Propofol

[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????

[stevierae]

anybody care to add anything to this recently deceased horse or has it been whipped sufficiently enough after losing its airway during a routine procedure by the untrained administration of a general anesthetic and lack of intubation experiences provided by weekend courses in acls by both gi md and nursing staff?

i'll add one. i just heard this yesterday from an anesthesiologist and a plastic surgeon collegue, both of whom do expert work. they were talking about the thoughts of one dr. friedberg, a cosmetic surgeon who does office based surgery using a propofol-ketamine technique. they both strongly agreed with a statement made by dr. friedberg, which is this:

"anesthesiologists are using it (ketamine) with propofol. they (anesthesiologists) are needed to count the drops of propofol as "one drop difference can be the difference between consciousness and apnea."

of course, you can substitute "crna" for anesthesiologist." the point is, they were agreeing with dr. friedberg that propofol is a dangerous drug in the hands of anybody but an anethesia provider.

best reference for this is on the website: http://www.drfriedberg.com

of course, i don't guess this will deter the rn (tish) who thinks that she and the lvns who work with her can do anything they want to do. she'll likely formulate some rationale as to why this caveat does not apply to her.

[originalred]

WOW, Is this thread dead??? Was there a mass suicide somewhere??? Or, can we all just get along...

[rn29306]

bad outcome in GI suite is probable reason for lack of posting, you know, OD of propofol by non-anesthesia providers..... lost the airway and the ACLS class that both the RN and GI MD took was over a year ago........."the dummy wasn't this hard to intubate was it, nor did the BP drop like this....

hypoxic brain damage is a downer on your day, patients don't really like it either..

[originalred]

I have never known of a group of people to be as arrogant and closed minded as ALL of you on both sides of this argument. There are pros and cons to everything (including life). It is people like you that can't see the forest for the trees that allow mistakes to happen. RNs pushing propofol in a GI Lab, absurd. CRNAs thinking they hung the moon, idiotic. People theatening people with lawsuits over a posting in a chat room, go do patient care. MDs that are GOD, get used to it. No one is perfect. We all make mistakes. I would be ashamed to work with most everyone who has chimed in on this. You need to sit down and take a moment to reflect on where you have been, where you want to go and maybe healthcare is not your cup of tea. :stone

[rn29306]

thank you for your insight

[originalred]

I am still not clear on the downplaying of ACLS and PALS. True, it is 1 weekend every 2 years for most. Nursing school was 2-4 years...15 years ago, CRNA training is another couple of years on top of the critical care exp...10 years ago. Med school is...years...many years ago. All who want to exceed in their field must continue to gain knowledge and experience from what they learned from the weekend class last year or the 2 semesters they spent in A&P 12 years ago.

It is not the amt of time "in class". It is what you do with it "after you get out" that counts.

That is why you have good Drs and bad Drs, Good CRNAs and bad, Good RNs...

[stevierae]

People theatening people with lawsuits over a posting in a chat room, go do patient care.

Who did this? :uhoh21:

[originalred]

About 5 pages back....this thread was rather famous on allnurses.com and even another site that I enjoy visiting. It was rather interesting.

I will go back and look but there was something about an RN pushing propofol and someone else wanted to know who and where so they could be at the trial and testify....

The conviction on each side that they are SO RIGHT is intriguing to me. No middle ground. Gives you a glimpse into what we are up against in the Middle East. There are some people who will never change regardless of how well an argument is stated...

[jwk]

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.

[originalred]

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.

[stevierae]

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.

[spaniel]

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....