Can RNs in CA give Propofol??

Nurses Medications Nursing Q/A

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  • by RNlmbhb
    Specializes in GI, Internal Medicine, Surgery, NICU.

I am new to California and looked up the policy for sedation meds that RNs can give and it is very vague. It states that a RN can give any medication as long as it a appropriately prescribed. I know in most states, RNs CANNOT give Propofol and just wanted to know if there is some other information I am missing?? I interviewed for a job today and the nurse manager told me that they give Propofol. I need to clarify with her if the RNs do, but from what it sounded like, they do.

26 Answers

Horseshoe, BSN, RN

5,879 Posts

RNlmbhb said:
Correct. They would train me and I would make sure I am comfortable with it before doing it. It is for an endoscopy job doing pre op, sedation and recovery. It's a small center (not in a hospital). So I'm a little skeptical, may ask her to clarify.

I would definitely proceed with caution. There is no reversal agent for propofol. That means you better darn well know what you are doing and feel very comfortable with your skill at inserting an airway/intubating if necessary, as well as all other ACLS protocols. There should be an anesthesiologist on site at all times, imo.

One nice thing about the Texas BON is that they are very specific with regard to how they interpret the Texas NPA. They go into great detail about RNs giving propofol, and here is their conclusion:

Quote
Therefore, it is the position of the Board that the administration of anesthetic agents (e.g. propofol, methohexital, ketamine, and etomidate) is outside the scope of practice for RNs and non-CRNA advanced practice registered nurses except in the following situations:

✔️ when assisting in the physical presence of a CRNA or anesthesiologist (the CRNA or anesthesiologist may direct the RN to administer anesthetic agents in conjunction with the CRNA or anesthesiologist intubating or otherwise managing the patients airway)

✔️when administering these medications as part of a clinical experience within an advanced educational program of study that prepares the individual for licensure as a nurse anesthetist(I.e. when functioning as a student nurse anesthetist)

✔️when administering these medications to patients who are intubated and mechanically ventilated in critical care settings

✔️ when assisting an individual with current competence in advanced airway management,including emergency intubation procedures

✔️ when utilizing a US FDA approved Computer-Assisted Personalized Sedation System in accordance with the US FDA approval requirements, where appropriate safety requirements are met (such as availability of anesthesia providers) after completing appropriate training.

http://www.BON.texas.gov/pdfs/practice_dept_pdfs/position_statements_pdfs/positionstatements2014.pdf

In other words, in the setting you are describing, the Texas BON would say that administering propofol without the physical presence of a CRNA or anesthesiologist would be out of your scope.

I would investigate your own BON's literature to see if they address this issue.

The Texas BON's last word on this issue is worth considering:

Quote
The Board again stresses that the nurse's duty to assure patient safety is an independent obligation under his/her professional licensure that supersedes any physician order or facility policy. It is important to note that the nurse's duty to the patient obligates him/her to decline orders for medications or doses of medications that have the potential to cause the patient to reach a deeper level of sedation or anesthesia.

kiszi, RN

1 Article; 604 Posts

I am not aware of any states that specifically prohibit propofol, although many states have some kind of statement on procedural sedation given by RNs, discussing proper training and skills, presence and/or availability of a CRNA or MD, and so forth.

I don't know the ins and outs of procedural sedation, because that is not my specialty, but I routinely use propofol on intubated patients in ICU. (North Carolina)

I'm sure you would not administer any medication for sedation without the proper skills and training, right? What type of position is this?

Specializes in Critical Care and ED.

There's a difference between running a propofol drip and pushing it. ICU RNs often run and maintain propofol drips but only anessthesia can push propofol.

EllaBella1, BSN

377 Posts

Specializes in ICU.

Yeah, in my state we can hang a propofol drip, but can't push it.

