Propofol

If you want to administer propofol, go to anesthesia school. It is is a potent anesthetic that can cause cardiac depression, hypotension, respiratory depression and loss of a protective airway. I give it every day and am always impressed with its unpredictablity and potency. Also, it is listed as an anesthetic and should only be given by professional anesthetists. See the package insert. It would be interesting to see how a jury would respond to an non-anesthetist administering an anesthetic.

Sorry guys, I feel stronly about this issue.
YogaCRNA

I have to agree somewhat with YogaCRNA. I work in ICU and give Propofol ONLY to intubated patients who are continuously monitored. I don't think it's appropriate for concious sedation. An 85yo 85lb patient can possibly have just as hard of a time clearing Propofol as anything else. I'm all for expanding our expertise, but opening ourselves up to liability is not cool.

I do NOT mean to imply that I don't think that appropriately trained RN's shouldn't give Propofol. I've used it for years, but you would not EVER catch me giving it to a patient for concious sedation who was not intubated.

Work in ICU but Aust. There is virtually nothing we cannot administer to a tubed patient and can give anaesthetic agents under medical supervision during intubation. But then our staff set up is completely different to American and the laws are also different.

I agree that propofol can cause hypotension, respiratory depression and loss of protective reflexes--as does demerol, fentanyl and versed given in quantities that some GI docs request for 'sedation'. We get unexpected responses from our 'sedation' too, like loss of inhibition when a pt decides he MUST get up off the stretcher during the procedure, or that he should strike out at the people that are 'tying' him down.

Like I said, so long as there are doctors available, RNs are not capable to provide the service, but as soon as there is no money/ reimbursement or no providers, we staff RNs are suddenly highly qualified to do what needs to be done. I expect that in 5 years when the demand by babyboomers overwhelms the supply of endoscopy suites and we need to 'speed up' the turn over, the staff RNs will suddenly be able to provide this service. Why wait?

I'd just as soon avoid it as long as possible. Yes, we can get adverse effects from normal IVCS, but those agents can be reversed. There is no reversal agent for propofol other than "tincture of time".
I am ACLS certified and have been in more codes than I cared to be in. But I still don't consider myself in the class of nurse anesthetists, especially when it comes to airway management.

Amy

The RNs are allowed to sedate with propofol in our CCU, the doc has to be there (this is usually during a bronch/cardoiversion, etc) and dictate how much to push. RT is also in the room managing the airway, crash cart on standby. It is a team effort. We have to pass the hospitals "test" before we are "certified". RNs job is to push, observe vitals and medication response. As a unit we also frequently run propofol gtts on intubated patients.

This thread concerns me from a legal and safety standpoint. Propofol is only indicated for intubated patients as an infusion. Bolus dosing may only be given with anesthesia. I do not as a nurse want to risk loss of respirations and an airway because I gave propofol to a non intubated patient-and will not do so despite pressure from some physicians who want to do a procedure. They'll say so and so- does it all the time and why can't i be like that nurse? My response is always -because I only work under my nurse practice act and do not choose to violate that-I then offer to call anesthesia to see when we can get the procedure scheduled appropriately. MDs back down. I then follow up with anyone the MD named and make sure that they understand the safety and legal ramifications of actions if what the MD is saying is true.
Intubated patients having a procedure typically are not considered concious sedation since they have a protected airway. In these patient I still do not bolus with propofo because these are anesthesia doses and not covered under my licensure and nurse practice act. Be careful.

Hi
In the ER here the ED has to present for the administration of all concious sedation. Yes we use propofol great stuff. Yes they are on the monitor and pulse ox and all. Takes all the strain out of reducing dislocated sholders and hips. And they wake up so fast.
Ansthesiologists and CRNAs want to be involved just so they can charge for another patient fee.

I think you should review the definition of conscious sedation....or moderate sedation which I believe is the current preferred terminology. All the RN's in our department are required to be ACLS certified in case a patient has an adverse reaction to the medications or procedures. This does not give us license to administer deep sedation or general anesthesia.

Indeed, administration seems to find a loophole to allow RN's to perform tasks and administer medication that was previously prohibited in order to save money and ease budgets. But there state nurse practice acts that prevent them from crossing certain lines. Some states do allow RN's to push Propofol. I think it's a huge mistake. There are nurse anesthesists and anesthesiologists who have received more training and education, who make a heck of alot more money than I do and they should be administering these dangerous drugs, not I.

In 7 years in endoscopy I've only had to bag 2 patients as a result of their sedation......one was a 97 yo bronchoscopy patient who had had 2 of versed and the other was a 76 yo patient who had had 25 demerol and 3 of versed. Reversal agents brought them back in no time. Thank God I had reversal agents to give.

I was at a GI nurses conference on Saturday where this issue was addressed by one of the speakers who happened to be Jo Wheeler-Harbaugh, the current president of the SGNA. She is very much against having RN's in the GI lab push propofol. Our lab follows SGNA guidelines.

Propofol is a great drug. When the anesthesiologists adminsiters it I appreciate its properties.

Librasun, Thanks for your support in the use of
propofol for sedation. I am a nurse that works at the
GI lab you described in southern Oregon. With proper
monitoring (EKG, SAO2, NIBP and ETCO2) Propofol is not
only safe but also very effective. For instance
narcotic using patients (we never see them) need large
amounts of narcotics and benzos just to control the
patient. If we are into an ERCP for 30 to 40 min
nothing is more frustrating then having a patient
twist and turn dislodging the cannula the MD just got
into the duct.
Our administration of propofol is small incremental
doses in which the patient’s airway is not compromised
and total comfort is achieved. I can’t say that
patients don’t desaturate but I haven’t noticed a
discernable difference in patients receiving propofol
as compared to Fentynl and Versed. Here we don’t just
use propofol, as the MD’s that do, must be
credentialed in deep sedation. Some of our MD’s are
not, and don’t use propofol so I have a pretty good
grasp on the use of both.
If we give our patient instructions prior to the
procedure with Versed there is a retrograde amnesia.
With propofol there is no retrograde amnesia, and as a
bonus the patient is wide-awake about 15 min. after
the last dose of propofol.
In conclusion propofol is safe and effective in the GI
lab setting when used by properly trained RN’s, MD’s
and well monitored here in southern Oregon we have
administered propofol to about 25,000 patients without
any adverse effects.
I encourage you to visit http://drnaps.org for more
Information about training and Nurse Administered
Propofol Sedation. Thanks again for your support.
sorry I first placed this as a new thread and it isn't.