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| No. 100 | 
Jan 06, 2005, 05:27 PM
Originally Posted by originalred I am still not clear on the downplaying of ACLS and PALS. True, it is 1 weekend every 2 years for most.
It's downplayed because you simply can't learn airway management in a 30 minute lecture and 30 min teaching station in an ACLS class.
The reason you will find anesthetists so passionate about this issue is because we know 1) how difficult airway management can be, 2) how easy it is to overdose with propofol, and 3) because "a little knowledge is a dangerous thing" applies very well to non-anesthesia personnel giving propofol for sedation.
I think if you re-read the posts, no one threatened a lawsuit. What you'll probably find is that people have said it will be very easy to have a successful lawsuit against RN's who administer propofol for sedation and have a bad outcome, given the warnings by the manufacturer against non-anesthesia personnel administering it, and given the recommendations of the ASA and AANA that only anesthesia providers administer it for sedation.
And I'm curious as to why, 10 weeks after the last post on this topic, you suddenly felt the need to stir the pot after this thread had died down. Pretty much everything that needed to be said about it has been said in 10 pages of postings.
 | | Advertisement Sponsored Links | | | | No. 101 |
Jan 06, 2005, 06:43 PM
Updated
Jan 06, 2005 at 06:47 PM by originalred
Originally Posted by stevierae Here's what I don't understand--putting safety issues aside---
WHY do you want to do an anesthesia provider's job---FOR A NURSE'S PAY????
WHY????
I just don't understand why you'd take on the extra headaches and liability--with NO extra compensation. And, believe me, there is HUGE potential liability for you.
I am an operating room nurse and a legal nurse consultant. I, too, have very strong feelings on the issue of nurse administered propofol, and they are, in part, THAT PROPOFOL SHOULD NOT BE GIVEN, BY A NURSE, TO A NON-INTUBATED PATIENT!!!!!!!! EVER!!!!
There are nurses perfectly cabable of administering Propofol, yes. They are called CRNAs.
I LIVE in Oregon. I will be WAITING for the day when I see the Medford facility called on the carpet for unsafe patient care practices, and I will be VOLUNTEERING my services as a behind the scenes consultant--or as an OR nurse expert--OR assisting with expert location--to any attorney who wants to put a stop to this dangerous practice and shut your facility down.
In fact, maybe I can be the one to make a few calls and speed up the process.
I am really tired of "gonzo" nurses who don't know what they don't know, and think it makes them look important to do an anesthesia provider's job. If you are not capable of delivering one level higher than deep sedation--that is, general anesthesia; skilled intubation and all--then you should not be delivering deep sedation. I don't even think you should be delivering MODERATE sedation. That's an anesthesia provider's job.
I get tired, also, of hearing about your capability to "rescue." Yeah, yeah, we're all (operating room nurses)ACLS certified; nothing special about that. But you guys in endo labs seem to think that as long as you can deliver--or THINK you can deliver; based on what you learned in classes-- ACLS, it almost makes it OK to take unnecessary risks.
Why GET a patient to a point where he needs to be "RESCUED?" The fact that he ends up there in the FIRST place shows that YOU HAD NO BUSINESS DOING WHAT YOU DID THAT GOT HIM THERE!!!!!!!
Ususally "rescue" means that you have to call on someone--i.e., an ER doc, who has to drop what he is doing and come to YOUR "rescue" by intubating the patient for you and dealing with all the unnecessary problems that have been created--i.e., a period of anoxia or hypotension or both.
You've had no adverse effects to date? Famous last words....many a nurse who gave Propofol in a plastic surgery clinic has used that phrase--and maybe she DIDN'T have any "adverse effects," by sheer luck or the grace of God--until the day she DID, and her facelift patient died...
This is one of the quotes I speak of. There are others if you will carefully peruse the previous posts.
I am sorry if I violated some sort of protocol by waiting so long to post. I will be more careful next time.
Why does the education have to stop with a 2 day ACLS class. I am a CCEMT-P (among other things). I am not satisfied, at the end of a class, to stick the card in my pocket and walk away. A card has never saved anyones life. As I am not qualified, I will leave it up to the reader to decide if a nursing license or a medical degree hanging on a wall quailfies someone to do brain surgery. Or, does the completion of college, medical school simple give you the oppurtunity to learn more.
And if it is "just" airway management...I feel that the number of intubations I have done in uncontrolled situations should qualify me to give propofol ;-)
I think this topic is of great interest and would like to see open dialogue between healthcare providers on the issue. I think you gretly underestimate the knowledge that is shared on sites like this and that most of us or not beating a dead horse. We are simple trying every way we can to advance the science of healthcare.
| | No. 102 |
Jan 06, 2005, 06:53 PM
Updated
Jan 06, 2005 at 07:06 PM by stevierae
Originally Posted by originalred This is one of the quotes I speak of. There are others if you will carefully peruse the previous posts.
