Bolus function on the IV Pumps

In my hospital system, giving a bolus of propofol, ketamine etc is considered practicing anesthesia and cannot be done by a RN. Its outside of our scope of practice = illegal in FL. Only a physician can give an iv push of those.

Ive seen it done under the table, of course.

Do you fellow ICU RN's have any experience in this and what do you do at your facility?

Where I currently work, if we have a patient on a continuous infusion of any sedation or analgesia, we always have an order for a PRN bolus equal to the hourly infusion. Typically, these infusions are ordered with a dosing range, and are titrated up, or down, by the bedside nurse based on either FLACC or RASS scores. If the rate is adjusted, the PRN dose is adjusted accordingly.

What you are describing was previously referred to as a nursing dose,” and depending upon where you were was a somewhat common, although unsanctioned or unapproved process. I think even then most state boards of nursing would have considered this practicing medicine. There was a previous thread (Nursing Dose) earlier this year in which this topic was discussed.

In my hospital system, giving a bolus of propofol, ketamine etc is considered practicing anesthesia and cannot be done by a RN…

You'll find this varies from state to state. In NC, an RN typically cannot administer a bolus dose of propofol to a non-intubated patient. However, if the ordering physician is in the room/at the bedside the RN can administer it as he or she is considered an extension” of the ordering physician.

As a new grad I learned what a "nursing dose" meant. Sometimes I would hear the term a "baptist dose" which in the Southeast meant, I gave double the Ativan. lol