Bedside surgery with no sedation

Trauma Columnist · Jan 30, 2005

Unbelievable. I too have had docs try to start procedures w/o adequate sedation/analgesia. Never gonna happen when I'm around. Being a patient advocate is what its all about!

Debbie_LPN · Jan 30, 2005

It really makes you upset. And yes, if that was the doctor's own family, then he would have used meds. Personally I think some doctors shouldn't be doctors.

AmiK25 · Jan 30, 2005

If the patient has a prn, by all means give that. If not, respectfully ask the MD if he/she is sure the patient should undergo an invasion procedure without analgesia/sedation. If you need to, respectfully refuse to participate in said procedure if the patient does not receive medication. Typically, all it takes is to say "are you sure....." and the MD will say, "ok, go ahead."

Ether,

No, you cannot give a medication without an MD order but you can usually pressure the MD into ordering something. You just have to remember to advocate for your patient in a firm, but civil manner.

renerian, BSN, RN · Jan 30, 2005

While it is not the Popular thing to do I have stood between several patients and doctors for things like that. I have also refused to let certain residents touch my patients after realizing they did not have the skills to do lets say a spinal tap. I move up the chain and am not treated kindly but hey it goes with the turf. I always say the Pad, "what if this was your mother or wife, what would you want done?"

renerian

Trauma Columnist · Jan 30, 2005

Yep - my line too Renerian!

BittyBabyGrower, MSN, RN · Jan 30, 2005

We had a plastics resident that went into a mom's room and tied and snipped an extra digit off of a kid. Didnt' tell us, just went in and did it.

I have seen more than one doc try to do procedures without pain meds in neonates...they don't seem to take the little ones as being ones that can feep pain. I had an anesth. guy bring a kid back after a PEG and said that he only paralyzed the kid, no pain meds, since "a PEG really doesn't hurt" He didn't like it when I said, Oh, have you ever had a big hole poked in your gut and a tube shoved it, and on top of it be paralyzed and can't scream or cry? He told me he was going to write me up for insubordination. I told him go right ahead.

renerian, BSN, RN · Jan 30, 2005

Snipped off a digit. LORDY that is horrible. Wow I am sure the parents were angry and hot about that...........

renerian :angryfire

Long Term Care Columnist / Guide · Jan 30, 2005

Hear, hear! I've never seen anything as blatantly inhuman and inhumane as what was witnessed by the OP, but I've gone rounds with docs many times on pain control issues, and the clincher is usually "If this pt was YOUR mother/wife/sister/daughter/fill in the blank, what would you do?" Of course, none of the MDs I work with would do any invasive procedure without ordering at least a couple of Percocet beforehand....... :angryfire

maturner · Jan 30, 2005

I witnessed a very sad incident yesterday. My elderly client was undergoing an EGD/ PEG tube placement, and received no sedation or pain management during the procedure. I was in a difficult situation (still a student). The nurse assisting the Gastroenterologist asked how much medication to give the patient, and he said casually "Don't worry about it." This patient was in the ICU because she had just experienced a stroke and was not able to communicate, so she wasn't a typical anxious surgical client - nevertheless her HR was in the 160s during the surgery and her BP went to 192/87. After the procedure her face was red and there were some tears from her eyes. This patient broke my heart - after the procedure my nurse preceptor and I brought her 2mg Versed and 4mg Morphine, which calmed her significantly.
Why would a surgeon not allow sedation/pain management for such a procedure? How would you have handled this situation?

From where did the order for the morphine and versed come?

begalli · Jan 31, 2005

Sheesh! No offense, but forget "what would you want for your family, yourself, etc.," and unless placing that PEG was a matter of life or death at that very moment, much like a medic in the field needing to secure an airway by way of a surgical trach, what the OP describes is just plain unethical! ANd we all know placing a peg is NEVER a matter of life or death! :rolleyes:

I would get in the bed and lie on top of my patient before I'd let ANY doctor do that to any one of mine.

When fellows or senior residents show up with their young residents to do procedures on my patients and if they don't order sedation and/or narcs right away, I ask "what do you want to use." I don't make it sound like it's a choice and they know that their procedure isn't getting done without me. Sometimes they need a little prodding or some suggestions just to remember because they're nervous.

Anyway...something like this would fly to ethics so fast, the docs heads would spin.

begalli · Jan 31, 2005

From where did the order for the morphine and versed come?

That's a good question. Because if a prn was already available, the RN, using her/his good judgement, should have given it whether the docs liked it or not.

RE Agent · Jan 31, 2005

I witnessed a very sad incident yesterday. My elderly client was undergoing an EGD/ PEG tube placement, and received no sedation or pain management during the procedure. I was in a difficult situation (still a student). The nurse assisting the Gastroenterologist asked how much medication to give the patient, and he said casually "Don't worry about it." This patient was in the ICU because she had just experienced a stroke and was not able to communicate, so she wasn't a typical anxious surgical client - nevertheless her HR was in the 160s during the surgery and her BP went to 192/87. After the procedure her face was red and there were some tears from her eyes. This patient broke my heart - after the procedure my nurse preceptor and I brought her 2mg Versed and 4mg Morphine, which calmed her significantly.
Why would a surgeon not allow sedation/pain management for such a procedure? How would you have handled this situation?

Why not give the meds before the procedure? A B/P in the 190's after a stroke is asking for trouble. Who can you report this doc to? I would not let this go unaddressed, and I would refuse to help this doc in a procedure like this. Nurses are patient advocates, aren't we?