NAPS (Nurse Administered Propofol Sedation)

  1. 0
    I am a relatively new RN (1 year in an ASC) who just took a new position in outpatient endo. Part of my job will be administering the mod sedation using fentanyl and versed and I am receiving training to do this.

    I have heard NAPS being tossed around a bit. I don't know if it is something the center is considering, and truthfully I haven't yet researched the position of my state's BON.

    The articles and position statements I have read thus far indicate a fair amount of polarity in opinion....GI docs seeming to approve of NAPS and CRNAs and anesthesiologists dead-set against.

    Anyone out there have any experience with NAPS? Or just an opinion and a point of view for me to think about?

    Thanks!

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  2. 8 Comments...

  3. 0
    Never heard of it but sounds dangerous. Of course the GI docs are for it because it would be more $$$ for them instead if having anesthesia there. What is going to happen when a patient goes apneic or obstructs? Who will be there to manage the airway or intubate if need be? Sounds like a catastrophe waiting to happen.

    I would check your states nurse practice act and see where it stands on propofol administration and who can do it.
  4. 0
    I've never heard of it, but nurses administer propofol for sedation in an ICU setting on a regular basis. Granted, those people have a secure airway already. Propofol has a very short half life and really if something goes awry you can bag the patient until it wears off. It's frequently better tolerated than fentanyl/versed. I would hope older patients, patients with cardiac or respiratory issues, OSA patients, liver or renal failure patients and other high risk patients would continue to be anesthesia cases.
  5. 0
    Quote from blondy2061h
    I've never heard of it, but nurses administer propofol for sedation in an ICU setting on a regular basis. Granted, those people have a secure airway already. Propofol has a very short half life and really if something goes awry you can bag the patient until it wears off. It's frequently better tolerated than fentanyl/versed. I would hope older patients, patients with cardiac or respiratory issues, OSA patients, liver or renal failure patients and other high risk patients would continue to be anesthesia cases.
    Except that the overwhelming majority of people's basic airway management skills are subpar at best. More often than not the stomach is insuflated instead of the lungs.

    No RN would be administering propofol to me or my family for sedation without a definitive airway.
  6. 0
    Quote from meandragonbrett
    Except that the overwhelming majority of people's basic airway management skills are subpar at best. More often than not the stomach is insuflated instead of the lungs.

    No RN would be administering propofol to me or my family for sedation without a definitive airway.
    But you'd be okay with RN administered fentanyl and versed? There's a very real risk of respiratory depression there too, and those drugs last a lot longer, though have reversal agents. I think all RNs should be able to properly bag a person for a length of time, since anyone can have a patient code on them. I truly hope a nurse administering any type of sedation has proper bagging skills. I would also hope in this setting that the RN has a higher trained resource to call in an emergent situation.
  7. 0
    Quote from blondy2061h
    I've never heard of it, but nurses administer propofol for sedation in an ICU setting on a regular basis. Granted, those people have a secure airway already. Propofol has a very short half life and really if something goes awry you can bag the patient until it wears off. It's frequently better tolerated than fentanyl/versed. I would hope older patients, patients with cardiac or respiratory issues, OSA patients, liver or renal failure patients and other high risk patients would continue to be anesthesia cases.
    Administering a propofol gtt to a vented ICU pt is completely different then pushing it for sedation for GI procedures. Yes the half life of propofol is real actively short, it is not short enough to prevent an anoxic injury if too much propofol is given and the pt goes apneic and/or obstructs. As a PP mentioned most people not trained in airway management have poor BVM skills and bagging against an obstructed airway is just about the same as not bagging at all. This is why this seems really dangerous.
  8. 0
    Sadly, this is being driven by insurance companies that don't want to pay for CRNA/MDA to administer during scopes.
  9. 0
    Quote from blondy2061h

    But you'd be okay with RN administered fentanyl and versed? There's a very real risk of respiratory depression there too, and those drugs last a lot longer, though have reversal agents. I think all RNs should be able to properly bag a person for a length of time, since anyone can have a patient code on them. I truly hope a nurse administering any type of sedation has proper bagging skills. I would also hope in this setting that the RN has a higher trained resource to call in an emergent situation.
    I would be ok with that. Fentanyl is very forgiving and you won't see respiratory depression with the doses of versed used for sedation in out pt procedures. As far as fentanyl, as you mentioned it can be reversed, but the half life is not that long. Having proper bagging skills and delivering effective ventilation are too different things. Just mashing the mask down and squeezing the bag is not bagging. Even with proper technique you may not be delivering effective ventilation if the airway is obstructed.
  10. 3
    Before Micheal Jackson used it as a sleeper and was killed by an incompetent PHYSICIAN!!!.....RN's competent in conscious sedation we able to give propofol....and in many states still do.

    I have given propofol many times in conscious sedation situations. With the proper training it is perfectly safe. YOu do NOT need to be a CRNA.

    However, with the proliferation of CRNA programs and the pursuit of the "big bucks" the bedside nurses have suddenly become incapable of these responsibilities Is a CRNA really NECESSARY to give a drug safely? This will get me flamed but I say no........it is unfortunate that the responsibilities of the RN are being minimized and "dumbed down" in favor of the use of move expensive nursing personnel. We were trained in the use of an LMA and anesthesia had to be in house. These patients were 1:1's until full recovery...with obvious dose/sedation limitations.

    Today....... if you are "JUST" a RN you are incapable of competent thorough and care. Annoying really.
    Devild0g, thelema13, and blondy2061h like this.


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