RN doing conscious sedation non-intubated patient - page 4

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.... Read More

  1. by   MiriamCCRN
    I see no reason why you cannot administer conscious sedation for procedures.
    As long as you are ACLS certified and have completed a CEU or CBL on it.
    The best thing to do is check with your state board of nursing, as each state is different. In Missouri their is no restrictions. In our facility the RN's administer fentanyl and versed for endoscopy procedures, if the physician wants propoful then anesthesia comes in on the case.
  2. by   sweetnepenthe
    Any patient could stop breathing from any or all of those drugs, so my concern would be whether or not I could effectively manage a patient's airway in the event of respiratory arrest.

    If I could not do it myself, is there someone IMMEDIATELY available who can?

    Just because a doctor is there does not necessarily mean that the doctor is skilled at airway management. An RT can usually bag well, but may not necessarily have good intubation skills as not every facility in every state permits RTs to intubate.

    Are airway management adjuncts such as LMAs, ETTs, ambu bags, suctioning equipment on hand for immediate use and ready to go?

    My recommendation would be that all nurses who give conscious sedation have actual practice on live patients in airway management--say a regular rotation in the OR with the anesthetist--to perform bagging and LMA insertion at the very least.

    Airway management is an art.
  3. by   ®Nurse
    Quote from nrskarenrn
    know thy practice act along with facilities policies!! op is talking about conscious sedation in non-intubated patients, giving first dose ---added to thread title for clarity.

    about 13 states do not permit rn's administer in this situation unless crna's

    list by state available at society of gastroenterology nurses and associates:

    competency assessment:

    1 moderate sedation self study module for non- anesthesiologists

    guidelines for competency assessment as a monitor for moderate

    test: moderate sedation competency assessment test

    happily for me, this practice is absolutely legal and endorsed by my facility in the state of california for both intubated and non-intubated patients. many procedures are done under conscious sedation and it is not a stretch at all, as a critical care rn, to do conscious sedation at the bedside. i also am required to perform a yearly competency check for my facility, much like the two-year competency for acls, pals, nals, etc.....
  4. by   guerrw
    I am an RN in a federal facility in florida. I work on an out patient clinic were we do conscious sedation for GI cases. I have been adminestering versed and phentanyl for about 4 yrs there until I found out that in the state of florida conscious sedation is not in our scope of practice. Now my employer wants to say that federal law trumps state law and that as long as they are asking me to do it is OK. However the same legal counsel that prepared the papers sent to me had a disclaimer that stated that if the state were to bring charges agains a nurse for doing this, they would defend us but could not garantee that they would win the case. Meaning I could loose my license. Does anybody know how I could approach this with my employer?
  5. by   AggieNurse99
    In TX, you as a nurse competent in moderate sedation with your facilty, can give fentanyl and versed. You are not allowed to give propofol to a non-intubated patient as a RN.
  6. by   kristykat
    I'm a nursing student in FL doing clinicals at a federal facility. The day that I spent in the GI lab, one of the RNs was responsible for conscious sedation using versed & fentanyl as well. I didn't realize that it's outside of our scope here.
  7. by   Babs0512
    Here, in NY, as an RN, I too was able to do concious sedation using versed/fentanyl or valium/morphine but never propofol. The patients had to be on O2, cardiac monitor, pulse ox, automatic BP, etc... We all had to be ACLS certified or PALS if it was a child and the crash cart had to be in the room. We also were credentialed by the hospital in concious sedation. My biggest beef with these procedures, is having to argue with the physician because the patient was "moving" and they would want to give them more of which ever drug - when their respiratory rate was 8 bpm - or their BP dropped into the 70's systolic - and the doc would say give more versed.... I would have to politely refuse - I remember a time when this situation happend, and I refused to give the med, the doc drew it up and gave it anyway - the patient ended up in ICU in near resp arrest. Narcan/Romazicon didn't help rouse the patient - my report CLEARLY stated my objection and refusal to give more medication - the reasons why, and the doc being an obstinate pie hole - did it anyway. The good news, the patient lived, and he never questioned my decisions after that. Lesson learned.