Nurses Pushing Propofol for Conscious Sedation -Your Thoughts? - page 3

I would be interested in getting feedback from GI nurses that are involved in propofol sedation in settings with and without anesthesia. Your thoughts and experiences please. Thank you, Randy... Read More

  1. Visit  wtbcrna profile page
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    I did my Masters research looking at sedation practices for GI procedures. I am sorry your outcome was less than satisfactory, but I see this all the time where patients come in wanting all these things that are out of the normal for that particular place and expect excellent outcomes. These patients set themselves up for failure before the procedure even starts.
  2. Visit  health professinal profile page
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    Quote from wtbcrna
    I did my Masters research looking at sedation practices for GI procedures. I am sorry your outcome was less than satisfactory, but I see this all the time where patients come in wanting all these things that are out of the normal for that particular place and expect excellent outcomes. These patients set themselves up for failure before the procedure even starts.
    There are 4 docs at that endoscopy center and they all use different med protocols. Besides, as an endoscopist, they should be familiar with different medications. And if not, since advance notice was given, they should familiarize themselves with a patient's choice of meds. So there is no "normal for that particular place". And this has nothing to do with expecting "excellent outcomes". I find it intteresting that you keep mis-characterizing the concerns expressed in my report.
    Last edit by health professinal on May 17, '11
  3. Visit  wtbcrna profile page
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    Quote from health professinal
    There are 4 docs at that endoscopy center and they all use different med protocols. Besides, as an endoscopist, they should be familiar with different medications. And if not, since advance notice was given, they should familiarize themselves with a patient's choice of meds. So there is no "normal for that particular place". And this has nothing to do with expecting "excellent outcomes". I find it intteresting that you keep mis-characterizing the concerns expressed in my report.
    You don't just familiarize yourself with a medication and hope to become proficient in its use for sedation. Do you think the endoscopist became proficient in doing colonoscopies by just doing one or two? There is a reason people in anesthesia spend thousands of hours getting experience doing sedations.

    I don't think I am mischaracterizing your concerns at all. I am giving you a provider's perspective and you can do with it what you want.

    It is also interesting to note that many countries do not routinely do sedation/analgesia at all for colonoscopies, because it isn't considered that painful. A lot of what we perceive is based on cultural perception.

    I have to ask what is/was your profession in psychiatry and level of education? I am a CRNA with a MSN.

    I don't see where the endoscopist was deceitful. You asked for a pediatric scope to be used, and you got a pediatric scope. You asked for only fentanyl. You got only fentanyl even though you got 3x the starting dose of fentanyl you quoted in the study it was still painful for you. The endoscopist and the nurse tried to convince to use propofol for your sedation you refused and got exactly the sedation done the way you wanted....

    I also don't see how the GI clinic violated any patient rights that you quoted also. They could have provided better customer service and been nicer, but again this maybe just a perception issue or they could just be jerks...
  4. Visit  health professinal profile page
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    "I am giving you a provider's perspective and you can do with it what you want". I am giving you a patient's perspective and you can do with it what you want. Amen.
  5. Visit  wtbcrna profile page
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    Quote from health professinal
    "I am giving you a provider's perspective and you can do with it what you want". I am giving you a patient's perspective and you can do with it what you want. Amen.

    Care to answer the question about educational level and what you did in psychiatry?
  6. Visit  health professinal profile page
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    No. Since I am giving you a patient's perspective, training as a psychiatrist etc. is not relevant.

    You have done a terrific job representing a provider's perspective. You couldn't have done a better job if you were a lawyer for a provider org or rep from a drug company.

    Now I would like to know if there are any others who would like to offer another perspective besides yours.
  7. Visit  wtbcrna profile page
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    Quote from health professinal
    No. Since I am giving you a patient's perspective, training as a psychiatrist etc. is not relevant.

    You have done a terrific job representing a provider's perspective. You couldn't have done a better job if you were a lawyer for a provider org or rep from a drug company.

    Now I would like to know if there are any others who would like to offer another perspective besides yours.
    This thread is about NAPS (nurse administered propofol sedation) not patients bad experiences with having a colonoscopy. You should find another thread on that topic or start your own thread if that is what you want to discuss.

    Yes, your education/profession is relevant to all discussions if you are claiming to be a health professional. Your posts leave me to believe that you are not a health professional, and more like a lay person that gets most of their health information from the internet.
    Also, the fact that your not willing to share your educational level/profession in anonymous internet forum gives reasonable doubt that you are health professional.
  8. Visit  health professinal profile page
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    Sorry, I didn't read past the title, "Nurses Pushing Propofol for Conscious Sedation -Your Thoughts?" so if there is no one else wishing to provide feedback, I will sign off this thread.

