Propofol - page 13
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,... Read More
Dec 9, '05Quote from originalredYou have not taken 3 extra years of schooling and earned a masters degree in nurse anesthesia. Nor do you have the graduate level understanding of pharmacology, physiology, pharmacokinetics, pharmacodynamics, pathophysiology, and anesthesia that I do as a CRNA. You should be very careful in making a statement that since you have intubated people that you are qualified to administer a general anesthetic induction agent. I sew at home---how about I close your abdominal wound when you have surgery? (I'm not trying to argue with anyone here, really. But, people seem to have a misconception about their boundaries, scope of practice, etc.) If you are interested in advancing your training, go the distance and earn the right to administer this drug with the proper, safe credentials.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.
Dec 9, '05Bias is not necessarily a bad thing as originalred seems to imply, it often is something that a savvy nurse gets through experience. All meds that are manufactured and then approved by the FDA are not equal in terms of their usage, administration, effect, and many other aspects. Saying this I sincerely hope I`m not telling anyone anything new here.
Of drugs in the you better watch your Hinney catagory Propofol is one of the worst, simply for the reason that it is usually ordered by a Dr, that doesn`t really want "conscious sedation". What the Dr usually wants is deep sedation to borderline anesthesia, to simplify his/her procedure, and propofol can do this without a doubt.
Unfortunately unless you are an RN, that is also a CRNA, you are not licensed to administer this drug as the Dr usually wants it. Using this drug for "conscious sedation" whilst sticking a garden hose down a persons throat seldom works as "conscious sedation", this isn`t my bias, just a statement made by my GI Dr, whose staff used a very smooth mix of Versed, and Fentanyl during my UGI, on waking I didn`t remember squat, and very quickly recovered, he told me this was par for the course. I had asked earlier about propofol, and he just shook his head saying "not in our lab".
My Bias comes from working with the Mothers Milk, and constantly bagging people, and often starting fluid boluses, which to tell truth the pts, rarely could tolerate.
All I can say is that after years of fooling with "conscious sedation" I prefer Versed, with Fentanyl, or MS. It works, never did I have to bag anyone, and found hypotension not to be a problem, as it is almost every time with Propofol. Fortunately in the ERs where I worked the Drs were very good about letting you use whatever you were comfortable with. I might also point out it wasn`t just my Bias evidently, as given the choice to a person everyone used Versed, with either Fentanyl, or MS.
Unfortunately during my time in the Cath lab, which I dearly loved, but quit over the use of Propofol, 2 of the Drs insisted on using it, and the worst part is they were EP guys, long procedures abound, and I certainly acted as an anesthesiologist more times than I care to remember, because these pts were not anywhere near conscious. Bias YES, I eventually got smarter I guess, as after thinking about what I was doing, I finally got out.
The goal: "CONSCIOUS SEDATION", propofol isn`t the correct drug.
The facts: Just read the pkg insert.
Dec 31, '05Quote from jwkDid jwk mean for unintubated people? I've seen it used by RN's in ICU and flight nursing here in FL. As a soon-to-graduate student I'd be interested to see the official FL rules for it's use.Did you know that in some states (Florida for example) it is ILLEGAL for RN's to give propofol?
Feb 13, '06:hatparty: Thursday 2-9-06, the Oregon Board of Nursing unanimously agreed that sedation with propofol is both safe and effective when given by RN's in the procedural arena. I would like to extend my thanks to all those who supported us during this turbulent time. We are seeing evidence based nursing in practice.
Feb 13, '06Quote from robrnFor continued updates on our progress and more about sedation with propofol, get the facts. Don't rely on outdated opinions or professional biases. Visit Dr. John Walker's web site www.drnaps.org. Dr. Walker has spent exhaustive research and development of sedation for procedures in both the inpatient and outpatient setting. We look forward to many years of good sedation and very good patient satisfaction in our GI lab:hatparty: Thursday 2-9-06, the Oregon Board of Nursing unanimously agreed that sedation with propofol is both safe and effective when given by RN's in the procedural arena. I would like to extend my thanks to all those who supported us during this turbulent time. We are seeing evidence based nursing in practice.
Feb 13, '06Quote from robrnSo obviously you have no professional bias - right.For continued updates on our progress and more about sedation with propofol, get the facts. Don't rely on outdated opinions or professional biases. Visit Dr. John Walker's web site www.drnaps.org. Dr. Walker has spent exhaustive research and development of sedation for procedures in both the inpatient and outpatient setting. We look forward to many years of good sedation and very good patient satisfaction in our GI lab
Feb 14, '06Quote from robrnand more about sedation with propofol
Its a general anesthetic.
Counterpoint: Georgia BON alligns itself with the ASA and AANA and is against nurse administered propofol and relies on anesthesia providers to administer this general anesthetic. A precendent has been set for this state. Now GA hospitals are changing their rules. Tit for tat.
edited out inflammatory language contentLast edit by SmilingBluEyes on Feb 16, '06
Feb 18, '06[FONT=Lucida Console] In Colorado only a anesthesiologist can administer Propofol and I am glad. I do conscious sedation everyday but I do not want to give Propofol. We use versed and sublimase.
Feb 19, '06Hi- I'm still putting off my colonoscopy and it is due (family hx colon cancer-father died at age 53, and I am 53). Can you tell me more re the sublimase? By the way, I would not personally do Propofol without a CRNA or anesthesiologist attending. I know for a fact that I'm a hard intubation.
Feb 19, '06We use propofol gtts for INTUBATED pts in my med/surg ICU. It's a godsend, since pt's can be sedated or awoken within minutes. Our protocol allows us to use it for 8 hrs & then switch to a versed gtt, unless otherwise ordered by the MD. As for conscious sedation with quick bedside medical procedures, nurses are not permitted by law to push propofol in my state (WA) -- only anesthesiologists. I'm not sure if this is true in other states.Last edit by lady_jezebel on Feb 19, '06
Feb 19, '06Quote from spanielHi- I'm still putting off my colonoscopy and it is due (family hx colon cancer-father died at age 53, and I am 53). Can you tell me more re the sublimase? By the way, I would not personally do Propofol without a CRNA or anesthesiologist attending. I know for a fact that I'm a hard intubation.
Sublimase is fentanyl, often a cornerstone for traditional conscious sedation.