Propofol

We absolutely DO NOT give propofol. Nor do the Gastroenterologists. Only the anaesthetists are supposed to according to our policies.

i have a unique point of view here...formally an ER nurse who believed anything could be done and be done well by an ER nurse...anything could be handled...

after being in school for only 2 months i can tell you adamantly and 100% that i was wrong...for those of you saying "i will just bag a pt" - that is the absolute hardest thing to do properly! if you have mastered that - you have succeeded to surpass many years of study by others...(i think not)

propofol is a wonderful drug...but it is a dangerous drug as well - and i agree infusion in an already intubated pt is ok...but as a bolus..forget it. it is right up there w/ ketamine and other drugs that nurses feel they can use just because they have once or twice w/o an adverse effect...well...when your patient dies..and as yoga stated- the insert says that it can only be given by an anesthesia provider...then you are screwed.

as for teeituptom who thinks MDA's and CRNA's only want to bill for extra services....you are clueless...it didn't go into this to bill...i went into this field for the learning...and quit being jealous and go yourself if it is too hard for you to understand that.

what allergies contraindicate administration?

which preparation of this drug will you give based on what ingredients it has?
--there are two preparations you know

what med are you going to give when you see profound hypotension??

what if they are hypotensive and tachycardic?

what if they are hypotensive and bradycardic?

what do you do when the sat drops to 70%?

what if you cannot efficiently bag the pt to maintain sats?

who is going to intubate that pt?

when was the last time they actually intubated? probably in ACLS class

what do you do when they wake up w/ a tube in their throat?

what do you give if they laryngospasm?

if you cannot answer these questions correctly w/o looking it up...you have no business giving this med. i have seen ALL of the above happen in only two months........

Interesting discussion, wouldn't want to use propofol as described in the preceding posts. It doesn''t provide conscious sedation but rather unconscious sedation or more properly close to TIVA (total intravenous anesthesia) when combined with opoids and the benzo's. Just bagging the patient may not be enough. Respiratory side effects, although the obvious, are not the only potential dangerous side effects of these combination of drugs.
Interesting how pushing the scope of RN practise is OK with the Docs / Hosp Admins when it saves them money and increases their profits; but when it increases the RN/CRNA's income it all of a sudden it moves to its outside the scope of practise for a nurse.
This practise is nothing more than a cost cutting tactic at the expense of the RN giving conscious sedation. If they want the patient unconscioous, no matter how short the duration of the drug, they should have an anesthesia provider do it for patient safety. Are we not advocates for patient safety?

in full disclosure i am an anesthesia student. i feel as others that in the realm of patient safety certain guidelines should be followed. in the realm of being a nurse and caring about the profession and those that practice it i will now voice my concern. i just visited the propofol website to look up the package insert.
http://www.diprivan-us.com/sedation/...ownav=sedation
then go to the prescribing section. must have adobe acrobat.
in bold letters it is to be administered only by anesthesia trained personel. there is also a section on icu patients.
now my point.
if you administer propofol outside of the package insert instructions (ie conscious sedation / rn administered) you will be crucified by any half arse attorny in court if a detrimental outcome for a patient is visited. it doenst matter if an md was there and intubated etc. if a patient is harmed using a drug outside of it's intended purpose you run a huge risk of losing your license.
what you do is your business, how you act in your profession is your business, patient safety is everybody's business.
i had a preceptor tell me just friday, no matter how sure or confident you are in a patients airway you must know that you can ventilate by mask.
what will you do if you cant ventilate a patient that stops breathing?
just my humble 2 cents
d

I can't believe ER personnel (includings MDs) are giving propofol to patients with a full stomach. YOU DON'T KNOW WHAT YOU DON'T KNOW. I will be pleased to make myself available to plaintiff attorneys in lawsuits against RNs who administer anesthesia, without benefit of a FORMAL education. A weekend course--you must be kidding.

I give propofol every day as a CRNA with 44 years experience. Each patient reacts differently to the drug and while its short action has advantages, a patient in an intermediate stage of anesthesia is a set-up for vomiting and aspiration, restlessness and hypertension.

