeat not one) complication. We were each trained slowly and carefully, and closely observed and supervised until completely competent. I personally have been infiltrating since before most anesthesiologist had even heard of it. Over the last 20 years, I have also assisting in training over 800 physicians and nurses from all over the world.

    This is a procedure that requires training and skill, but with adequate training, a careful and cautious disposition, and proper instrumentation, it is not difficult to refrain from puncturing bowels or lungs! The anesthetic is infused in the subcutaneous fat, above the muscle. It is very tactile. I can most certainly feel the difference between fat and muscle, and the awake patient immediately will inform you if you even touch their muscle. That is part of what makes tumescent liposuction so much safer than liposuction under general anesthesia, where one may not realize the bowel has been punctured until the patient becomes ill. Tumescent local anesthetic is slowly and gently infused into an awake patient who can constantly provide feedback regarding their level of comfort.

    Please know that I would not recommend that any individual, regardless of license, inject tumescent local anesthetic without adequate training, not just on injection technique, but also on dosaging, medication interactions and medication error prevention.

    Please see tumescent.org for further info.
    Last edit by liponurse on May 7 : Reason: typo
    GHGoonette likes this.
  11. Visit  liponurse profile page
    0
    Additional and extensive info on infiltration can be found at the following link, although use of spinal needles are now minimized in favor of the use of multi-lumened blunt tipped 16g or 16g infiltration (Monty) cannulas.

    Chapter 26: Tumescent Infiltration Technique - Liposuction 11 Liposuction Training
  12. Visit  jwk profile page
    1
    Sorry liponurse - the translation for your post is "lazy surgeon, more interested in money than patient safety". It doesn't matter how rare complications are in your hands. It only takes one and your career is gone. All that's being done here is maximizing the number of patients and $$$ for the surgeon. I'm sure you probably do a fine job - but why on earth would you take that risk?
    Maevish likes this.
  13. Visit  offlabel profile page
    1
    Quote from jwk
    Sorry liponurse - the translation for your post is "lazy surgeon, more interested in money than patient safety". It doesn't matter how rare complications are in your hands. It only takes one and your career is gone. All that's being done here is maximizing the number of patients and $$$ for the surgeon. I'm sure you probably do a fine job - but why on earth would you take that risk?
    Really? ICU nurses have way more to go wrong than this...don't know if you've ever seen this, but it's a very blunt trochar at zero to 10 degrees ( or thereabouts) to the abdominal fascia. Anyone is one "mistake" from trouble...what exactly is the point? Has the BON checked with JWK about this? They're the governing body here and odds are if there is a problem, it lies with them. I'm betting there isn't.

    Are you aware of something the rest of us are not?
    liponurse likes this.
  14. Visit  liponurse profile page
    1
    I am well trained, very proficient and practicing within the scope of my license. I am covered by malpractice insurance. Using jwk's rationale, why would a nurse ever do anything where a mistake could happen if it would be career ending? One could say that physicians should do every nursing procedure! Obviously, any nurse who injects tumescent local anesthetic needs to first be sure she/he is practicing within the scope of her/his license (as every state is different) and receive thorough training. That is what any good nurse does, regardless of the procedure.

    The surgeon I work for is far from lazy but there are many surgeons out there that do not have the patience to inject tumescent local anesthetic, yet tumescent liposuction is the gold standard due to its low complication rate. Sure - it can be done badly - that is why physicians and nurses have an ethical duty to be trained and knowledgeable before "practicing" on patients.

    If nurses can assist surgeons so that true tumescent anesthesia is utilized even more than it already is, then patients will benefit. True tumescent anesthesia is done slowly (30 minutes to 2 hours, depending upon number of areas and patient sensitivity) and gently on awake healthy patients. There is no need for IV sedation in most cases. The risk of deep vein thrombosis, pulmonary embolism, pulmonary edema and respiratory depression is negligible. Translates to increased patient safety.

    I've done thousands of cases. I doubt anyone does it better, or has more knowledge - yet I am "only" a nurse. I do my best to share that knowledge when training surgeons and nurses. I have queried several of the nurses I have trained over the years, and they have done thousands of cases of their own, and state there have been no complications. I enjoy creating a comfortable positive and SAFE experience for patients and helping others to do the same. That is why I do it.
    Last edit by liponurse on May 15 : Reason: Typo
    Maevish likes this.

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