Just wondering, how many of your vented pts are sedated, and with what? Are there certain pts that you always do or do not sedate, or is it always a case by case basis.
Most nurses on my unit would agree that we do NOT sedate people enough. Of course, I know we shouldnt be snowing every pt in the unit, lol. Nobody gets propofol, if they come in on it they have us stop it. They typically don't order anything continuous right off the bat... maybe they will order something Q1hr PRN and then when you explain how it doesn't make sense to be in there pushing fentanyl every hour, then you may get a continuous PCA dose.
We do end up with quite a few people on continuous Fentanyl, usually running at 50-100, maybe up to 200 after they are on it long enough and still sitting straight up in bed.
Rarely we might have a mg or two of Versed on board as well.
The only exception would be our pts on bilevel- most times they are very well sedated and paralyzed.
... they keep trying to make plans to help decrease our # of unplanned extubations (big problem in our unit) but none of these plans involve adequate sedation.
Ugh! Some nights I feel like I'm in the rodeo. Plus, we have all private rooms, so if I'm stuck in one, have no idea whats going on in the other until alarms are going off.
Opinions/ experiences/ advice??
How cruel!!!!!!!!!! We ALWAYS sedate. Most patients who require intubation will need at least 24hrs vent/rest time before even discussing wiening/extubation. I would fight this tooth and nail. Maybe you should intubate your medical director and then see what he thinks! Hope I don't have to be in your ICU!
Fight the good fight and keep advocating for your patients!
If we couldn't sedate our patients, most of them we couldn't get a decent enough ABG to start wiening. I HATE using fentanyl for "sedation". Fentanyl is for pain control and just like other narcotics, it sometimes has the opposite effect and instead of sedating, it causes aggitation.
Lord, I would have to be sedated if I couldn't help my patients be comfortable and heal!
Last edit by mlykateRN on Aug 21, '12
: Reason: add something else