    (a psychiatrist as patient who experienced a doctor and Nurse Pushing Propofol for Conscious Sedation)
  9. Visit  wtbcrna profile page
    0
    Quote from health professinal
    Sorry, I didn't read past the title, "Nurses Pushing Propofol for Conscious Sedation -Your Thoughts?" so if there is no one else wishing to provide feedback, I will sign off this thread.

    (a psychiatrist as patient who experienced a doctor and Nurse Pushing Propofol for Conscious Sedation)
    A psychiatrist that has trouble communicating with other health professionals and controlling the conversation without becoming emotional.........
  10. Visit  health professinal profile page
    1
    Advertising or personal attacks are NOT allowed.

    This CRNA with a MSN has done a terrific job representing a provider's perspective. He (I assume) couldn't have done a better job if he were a lawyer for a provider org or drug company.

    Perhaps the difficulty in communicating also has to do with the differences in corpus callosum. I will sign off this thread now since I have not received any other responses.
    wtbcrna likes this.
  11. Visit  wtbcrna profile page
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    Quote from health professinal
    Advertising or personal attacks are NOT allowed.

    This CRNA with a MSN has done a terrific job representing a provider's perspective. He (I assume) couldn't have done a better job if he were a lawyer for a provider org or drug company.

    Perhaps the difficulty in communicating also has to do with the differences in corpus callosum. I will sign off this thread now since I have not received any other responses.
    Fair enough I will quit antagonizing, but there are two sides to every story. Maybe next time you can find a provider who will communicate better.
    There are many ways that sedation for colonoscopies can and are done. The overall method that has shown to have the best outcomes is propofol sedation with or without small amounts of versed and fentanyl or Demerol. One of the biggest areas of research right now in anesthesia is POCD (postoperative cognitive dysfunction). Propofol has shown to offer fastest return to baseline cognitive function. The reason I say all this is because I would bet most providers don't take the time to explain these things to patients or take the time to build rapport with their patients.
  12. Visit  PMFB-RN profile page
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    My hospital has a protocal for using propofol for sedation by regular (non CRNA) ICU, ER and Rapid Response nurses who have gone through a hospital training program.
    I use it all the time for cardioversions, reductions of dislocated shoulders, GI procedures done in the ICU etc.
  13. Visit  foraneman profile page
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    Quote from wtbcrna
    I did my Masters research looking at sedation practices for GI procedures. I am sorry your outcome was less than satisfactory, but I see this all the time where patients come in wanting all these things that are out of the normal for that particular place and expect excellent outcomes. These patients set themselves up for failure before the procedure even starts.
    I have to disagree. It is not up to a patient to know what is or is not 'out of the normal' for a particular clinical setting. It is up to the practitioners to educate the patient, whether health professional or not, as to what their capabilities or particular clinical protocols are. Do you do colonoscopies without propofol? SIMPLE question. Can it be done with only fentanyl? SIMPLE question. Can it be done with ped colonoscope? SIMPLE question.

    All deserve simple, courteous and direct answers. Patients asking questions and making requests for care should never be labeled as 'setting themselves up for failure'. I might highlight the fact that this scenario is ANOTHER reason why RN's should NEVER be administering propofol sedation for this or any other procedure. ONLY a trained anesthesia provider, like a CRNA, should do so. ANY CRNA could take this patient request in stride and titrate fentany;/versed/demerol/dilaudid/whatever if the patient did not want propofol. I might point out that the propofol in the CRNAs hands would however be the best patient choice in most cases...with a touch of fentanyl no doubt. I don't say this to 'protect turf' or $$$...I am saying I would NEVER in a million years let an RN sedate myself or a family member with propofol...EVER EVER EVER...that's because I HAVE seen the 1 in 500...or 1000....or whatever u want to claim...that after a 'little' propofol turns blue, vomits bile and has a laryngospasm while the non-anesthesia provider freaks out pushing the big button on the wall.

    Since propofol has no analgesic properties you either dose to a near plane of general anesthesia to avoid any pain recall or you add an analgesic. The fact that the OP did not have ANY effect from the 'fentanyl' here is rather concerning. If one adds the inappropriate behavior of the RN to the mix you have to wonder about the possibility of diversion for self administration.

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