To the person who had the nerve to post about anesthesia professionals getting paid for administering anesthesia, my answer is: of course I want to get paid for placing patients in an anesthetized state and even more important, waking them up. I value my work and want to get compensated for its value. I got over the "nursing mentality" of hard work and little pay a long time ago.

Without apology,
YogaCRNA

amen, amen and amen

I am an operating room nurse with over 25 years experience, and I do not feel that OR nurses--or endo nurses--should be giving conscious sedation, and definitely NEVER propofol. All the "training"--inservices, rather--they can give us in the world does not equate to the training any CRNA or anesthesiologist has, particularly in airway management, and the fact is that we are not trained to handle one level deeper than conscious sedation--that is, general anesthesia.


Check out the ongoing thread of mine in the CRNA section entitled "OR Nurses Giving Conscious Sedation--Why Should We?" I would welcome your comments.


Also, if you have no other objections to putting your license on the line, think about it--they just don't pay us enough to do a CRNA's or anesthesiologist's job.

An article follows for your general interest. As usual it, took a patient death to effect change to an ongoing dangerous practice.


FYI on Propofol Administration by RNs


Saying that it has received several reports of adverse events, including
the death of a cosmetic surgery patient, after RNs improperly
administered propofol, the American Association for Accreditation of
Ambulatory Surgery Facilities (AAAASF) is rushing to ensure that only
those trained to give general anesthesia or rescue from general
anesthesia administer propofol in its 1,100 or so accredited facilities.
The AAAASF announced last week that facilities that want to continue to
use propofol -- even if only for "conscious sedation" -- must either
upgrade to a Class C facility (where all anesthesia must be administered
by an anesthesiologist or CRNA) or promise to always use an anesthesia
professional to administer the drug. Facilities must comply by May 1.

"We decided that we need to get our standards in line with the
manufacturer's recommendations," says Jeff Pearcy, executive director of
the AAAASF. "The easiest way to do that was to require those facilities
that want to continue to use propofol to become Class C facilities."

For Class B facilities that would like to continue to use propofol but
won't use other types of general anesthesia, complying with the new
standard is simple. These facilities must fill out a form certifying
that they have a dedicated anesthesiologist or CRNA administering the
sedative-hypnotic. They also must have neuromuscular blocking agents
available in the facility. No on-site inspection is necessary. There
will be no additional charge, says AAAASF.

Those facilities that are upgrading to a C and plan to use general
anesthesia (inhalational) in addition to using propofol must comply with
all Class C criteria, says AAAASF.

AAAASF President Michael F. McGuire, MD, a board-certified plastic
surgeon, says the major motivation for making the change was that
"administration of propofol by a non-anesthesia provider is really not
appropriate."

Dr. McGuire adds that the new standard has caused quite a bit of
confusion and concern, mostly among Class B facilities that don't give
inhalational anesthesia and misread the standard to mean they couldn't
administer propofol unless they bought an anesthesia machine and CO2
monitor. Part of the confusion, he says, lies in the nature of the
propofol.

"Is propofol a general anesthetic or a sedation agent? It's both.
Really, truly, it is both," says Dr. McGuire. "At a certain level and in
a certain individual, it is a sedation agent. In other individuals or at
higher does, it becomes a general anesthetic agent. It's so
unpredictable, which is not a problem if you're an anesthesiologist but
can be if you're a surgeon trying to do surgery and supervise a nurse
giving the medication."

Ditto on Yoga's remarks, and Athomas. I was previously a CCL nurse giving "conscious sedation", and just being in my second semester of anesthesia school has drastically changed my thinking on RN's and sedation. If you want to give propofol and play anesthetist, then apply to anesthesia school. Otherwise, be ready to spend ALOT of time on the stand in court.

Last week in the ER the MD demanded that I push propofol for sedation to reduce an ankle dislocation. I gently refused, explaining that I was not comfortable, can't we use a different drug, etc... The MD threw a fit and complained endlessly to the team leader (who did not stand behind me), and got some other nurse (who laughed at me) to do it. The procedure went without incident, but I am glad I didn't do it, especially now that I have found a hospital policy which specifically states that propofol can only be administered by MD's or Anesthesia providers.

Not having found support from my "peers" at work, I'm thankful for this thread. I have just been admitted to a CRNA program, and will be pushing propofol soon enough...until then, I'll keep my license, thank you very much!