Cardioversion Sedation goes Beyond Moderate-Help

[taj09]

I need some sound advise from experienced nurses regarding IV Conscious Sedation in the setting of elective cardioversion. In our Texas cath lab we perform these with the cardiologist at the bedside. We are administering the med-usually midazolam and mepheridine concurrently (never propofol). We are ACLS/BLS current, and have the reversal drugs at hand full monitoring equipment, etc. Problem enters with Texas BON position statement that "it is beyond the RN's scope of practice if the patient goes beyond the concept of moderate sedation" yet they admit that sedation is on a continuum and it is not always possible to predict how an individual will respond.

We are actually rendering the patient unresponsive (deep sedation) to give up to 3 stacked shocks.

So I ask the facility risk manager- her response was "as long as the physician is qualified to rescue an airway"... and is current in his qualifications we are "okay". So I ask who's responsibility is it to make certain the cardiologist is qualified (assuming it is the facility) and I haven't received a response. It's been 2 months now.

Now I have been a critical care nurse for 16 years, a cath lab nurse for 7 years and know the docs. We haven't had any bad outcomes and I feel confident in rescue and sometimes feel like I can handle the situation better than the doc.

So what are your thoughts on this?

[taj09]

To JoPACU RN,

"Suggest you get studies to prove this as what you do is no longer standard of practice."

So my question is what is the current standard of practice out there on elective cardioversions and whos standards are being followed?

[*traumaRN*]

It is fairly common that sedation goes beyond "moderate" sedation. In fact in the ER for joint re location and cardioversion often these procedures cannot be completed without "deep" sedation. Another reason why propofol should be the drug of choice for these procedures, if they get to deep and stop breathing spontaneously you bag/mask for a couple of minutes and they wake up fine. Not the case with narcotics and benzos. Of course you have reversal agents but you open yourself to whole new set of problems if you go that path.

For a list of state by state nursing regs click here (link censored by admin)

If you are concerned about not being prepared to rescue the patient, then learn how. You have been a nurse for how long? Nurses expect the State Board to be on there side. State boards have one purpose - To protect the public, that's it. don't look to them to bail you out of anything.

I do not understand why so few nurses take it upon themselves to be proactive in learning more. Airway courses are available, sedation training courses are available, propofol sedation training for nurses courses are available.

If you Google any of these phrases you will find places that provide such training.

It is through education and training that you gain the confidence and competence to provide proper patient safety.