Propofol

Specialties Gastroenterology

Published

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????

Specializes in Vents, Telemetry, Home Care, Home infusion.

Abstracts:

Registered nurse-administered propofol sedation for upper endoscopy and colonoscopy: Why? When? How?

Registered nurse-administered propofol sedation for endoscopy.

Journal article:Gastroenterology Nursing

July/August 2004

Volume 27 Number 4

Pages 176 - 180

Propofol for Sedation in the Endoscopy Setting: Nursing Considerations for Patient Care

If you are interested in a very good prospective study of nurses giving propofol for sedation. Check out Gastroenterology November 2005, volume 129 Number 5.

I would also like to suggest contacting Dr. John A. Walker director of NAPS (Nurse Administered Propofol Sedation) for suggestions and approaches to overcoming adversaries to a better, and safer, way of administering sedation. The evidence is in and the answer is NAPS.

And of course this is all TOTALLY unbiased.......

Just remember:

The package insert has NOT been changed - poor outcome will equal a big check with lots of zeroes on an indefensible lawsuit;

and quite a few state nursing boards consider it illegal.

And with that :deadhorse

And of course this is all TOTALLY unbiased.......

Most abstracts, discussions, arguments... are biased based on your experience. Some of these "articles" have thousands of procedures done with propofol and no negative outcomes...At some point we have to look at the big picture and total number of positives vs the occassional negative. People would stop driving cars if the only thing they thought about was the crash on I-5 yesterday. People died and it is tragic but look at the total number of people who do get where they are going.

Same with planes...

Same with propofol...

Holy Cow!! Have none of you guys taken ACLS? I would LOVE to be able to give Propofol. The patient wakes up in seconds. It has a half life of 1.8 minutes!!! I would rather bag a pt for 1.8 minutes than give an 85 y/o 85 lb lady 125mcg of fent and 5 mg of versed!!!!!! Then have to reverse her!

I understand there is an Endo lab in southern Oregon that trains RNs in GI to administer propofol---would love to go there!!!

When I worked in the Midwest as a recovery room nurse we had a procedure room for ECTs, and the Drs started the propofol and we managed it during and post procedure. I NEVER had a problem with airway (if that is the concern)--only with people waking up TOO FAST!

Don't sell yourself too short, RNs keep people alive all the time. All the nurses in our GI lab have ICU/ER experience and ACLS. We need to expand our expertise, not limit it. As long as we are appropriately trained and supervised by an MD, there is no reason to fear administering a medication that enhances the patients comfort and safety during procedures.

No offense, but I went to 3 more years of schooling, earned a masters degree in nurse anesthesia, and gained the advanced knowledge of pharmacology, physiology, and airway managment it takes to manage this drug. Propofol is used to induce general anesthesia. It is a dangerous medicine. Yes, it can be used as part of a monitored anesthesia sedation administered by a qualifed anesthesia provider.

ACLS aside, you are not trained on how to mask ventilate (correctly), open an airway with your hands, support the airway, make determinations about the airway status, etc. You should consider obtaining the proper credentials instead of trying to confer a degree/training in something you don't have. You in fact should be very afraid to administer things that you are not trained in. You should also know that propofol has no analgesic properties to "enhance patient comfort".

You should also know that if a patient were to suffer a bad outcome under your care in administering this drug, you wouldn't have a leg to stand on legally. Your MD colleague would hang you out to dry.

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.

You 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.

Bias 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.

OhERRN1984

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Specializes in OB, lactation.

Did you know that in some states (Florida for example) it is ILLEGAL for RN's to give propofol?

Did 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.

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.

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.

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 http://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

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
So obviously you have no professional bias - right.
and 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 content

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