Using Propofol for sedation on vented pts?

[Scrubz]

Is Propofol used on vented patients? Since the half-life of Propofol is so short wouldn't it be more justified using a longer activing sedative? I assume that Propofol isn't used for long-term vented pts right? Maybe just initially?

I'm still in school so I have no experience with any of this other than what I hear or see, so thanks for any responses. I was just curious.

[danamobile]

do employers have clear outlines for specialized drug administrations in most p laces of work? that scares me, seeing ill likely be working in the states next year!!!

[cardiacRN2006, ADN, RN]

Is what you are asking, "How will I know what I can and can't do in each state?"

[danamobile]

Is what you are asking, "How will I know what I can and can't do in each state?"

i think so lol :) or if the information is readily available as well..

[cardiacRN2006, ADN, RN]

You know....I don't know!

It's easier for me, because I learned what I can and can't do in nursing school. I can go to my BON's website and look up my scope of practice and nurse practice act. I can only assume that you can do the same for each state...?

[Indy, LPN, LVN]

Propofol is milky white goodness. We aren't allowed to bolus it. Strict policies outline it's titration using a written starting rate, ie., 10 mcg/kg/min, and titrate to a rass of -2. We get the MD's to bolus (vented patients only) when needed, though they occasionally telepathically bolus while inserting a line. It's hard to multitask when you are in a sterile field.

Wow! Telepathy? If I could do telepathy I wouldn't need a second set of hands during foley insertions or dressing changes... that would be so nice!

[dfk, RN, CRNA]

Wow! Telepathy? If I could do telepathy I wouldn't need a second set of hands during foley insertions or dressing changes... that would be so nice!

i don't know about you, but i was able to develop the skill of putting a foley in with my teeth, that way i freed up my hands for other stuff. really cuts down on time !

[danamobile]

i don't know about you, but i was able to develop the skill of putting a foley in with my teeth, that way i freed up my hands for other stuff. really cuts down on time !

if you can inflate the balloon by blowing, then you have mad skillzzzz

[junebuggy9]

Looking for info on how many step-down units are using propofol vs. the units. At this time we only use it the icu's, but the docs are saying other hospital are using it in the step-downs. Any one using in the step-downs? Thanks for the help.

[pinkeyICU]

Propofol should never be bolused except under the direct supervision of an MD (although I know some "slips in" at times). I've seen nurses bolus for hypertension, which is inappropriate. The cause of the hypertension should be determined....is it simply agitation? Does the pt need pain medication? Does the pt need an antihypertensive agent? I, personally, love propofol, however we should not let ourselves slip into becoming lax with something due to familarity. Also, if your facility goes to "smart pumps" with wireless connection to pharmacy, someone could get in big trouble for bolusing propofol. The short-term benefits do not outweigh the possible long-term effects on my career to risk that.

Also, "milk of amnesia" is a misnomer, as propofol has no amnesia properties (unlike versed). I once had pt tell me (after extubation) that he remembered everything the nurses were saying when he was sedated. Yikes! I remember that whenever I'm bathing my intubated, diprivan'ed pts....They may remember when they wake up!

Also I have worked places that switch over from propofol to versed after 48 hours (much to nurses dismay in many cases because it is SOO hard to get a wild one down quickly w/versed). However versed is a slightly safer drug, and much cheaper (draw your own conclusions). I have also worked at a facility that uses propofol exclusively, no other sedating gtt for tubed pts. They also have standing weaning parameters, which necessitates the quick vacation/resedation propofol offers.

And, I'm pretty sure the package insert states that propofol should only be used in surgery and ICU, not step down units. I, personally would not like to see step-down units using propofol. Too much margin for error when you've got 4 or more pts and are not constantly, visually, monitoring them.

[gradcare, LPN]

To junebuggy

re step downs using the "milk of human kindness". I'm presuming that these pts do not have an artificial airway and are not vented (that's what step down is to me). Thinking about how the stuff actually works, then using a substance with little difference between what "settles you down" and what "takes you down" can get a little hairy. (and I'm too old to do "interesting" anymore).

Also last year there was a thead on neuroicu re propofol infusion syndrome which can cause things as benign as green urine or as bad as mycardial dysfuntion.

To me these things rule out propfol for the non intubated pt (except as an induction agent).

I think there was also a thread regarding propofol on the CRNA side of thigs too.

Cheers.

[bethem]

I'm in Australia. We can, and do, bolus propofol, midazolam, morphine, fentanyl - whatever's running if we need to. Obviously clinical judgement prevails - you won't be slamming a giant bolus into a hypotensive patient, but if it's sedate or lose the tube, we sedate. Love it!

[swolfe_2]

We want a short half life so that we can turn it of to do "sedation vacations" and check pt's neuro status etc....... Also if your pt starts to dump their BP for any reason, you need to be able to lighten their sedation. Propofol can decrease cardiac output. Usually pts will have trach placed after a few weeks.