Any NPs Administering Propofol?

Specialties NP

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Specializes in general, interventional card and ep.

Hi, I am an NP in the Cardiac Services Dept (mostly Cath Lab/EP service for now). My administrator has proposed an addition to my responsibilities---administering propofol for our Electrophysiologists during DFTs/ICD implants/cardioversions.....I have been assured this is legal and within my scope of practice, but I will be looking into this myself. I plan on speaking with the NY State Board of Nursing tomorrow.....just wondering if any one else out there is doing this, what you did to become credentialed, any tips etc.....Thanks in advance!

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Specializes in Nephrology, Cardiology, ER, ICU.

I think you are wise to take it up with your state BON.

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I think you are wise to take it up with your state BON.

.... and get their response in writing.

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Specializes in Transplant/Surgical ICU.

I am confused, as an ICU RN it is within my scope of practice to administer propofol. So, why can't you (an NP)? Is it because in the EP lab it would be used as an anesthetic? Are nurses only allowed to administer propofol to vented patient with a secure airway?

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Specializes in Cardiac.
Are nurses only allowed to administer propofol to vented patient with a secure airway?

Bingo. We are only allowed to give it in pts with protected airways.

In addition, we are only allowed to give it as an infusion, not IVP. Whearas for conscious sedation/procedures it's given as an IVP.

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Specializes in Transplant/Surgical ICU.

i found this article: propofol sedation: who should administer?

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I am confused, as an ICU RN it is within my scope of practice to administer propofol. So, why can't you (an NP)? Is it because in the EP lab it would be used as an anesthetic? Are nurses only allowed to administer propofol to vented patient with a secure airway?

The difference is that a RN follows orders and a NP gives them, just like a doctor. You can't even begin to compare our scope of practice or the liability associated with it. A NP may be a RN, but a RN is NOT a NP.

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Specializes in general, interventional card and ep.
Bingo. We are only allowed to give it in pts with protected airways.

In addition, we are only allowed to give it as an infusion, not IVP. Whearas for conscious sedation/procedures it's given as an IVP.

That is exactly the situation--I am being asked to administer bolus dosesfor moderate(deep?) sedation IVP. I can't find anything on the NYS Dept of Education/Board of Nursing website about NPs administering, only that RNs cannot administer or monitor pts receiving propofol without protected airways....

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Specializes in Nephrology, Cardiology, ER, ICU.

In IL, there must be an MD in the room and/or CRNAs can give in the OR (where full intubation/resuscitative equipment is readily available). There must also be someone present (in the room) that is trained and able to immediately intubate.

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Specializes in general, interventional card and ep.
In IL, there must be an MD in the room and/or CRNAs can give in the OR (where full intubation/resuscitative equipment is readily available). There must also be someone present (in the room) that is trained and able to immediately intubate.

How would it work if the MD in the room is the doc implanting the ICD (the operator)? Could an NP give the propofol and monitor the patient? Thanks for taking the time to respond here. :up:

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.

We always have an anethesia resident and attending to administer anesthetics to non-intubated patients in the ICU during procedures that require some form of conscious sedation such as elective cardioversions. However, hospital policy only allows personnel from anesthesia to intubate in the ICU and us ICU NP's are not credentialed to intubate. I've ordered conscious sedation medications to already intubated patients in the ICU for bedside procedures such as bronchoscopies and thoracenteses that we can do on our own. I should try to find out what the protocol in our EP Lab is from our NP's in Electrophysiology.

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How would it work if the MD in the room is the doc implanting the ICD (the operator)? Could an NP give the propofol and monitor the patient? Thanks for taking the time to respond here. :up:

Illinois is unusual as it is the only state (as far as I know) to regulate conscious sedation by CRNA's. The nurse practice act there has pretty explicit regulation of conscious sedation. It then goes on to lay out the educational requirements for the physicians (ie how much CME they must have to supervise CRNAs doing cases under their supervision). The requirements are different for general anesthesia.

In most other states conscious sedation is not addressed in the NP practice act. There are generally rules about anesthesia being the domain of the CRNA. Part of the issue comes from the PI of Propofol which states it should only be given by an anesthesia provider. However, off label use of a drug is common. There are a number of studies that show that it is safe when given for procedural sedation by trained RNs. Given that it should be fairly easy to show that it can be given by a trained NP.

The other issue deals with the RN license. I'll defer to the experts but if a procedure (ie Propofol administration) is specifically prohibited for an RN is it also prohibited to an NP (as the NP license derives from the RN license)? Assuming of course that it is not addressed in the NP rules.

The reason that this is probably germane is that Medicare issued rules last year allowing NPs (and PAs) to bill for conscious sedation. This can add between $3-900 dollars to a practice income for a sedation. As a number of others have mentioned only the BON can answer this question. The state law does not specifically answer it. However I not a number of red flags that may indicate they are not so inclined.

1. NPs in NY must operate under a practice protocol. I doubt any of the protocols are sufficiently new to address conscious sedation (specifically Propofol sedation). The ACNP book may address it. Caveat I have not read all of the books listed.

2. NY is very restrictive on who it allows to give anesthesia in an outpatient setting. For example on physicians are allowed to give GA in an office based setting for Podiatrists.

This is an interesting area for NPPs. Good luck

David Carpenter, PA-C

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