I am sorry if I violated some sort of protocol by waiting so long to post. I will be more careful next time.
Why does the education have to stop with a 2 day ACLS class. I am a CCEMT-P (among other things). I am not satisfied, at the end of a class, to stick the card in my pocket and walk away. A card has never saved anyones life. As I am not qualified, I will leave up to the reader to decide if a nursing license or a medical degree hanging on a wall quailfies someone to do brain surgery.
And if it is "just" airway management...I feel that the number of intubations I have done in uncontrolled situations should qualify me to give propofol ;-)
I think this topic is of great interest and would like to see open dialogue between healthcare providers on the issue. I think you gretly underestimate the knowledge that is shared on sites like this and that most of us or not beating a dead horse. We are simple trying every way we can to advance the science of healthcare.
Oh, that was my post----I simply told the poster that I would do anything in my power to get the Southern Oregon facility closed down (and I have already filed a complaint with the Oregon State Board of Nursing and written to several politicians about it.) And, yes, I told her I would use my own expertise as an operating room nurse and legal nurse consultant to testify, (and locate other experts as needed) if needed, even before the state legislature, about the danger of non-anesthesia providers administering Propofol, particularly in a non-airway protected patient and outside of a hospital. What's wrong with that? I think it's my duty--every RN's duty--to speak up in known or even potential dangerous patient care situations. If we wait for "someone else" to do it, lives could be lost unnecessarily. The activities at this endo lab are sentinel events waiting to happen.
Propofol administration in non-intubated patients belongs in the hands of anesthesia providers--period. There is no "middle ground" here.
Can't quite figure out how you determined my post to be
" threatening a lawsuit over a posting in a chat room."  As jwk pointed out to you, no one is threatening any lawsuits here--you simply read the post wrong.
| | No. 103 |
Jan 07, 2005, 02:34 AM
This is part of the reason I asked a question regarding the virtual colonoscopy. In all seriouness could someone try to answer me?
Indeed indeed -try to intubate someone who is difficult and with no backup!! Would love to be the one to just have Versed/Demerol, but inadequate for me. But I do not ever wanna get into the "Uh Uh" difficult to intubate situation. Hence my question re virtual colonoscopy in a prior section. PPLEASE....
| | No. 104 |
Jan 07, 2005, 10:46 AM
My bad stevierae. It is human nature to read things the way we want to. I do think the people in this clinic would feel threatened with the loss of their job and possible action by the board. They may need it. But this still takes us away from the discussion of: should this drug be given by RNs???
It strikes me as odd that both sides seem absolutely closed to any thought that the other may have a point to consider.
The package insert says propofol MUST BE GIVEN BY SOMEONE trained...you know the rest.
It also states the standard dose for anesthesia and MAC sedation. No brainer. Nurses should NOT GIVE IT.
I will continue to look at the literature but I have seen nothing that addresses the doses that the Endo people are giving. Usually much less than what is needed in OR...Is that where they are coming from.
There have been several posts about reinbursement. Why would an RN do something she is not paid for? Again, this takes us away from the heart of the discussion. Most of do things daily that we are not paid for but enhances pt care. I wish I could charge my employeer everytime I read and article or attended a class to further my ability to deliver quality pt care.
What are the BONs doing about these facilities (nurses) that are givivg these drugs?
If it is a question of training, why do some MDs allow these practices to continue??
There is something deeper (in my opinion) that is not been discussed. Is it a turf war? Is it job security? Is it the absolute disregard for patient safety by gonzo nurses? Why such a gap???
| | No. 105 |
Jan 07, 2005, 01:45 PM
I just don't understand the debate. Ventilated ICU pt - go for it RN. Anyone else, have an anesthesia provider give it. Why any nurse would want to take the risk I just don't know - it seems like common sense. That said - to each his own & Viva la difference!
| | No. 106 |
Jan 13, 2005, 07:07 PM
We use Propofol ALL the time in our MCCU and SICU! We hang it as an IV drip I have never given it IVP though. Originally Posted by czipp I wondered if anyone of you as RN's
use propofol? Only the anesthesia
people are using it. When anesthesia
is used they use propofol. We as Rn's are pushing the Demerol, Versed, Morpheine, Nubain,elc.for conscious sedation. We
are not "allowed " to push propofol or
really any Fentanyl. Is this typical?
Or are we as RN's being overruled or
not allowed to push such drugs..........???
We usually use Demerol and Versed.
but propofol requires a nurse anesthestist or an anesthesiologist.
Is this common???? | | No. 107 |
Jan 14, 2005, 06:57 AM
Updated
Jan 14, 2005 at 07:00 AM by stevierae
Originally Posted by DR2004RN We use Propofol ALL the time in our MCCU and SICU! We hang it as an IV drip I have never given it IVP though.
