[bill4745]

Can someone give me a link to a website that tells me what drugs I can give IV? I'm mainly interested in drugs for conscious sedation. Some of my co-workers tell me that we can't give some of the commonly used drugs.

[jmgrn65]

well it depends on your facility's policy but most drugs can be given by an rn

[traumaRUs]

It is also dependent on your nurse practice act. Propofol is the one that brings to mind the most controversy. Check with your risk management office and your state board of nursing website. GOod luck.

[neneRN]

I'm in FL; there are three that we can't give- Diprivan (IV push), Ketamine, and Brevital.

[RNinED]

I am glad that concious sedation and propofol came up here. Today my ED Dr wanted me to push propofol for a closed reduction of hip dislocation that had occured less than 30 min prior to arrival. I related to the MD that we did not use propofol in the ED for cons. sedation. I was, thankfully, workng with two very experienced RNs that helped me get the policy and procedures to show him we were not covered for that drug in our ED for this type of sedation. The patient had to wait until the MD had exhausted all his resources including calling the anest. who was not avail. before he would agree to versed. (1.5 hours) The whole procedure took less tha 5 min. for sedation and reduction and 30 min. for pt to recover nearly completely. he was dcd home within 1 hour after sedation. The pt suffered too long even with fentanyl 200mcg. DOES ANY ONE HAVE A CLEAR POLICY PROCEDURE FOR PROPOFOL FOR CONSIOUS SEDATION IN ED? I had a precepting sn with me and he got to experience the ability of nurses to keep pt safe and stand up to MD who really wanted it his way. I was very dissappointed that the pt had to wait though.

[RunnerRN]

We also cannot use Propofol for IVP in our ED. We are allowed to hang it as a drip for intubated pts that we will be holding for awhile. I personally hate the drug, mainly because I'm pretty unfamiliar with it....we rarely end up hanging it. We have had a few moonlighters in the last year who have had different med orders (not weird....just different from how we normally do things). I try to gently push them toward what we normally do/what I'm comfortable doing.
We do use Ketamine IVP for kiddo conscious sedations. I have a personal policy that my pediatricians know....I prefer not to be the one pushing it, but either way the doc HAS to be in the room. And I figure if they're in the room, they might as well be pushing it I more or less lump Ketamine in with Propofol. There is just way too much gray area for me and my license.

[paradisemakai]

My understanding is that RN's can give any IV meds the MD orders, BUT that it is the RN who must make sure that the med is safe to give, so in the case of propofol if would be up to your judgement to refuse. If your facility has standing orders, as many ER's do, so much the better.

Speaking of making sure the med you push is safe: I once had an obtunded patient in the ER, and we were awaiting stat labs, but the lab was taking too long. The attending asked me to push Calcium, and I refused. He gave it, and the patient coded. We got the labs back after 1/2 hour of CPR, and his K was 1. Big mistake, and am I ever glad I refused to give the Calcium. If I had, I would have been so traumatized that I would have handed over my license right then and there.

[Lurksalot]

Our head of anesthesiology designed a facility protocol for conscious sedation use in the ED/CC areas for specific licensed staff, both RNs and docs. To be initially approved to administer, we have to take a class and be monitored through 3 procedures, and then re-cert is a yearly exam. In our facility the docs must push the first dose, and then the RN can do the subsequent doses. We use propofol, ketamine, versed, etomidate, fetanyl, pretty much according to what the doc prefers and what is appropriate for the patient.

[S.T.A.C.E.Y]

I'm in my final clinical placement in the ER now, and I've seen propofol used several times for concious sedation....though it was always the docs pushing it. What is the controversy around propofol? Is it about the drug itself, or who's pushing it????

[ritarunningfeet]

I think it all depends on your state and hospital. We can push almost any drug, about the only one we don't do is pentathol, we mix it and then the dr pushes it. Only one of our doctors actually likes to use it. We can do all the other RSI and conscious sedation drugs.