Horseshoe, BSN, RN

5,879 Posts

Since propofol can induce deeper levels of anesthesia, I'd just be really really sure you feel completely comfortable with how it's being administered at your facility. I work endo, and at my facility, propofol is not used for "conscious sedation," but as general anesthesia. We use CRNAs. RNs can give other drugs to induce conscious sedation, but not propofol.

Boomer MS, RN

511 Posts

Specializes in Med Surg/ICU/Psych/Emergency/CEN/retired.
Since propofol can induce deeper levels of anesthesia, I'd just be really really sure you feel completely comfortable with how it's being administered at your facility. I work endo, and at my facility, propofol is not used for "conscious sedation," but as general anesthesia. We use CRNAs. RNs can give other drugs to induce conscious sedation, but not propofol.

I am in CA. While still in the ED, I was asked to push propofol for procedural sedation. I refused and gave it to the ED MD to push. The dose was much lower for procedural sedation. In that facility, the ED MDs loved it b/c of its short half-life. Patients woke up sooner with much less drowsiness. I became unpopular (not one other RN questioned giving it) when I went to ED medical director, which sort of opened up pandora's box. Anesthesia was furious that it was being given for procedural sedation and stopped it, stating that the ED MDs were not trained in the use of such drugs. Perhaps a turf war, but I was so uncomfortable. That is also because at my previous job at the U of Pittsburgh ED any drug like that for procedural sedation was drawn up by RN, pushed by anesthesia with RT at the bedside. New rule at CA facility was that only intubated patients could receive propofol in the ED by an RN. I do think, however, if there is written policy in place, you will be fine with proper training. But go with your gut. I remain puzzled at what goes on in different facilities.

Specializes in ICU.

As an icu nurse, we hang propofol drips all the time. We also bolus propofol. That's an interesting situation you bring up.

Horseshoe, BSN, RN

5,879 Posts

NurseGirl525 said:
As an ICU nurse, we hang propofol drips all the time. We also bolus propofol. That's an interesting situation you bring up.

I did too, in ICU. But my patients were on the vent. If you are giving propofol to a patient as part of sedation, you've got to be really careful not to depress their ability to maintain their own airway. And lacking a reversal agent, you also need to be able to intubate or have someone in the vicinity who can. I personally don't have the skills to do that, even though I know in theory how to do it.

Specializes in ICU.
Horseshoe said:

I did too, in ICU. But my patients were on the vent. If you are giving propofol to a patient as part of sedation, you've got to be really careful not to depress their ability to maintain their own airway. And lacking a reversal agent, you also need to be able to intubate or have someone in the vicinity who can. I personally don't have the skills to do that, even though I know in theory how to do it.

We use it for our vented patients as well. There is a whole protocol in place as well with it. We don't keep them sedated any longer than they need to be. Most get a sedated vacation each day as they try to get them off sedation as much as possible. It does have a short half life though, which is nice. It's why we use it, as opposed to other agents.

sammiesmom

144 Posts

Never seen docs around here order it for moderate sedation only on vented patients. I will not be comfortable "pushing" this drug on unvented patient.

Lev, MSN, RN, NP

4 Articles; 2,805 Posts

Specializes in Family Nurse Practitioner.

In my state, RNs can hang propofol as a drip but they are not allowed to push propofol. 99% of the time we use propofol to sedate our intubated (but not brain damaged) patients in the ER and also commonly use it for conscious sedation in the ER because it is so short acting. We have respiratory therapy at the bedside and end tidal monitoring set up for all conscious sedations and we will bag if needed.

chivon101

91 Posts

Specializes in ER.

In Texas as a nurse you are not allowed to push propofol but the ED docs use it all the time for procedural sedation. In California I was able to push it for for procedural sedation. We use it all day, everyday for reductions of broken bones and shoulder dislocations. It's not that bad and has a short half life. Sometimes we use ketamine but mostly propofol. We also use it for intubated patients especially those with head injuries. It's preferred where I work due to the short half life, neurologist can turn it off to assess the patient.

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