RN doing conscious sedation non-intubated patient

Nurses Safety

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I am an RN Circulator. We have a surgeon that does pain injections. I am the anesthesia for the cases. I hook them up to all the monitors at the anesthesia machine and monitor them during the case. I push fentanyl and Versed. So my question is Do you think I should bed doing this? Would you push these drugs? Thanks for any feedback...:uhoh3:

Specializes in OB, M/S, HH, Medical Imaging RN.
heres a question for you guys... i work in an outpt endoscopy clinic and work with 2 RN's. neither of them are ACLS certified, and i am (paramedic), so they push the drugs and i monitor the patient and am on standby for any kind of emergency (while snaring polyps in the mean time). i told my boss i didnt think this was a very safe practice, and i wanted them to be ACLS cert too, because i have to bounce back and forth between procedure rooms and monitor the recovery room (there are only the 3 of us and a CNA) and she said it was no big deal because there is a physician in the area at all times.

what do you guys think?

In our imaging center the nurses all have ACLS. It is mandatory if you work in the dept in any capacity!

Specializes in Peds Cardiology,Peds Neuro,Pedi ER,PICU, IV Jedi.

We use these meds for conscious sedation while putting in chest tubes and central lines on the floor if necessary (ie - immediate intervention needed). The RNs draw up and push the meds while we monitor VS and intervene as needed. As others have stated, if you have questions, check the TX BON website concerning your scope of practice. It is my understanding, however, that you are able to perform conscious sedations - we have a CBT on it every year, and we do it here quite frequently.

Specializes in Peds Cardiology,Peds Neuro,Pedi ER,PICU, IV Jedi.
heres a question for you guys... i work in an outpt endoscopy clinic and work with 2 RN's. neither of them are ACLS certified, and i am (paramedic), so they push the drugs and i monitor the patient and am on standby for any kind of emergency (while snaring polyps in the mean time). i told my boss i didnt think this was a very safe practice, and i wanted them to be ACLS cert too, because i have to bounce back and forth between procedure rooms and monitor the recovery room (there are only the 3 of us and a CNA) and she said it was no big deal because there is a physician in the area at all times.

what do you guys think?

You are correct in your assesment that everyone involved needs to have ACLS. This is a "must have" when dealing with the potential complications. At my facility, everyone is required to have PALS if you work at the bedside.

heres a question for you guys... i work in an outpt endoscopy clinic and work with 2 RN's. neither of them are ACLS certified, and i am (paramedic), so they push the drugs and i monitor the patient and am on standby for any kind of emergency (while snaring polyps in the mean time). i told my boss i didnt think this was a very safe practice, and i wanted them to be ACLS cert too, because i have to bounce back and forth between procedure rooms and monitor the recovery room (there are only the 3 of us and a CNA) and she said it was no big deal because there is a physician in the area at all times.

what do you guys think?

To me, having a ACLS certification should be a job requirement for RNs practicing in an area where they are expected to give conscious sedation. Doesn't make sense to me. Yes, I think you are right, those nurses should get certified.

Specializes in OR, PACU, GI, med-surg, OB, school nursing.

I work in GI endo as a circulator. I push Versed & Demerol, monitor the patient, and handle specimen labeling. If Propofol is needed, an anesthesia provider comes in for the duration of the case. ACLS was an absolute requirement for the job; however, my scrub nurse is not ACLS-certified. I've only been in this job for two months and have not had any formal training in conscious sedation, but I'm going to an all-day conscious sedation workshop in May. I've read a lot on my own, but I can't wait for the workshop. I feel like I could definitely use more education on the topic.

Use of Propofol by RNs is a very controversial subject. It's my understanding that it's against the Nurse Practice Acts of most, but not all, states.

I gave Fentanyl and Versed in ICU, CCU, and Telemetry settings-where they were monitored and there was resuscitation equipment. We would also have respiratory therapy available during conscious sedation as well. We(nurses and physicians) also were required to have yearly consious sedation education and passing test as well as have BLS and ACLS (PALS if we were working with peds patients)

Does anyone have a test they would share on conscious sedation for nurses. I hate to create the wheel and need a quiz to go along with a competency session for cath lab rn's. email me at [email protected].. Thanks

Specializes in Emergency & Trauma/Adult ICU.
heres a question for you guys... i work in an outpt endoscopy clinic and work with 2 RN's. neither of them are ACLS certified, and i am (paramedic), so they push the drugs and i monitor the patient and am on standby for any kind of emergency (while snaring polyps in the mean time). i told my boss i didnt think this was a very safe practice, and i wanted them to be ACLS cert too, because i have to bounce back and forth between procedure rooms and monitor the recovery room (there are only the 3 of us and a CNA) and she said it was no big deal because there is a physician in the area at all times.

what do you guys think?

Respectfully, I think I would never have a procedure done in your endo clinic, nor would any member of my family.

The standard of care in my state is for the RN who administers moderate sedation meds to remain at the patient's bedside for at least 30 minutes after the last dose is given. No bouncing back & forth between rooms.

IMHO, only someone with their head up their butt would dream of running a free-standing (meaning back up is calling 911) procedural clinic with non-ACLS staff.

Specializes in ER/EHR Trainer.
I think you know very well what the answer to your question is.

1)You are operating outside of your scope of practice, 2)if you hurt anyone you will go to jail 3) You are saving the surgeon A LOT of money which does not make it right.

The job you are doing is called anesthesia, and nurses who perform anesthesia are call ANESTHETISTS. They usaually have a masters degree in anesthesia and certification. But you know this. Be careful okay? Use your noggin- you know the right answer....

Conscious sedation as practiced by those who are trained and in the states it is allowed is perfectly legal. In NJ critical care nurses can administer medication, however, during procedures the physician must administer the first dose. It is all a matter of checking with your BON and knowing your job requirements.

Maisy

Yes, this is absolutely correct, you must be certified in ACLS and have all emergency equipment at the bedside

Specializes in ICU.

I've pushed all of those drugs including propofol in an ICU setting. I did have to take the moderate sedation competency.

Specializes in Cath Lab/ ICU.
I think you know very well what the answer to your question is.

1)You are operating outside of your scope of practice, 2)if you hurt anyone you will go to jail 3) You are saving the surgeon A LOT of money which does not make it right.

The job you are doing is called anesthesia, and nurses who perform anesthesia are call ANESTHETISTS. They usaually have a masters degree in anesthesia and certification. But you know this. Be careful okay? Use your noggin- you know the right answer....

What!??? Is this a serious reply?

CS is my primary job. I push these meds daily...

As long as it is concious sedation, you are certified competant in CS (take the annual class and test), and you have ACLS you should be OK. Sounds like you are not using propofol which would be just one criterion that would cross the line (and there are enough threads here about that)

Also, you should not also be circulating the case. In most ORs, a second circulator is used. If you are giving sedation then monitoring the pt is your only responsibility.

in the cath lab, I do CS and circulate. We don't use a second circulator...

It's amazing the differences between locations! I'd hate to move and find my scope and job abilities limited.

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