[New CCU RN]

Originally Posted by stevierae

Not with Diprivan you don't--and if you DO, you shouldn't--dangerous practice without a protected airway--but, if you are simply taking your chances and depending on the RTs, pulmonologists and intensivists to bail you out in case of a crisis, I guess that's your decision--but why take on that responsibility and risk your license by doing something that they simply do not pay us enough to do, and that others are better trained, and better paid, to do?

Just read about an anoxic brain injury suffered during a TEE--RN gave Propofol even though the O2 sat read 70%--in an ICU, non-intubated patient--WHY? I guess she will tell her story in court--

I don't disagree that it is a risky thing to do and needs more guidelines as there is such a fine line. I was responding to your quote about saying in an ICU the patients all have a protected airway, bc that simply is NOT the case... that is all.

I am just stating what I have seen. Personally, I have never given Dip on a non tubed patient, but many, many nurses in my unit have. It is in my unit a norm. I always request the MD give it and document med given by Dr so and so.....

Would you please provide that article you read about the nurse giving the Dip on a patient w/ O2 sat of 70%... I would be interested in reading it.

[stevierae]

Originally Posted by New CCU RN

I don't disagree that it is a risky thing to do and needs more guidelines as there is such a fine line. I was responding to your quote about saying in an ICU the patients all have a protected airway, bc that simply is NOT the case... that is all.

I am just stating what I have seen. Personally, I have never given Dip on a non tubed patient, but many, many nurses in my unit have. It is in my unit a norm. I always request the MD give it and document med given by Dr so and so.....

Would you please provide that article you read about the nurse giving the Dip on a patient w/ O2 sat of 70%... I would be interested in reading it.

Actually, my reply regarding protected airways in ICU was in reference to a post by newnurse2003, who stated that it is part of her job description to give Propofol to her intubated patients--and I was responding to her post by saying:

That's different--by her own description, the patients SHE is giving Propofol to already have protected airways--either by virtue of being intubated or trach'd--and have RT, pulmonologists, and intensivists--and sometimes anesthesiologists-- available 24-7--unlike cosmetic surgery and endo patients.

It's not an article--it is a plaintiff medical malpractice case another LNC colleague is currently reviewing (I am an LNC.)

[New CCU RN]

Originally Posted by stevierae

Actually, my reply regarding protected airways in ICU was in reference to a post by newnurse2003, who stated that it is part of her job description to give Propofol to her intubated patients--and I was responding to her post by saying:

That's different--by her own description, the patients SHE is giving Propofol to already have protected airways--either by virtue of being intubated or trach'd--and have RT, pulmonologists, and intensivists--and sometimes anesthesiologists-- available 24-7--unlike cosmetic surgery and endo patients.

It's not an article--it is a plaintiff medical malpractice case another LNC colleague is currently reviewing (I am an LNC.)

There is no post on this from newnurse2003....

[stevierae]

Originally Posted by 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---

[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?

[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.

[New CCU RN]

Originally Posted 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.

My concern is that I am seeing propofol used more and more frequently for conscious sedation on a nonprotected airway....

[gaspassah]

are you from baton rouge? that sounds an awful lot like a situation that happened at a hospital i used to work at.

Originally Posted 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.

[deepz]

http://www.time.com/time/magazine/ar...0.html?cnn=yes

deepz

[NurseasPatient]

Originally Posted 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?

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.