Conscious Sedation Cath Lab

Specialties Critical

Published

Hello all

It seems that regulations differ HUGELY from state to state when it comes to RNs administering conscious (moderate) sedation, which includes analgesia. I have read a few older posts on this subject on this website: can any seasoned RNs out there give me some current feedback about current practice please? In settings such as radiology and cath lab, what are nurses administering and what is beyond the limit of the RN scope of practice? At what point does the anasthesia provider need to be present (by that, I guess I mean who out there is administering propofol?) And...why the hell is it so fragmented and non standardized? It makes me a bit nervous! One state says it's fine - the next state says it's illegal...How are we to know which drugs we are legally permitted to give as RNs when there are literally thousands of them out there? Obviously we come across the 'commonly used' drugs depending on where we work, so we feel confident about what we can and can't do. But, it's not always that clear cut, is it. Sometimes the situation is unusual or our practice is callenged. RNs out there who are NOT CRNAs, please let me know what y'all are up to when it comes to CS. I will be working in a Cath Lab soon and am interested to know what everyone is doing. Thanks!

Fascinating! Lmbasurto, do you work in endoscopy? Those who give propofol - do you have moderate/conscious sedation certification? Are you trained to insert LMAs if the patient stops breathing spontaneously? Do you receive a higher salary due to your advanced skills or is this not considered to be 'advanced'? I don't know how on earth travel nurses keep abreast of all these different state laws. Interesting how one state can deem an activity as illegal and another state think it is fine. Lots of overlap with medicine. Sign of the times I guess. I think our job/role needs redefining. We, and our jobs, are clearly not the same as nurses were 50 years ago, we obviously live in a very different world nowadays with advances & technology etc. But legislation and public opinion hasn't kept up with what we actually do in practice. Too many discreapncies IMHO. When I'm in charge it will all be different lol!

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

LOLOLOL...higher salary....:roflmao:....no. You will not be paid more for additional skills. Travel nurses pay close attention to hospital policy and procedure and look up each states nurse practice acts. There is no need to know how to insert a LMA although some facilities may have that as a part of their policies. There is always the MD at the bedside....respiratory in house...or hospitalists or anesthesia in house who would be the designated person to intubate.

Our roles here in the US are ever changing and I think the professional and policies have kept up rather well. The US doesn't have one nursing governing body hence they all make their own rules. Many of these anti-propofol rules came out after...believe it or not...Micheal Jackson's death. As I said before there is a certification that can be taken for about $200.00 US but it is NOT recognized nationally. Each facility you work will have their own policy and competency class that will grant you approval/competency within that facility. YOU will have to become ACLS certified...which is something the hospital will provide.

Are you coming here on a travel assignment?

It will make more sense to you when you get here

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Specializes in Emergency, Telemetry, Transplant.

Now my only exposure to moderate sedation is in the ER. Our hospital policy (which conforms to the state nurse practice act) is that the ER attending must be present when the sedation drugs are given. I always chart "propofol xx mg given IVP under direct supervision of Dr. R. Smith." Each doc has the own sedation "cocktail" (propofol, etomidate, ketamine and fentanyl can be added to the mix, so to speak), but generally the nurse pushes the med, but the attending must be there.

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I work in ICU. We do bronchs on the unit because our docs are critical care/pulmonary.we are a closed unit so our team of docs don't leave the unit unless a code is called. We are also the code team. Depending on the rate I'll hang two or three bottles (100ml) in a shift. Our GI lab does waste down we do waste up so to speak. EGDs get done on the unit with the GI doc at bedside. The patients that are on propofol drips are already intubated. We titrate to goal. We do have to have ACLS. And training for titration. It is crazy how each state and hospital are different. When we get travelers some don't fill comfortable titrating propofol because where they worked before they couldn't titrate without a doc in the room.whereas we don't have to have doc at bedside to go up 5mcg or down 5mcg.

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Specializes in critical care.

Push dose or drips? We hang and titrate propofol on our intubated patients in ICU, but only a physician or anesthetist can give it IVP.

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Push dose or drips? We hang and titrate propofol on our intubated patients in ICU but only a physician or anesthetist can give it IVP.[/quote']

Drips. We don't push propofol.

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