procedural sedation - page 4
Are any of you out there involved in providing "conscious sedation," or "procedural sedation?" If so, in what setting? Any guidelines or tips from your experiences? Thanks... Read More
Jul 1, '02Anyway, to get back to the original question, BRobison (if you're still even checking for replies), I am an RN in the cath lab and we give CS ALL THE TIME. However, the hospital has just recently changed the name of the policy to "moderate sedation" just to really confuse everyone. RN's in certain settings (cath lab, radiology special procedures) can give CS under MD (in our case, cardiologist) supervision. We use Versed and Fentanyl primarily, although we have in our narc box IV Valium and Morphine as well in case we need it. Of course we have Narcan and Romazicon readily available. In order to be able to give CS we must pass a competency test, and all doctors that we work with are required to pass a competency test of their own, as well. We continuously monitor EKG, O2 sat, respiratory rate, LOC, and check NIBP q 5 min. (During many of our procedures we have an art line in, as well, as part of the procedure.) If patients are ASA Class III or higher, require supplemental O2 to keep pulse ox >92%, or have a history of sleep apnea we are required to call for an anesthesia consult per the policy. We VERY rarely (and I hope I'm not jinxing myself, here) need to reverse our patients (on the scale of maybe once or twice a year, at least in my department).
As a side note, nurses in my facility can not give propofol to patients who are not intubated. In the ICU we do use propofol drips for sedation for vented patients, as well as Versed and Fentanyl drips. In the cath lab, we often do cardioversions and have anesthesia come to administer propofol. If they're unavailable, we use our standby Versed and Fentanyl, but it's so much nicer to have them there--for us and for the patients!!
Hope I answered your question.
KarenLast edit by NurseGirlKaren on Jul 1, '02
Jul 9, '02Thanks, Karen, for your thorough response. Sounds like your department isn't cutting any corners and is providing a good situation for patients and staff, alike.
Aug 2, '07I work in radiology, and we are trying to bring about change in the way we perform sedations for MRI. Currently, a patient who is medicated with ativan before coming down for a procedure is not required to be monitored, but if we medicate this same patient in the department for the same procedure, we must monitor and do all the paperwork that goes along with it. How is this type of thing handled in other facilities?
Aug 11, '07the OP was over 5 years ago, this is a really old thread, even seems like recent post would be more appropriately handled in critical care nursing forums...just my two cents
Aug 12, '07The use of propofol as a sole agent for sedation is safer and results in less side effects than do versed/fentanyl, and may be safely be administered by RNs in the endoscopy, office surgical suites, ED, oral surgeons offices, and ICU without the need of CRNAs or MDs, that could not possibly numerically supply the numbers needed should the anesthetists/anesthesiologists be required for administration of this drug. Mix propofol with anything else, and it is a different ballgame with worsening respiratory obstruction. Propofol administered as a sole agent in small boluses, causes respiratory depression for less time than it would take the nurse to access narcan and flumazenil, administer them, then wait for the effect. RNs can and should be administering propofol as a sole agent in those settings. The company that currently has the IND for the drug that is nearly 2 decades old, has no impetus to spend the millions necessary to eliminate the warning on propofol that has largely been supplanted by clinical practice that has demonstrated safety and efficacy of RN administered propofol.
We need to use the precious resources available for delivery of anesthesia to the patients that are high risk and need such rather than creating regulatory barriers to the RN administration of this drug, especially when the CRNAs and MDs are not planning to be available for its administration in the office or dental setting, nor would be reimbursed by insurance for their presence in such settings.