That's different--you have a patient with a protected airway, and RT, intensivists, pulmonologists and anesthesia immediately available. We are talking apples and oranges here.
The subject of this thread surrounds gastroenterology RNs who think it's in their scope of practice to give Diprivan during colonoscopies and gastroscopies in free standing endo labs. They don't have the resources you do, and their patients don't have protected airways. Somehow, they think because they take ACLS every two years, it's OK, because theoretically they can "Rescue" the patient. They also think because they have a doc there--that is a gastoenterologist--he will magically take over.
This logic is flawed, because, first of all, if a nurse takes a patient to a place from which he needs to be "Rescued" then she does not know what she is doing in the first place. I will say it again--this is a drug that has no business being given by ANYONE but an anesthesia provider in any setting in which the patient does not have a protected airway.
Second, do you really believe that most gastroenterologists are capable of running a code? I've worked with surgeons who just stay sterile and step away--if called upon to do CPR, they do it wrong. In an operating room setting, anesthesia runs the code, the circulator is his right hand, giving drugs, starting IVs, defibrillating etc--and the scrub delivers CPR. It's a well choreographed ballet--we have all done it before.
Most importantly, we generally already have a protected airway when a problem occurs. If not, we soon will have a protected airway. That's why we have skilled anesthesia professionals.
In an endo lab, do you think they have those skills? Doubtful. In reality, they will end up calling 911, and pointing fingers. Do you think these gastroenterologists are going to take the blame for a patient with laryngeal edema and cerebral anoxia? Think again.
| | No. 108 |
Jan 17, 2005, 09:07 AM
Second, do you really believe that most gastroenterologists are capable of running a code? I've worked with surgeons who just stay sterile and step away--if called upon to do CPR, they do it wrong. In an operating room setting, anesthesia runs the code, the circulator is his right hand, giving drugs, starting IVs, defibrillating etc--and the scrub delivers CPR. It's a well choreographed ballet--we have all done it before.
Most importantly, we generally already have a protected airway when a problem occurs. If not, we soon will have a protected airway. That's why we have skilled anesthesia professionals.
So now it is not only nurses that shouldn't give prpofol but any Dr other than an anesthesia provider...
How many codes do you guys have in OR??? And why are the anesthesia providers better versed in ACLS? We have a few anesthesia Drs that are the best in the world at codes. We have a couple that will come in and stop everything until they get the pt intubated...even if the pt is in vfib...and then leave.
And you continue to downplay the weekend every 2 year ACLS class. How long have your anesthesia providers been out of school??? Did they take an ACLS course 2 years ago??
The REAL learning starts after class, after graduation...you have to be exposed to these situations on a frequent basis or continue to study or anyone will lose their skills.
I still think there is an underlying cause for all the debate that no one will admit. Turf war, reimbursement, ego, pt safety??? I have seen very little proof from either side that would say it is OK to give or not.
While the package insert is a heavy hitter, stop and read every package insert on every device or drug we give. We might all want to reconsider what we do.
| | No. 109 |
Jan 17, 2005, 09:30 AM
Originally Posted by originalred So now it is not only nurses that shouldn't give prpofol but any Dr other than an anesthesia provider...
ABSOLUTELY CORRECT IF THEY CAN'T MANAGE THE AIRWAY - and trust me, most of them can't. Originally Posted by originalred How many codes do you guys have in OR??? And why are the anesthesia providers better versed in ACLS? We have a few anesthesia Drs that are the best in the world at codes. We have a couple that will come in and stop everything until they get the pt intubated...even if the pt is in vfib...and then leave.
And you continue to downplay the weekend every 2 year ACLS class. How long have your anesthesia providers been out of school??? Did they take an ACLS course 2 years ago??
You're not serious are you? We deal with critically ill patients every day. We use the skills and physiology and pharmacology that ACLS only touches on on a DAILY basis.
And guess what? Anesthesia recertifies in ACLS every two years, mainly to keep up with changes in accepted protocols. We do it in a very brief session that lasts less than a couple of hours, testing included. Why? Because the rest of it, we do every day. Duh. Originally Posted by originalred I still think there is an underlying cause for all the debate that no one will admit. Turf war, reimbursement, ego, pt safety??? I have seen very little proof from either side that would say it is OK to give or not.
While the package insert is a heavy hitter, stop and read every package insert on every device or drug we give. We might all want to reconsider what we do.
It's not a turf war. I can't tell you how many gastroenterologists butts I've saved multiple times when they've OD'd their patients on any number of drugs. Propofol is perhaps the most dangerous, because it's too easy to give too much, and too easy to become impatient when it doesn't work as quickly as you think it should. There is no anti-propofol drug. Romazicon and Narcan don't work. If you've OD'd with the propofol and your patient is apneic, and you can't manage the airway, you're screwed.
And yes - you better read the package insert. The attorneys certainly have.
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