Conscious Sedation Cath Lab

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Hello all

It seems that regulations differ HUGELY from state to state when it comes to RNs administering conscious (moderate) sedation, which includes analgesia. I have read a few older posts on this subject on this website: can any seasoned RNs out there give me some current feedback about current practice please? In settings such as radiology and cath lab, what are nurses administering and what is beyond the limit of the RN scope of practice? At what point does the anasthesia provider need to be present (by that, I guess I mean who out there is administering propofol?) And...why the hell is it so fragmented and non standardized? It makes me a bit nervous! One state says it's fine - the next state says it's illegal...How are we to know which drugs we are legally permitted to give as RNs when there are literally thousands of them out there? Obviously we come across the 'commonly used' drugs depending on where we work, so we feel confident about what we can and can't do. But, it's not always that clear cut, is it. Sometimes the situation is unusual or our practice is callenged. RNs out there who are NOT CRNAs, please let me know what y'all are up to when it comes to CS. I will be working in a Cath Lab soon and am interested to know what everyone is doing. Thanks!

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Specializes in CRNA.

I'm not an RN yet, but know our nurses in the ER in Oklahoma can administer propofol with a Dr's order. I could give it on the ambulance if it was already started before we transported.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Know your state. If wildly varies because the laws do. Which actually depends on whether there has been a problem and how strong anesthesia and CRNA's are represented. In the labs I ahve owrked in the states I ahve worked RN's in this setting can give propofol with the MD present in the room.

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Thanks for your replies. Do you have CS certification? Is there anybody else out there please who could provide any feedback and/or experience with this issue? I agree, it is imperative to know individual State laws. What kind of analgesia/sedation are RNs out there administering? It seems that fentanyl and midaz/versed are most commonly used. Do people find that this generally works out fine and no additional assistance is required? Or has anyone had a negative experience with CS? Thanks!

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Thanks for your replies. Do you have CS certification? Is there anybody else out there please who could provide any feedback and/or experience with this issue? I agree, it is imperative to know individual State laws. What kind of analgesia/sedation are RNs out there administering? It seems that fentanyl and midaz/versed are most commonly used. Do people find that this generally works out fine and no additional assistance is required? Or has anyone had a negative experience with CS? Thanks!
Welcome to the US. Nothing is standardized..... every facility will have different policies even within the same state. You will not only need to know the state laws/Nurse Practice act but facility policy on each particular drug. Here is one state's regulation from the Board of Nursing....http://www.ok.gov/nursing/prac-rnguid.pdf

Each facility will have a Moderate Sedation Competency course/test you will have to take given by the facility that will cover that you are "educated" about Moderate Sedation and have passed competency. These are simple one or two day classes followed by a test. There is a certification that is recognized by the ANCC online for about $200.00 US...American Association of Moderate Sedation Nurses It is not recognized nationally yet. Sedation Certification « Sedation Certification for medical professionals Sedation Certification

Drugs are pretty common...Morphine, fentanyl, Versed. Sometimes ativan or Valium... I have given propofol as well. I have had reactions from anaphylaxis...resp arrest, hives to restlessness. It comes with the territory. For the most part patients do just fine and can be very cute on versed/meds. I had a patient serenade us through the entire procedure with dirty little songs.

You will have to become ACLS/CPR certified and PALS if you deal with children

Anything else you need? Welcome to the US!

thread moved to critical care for best response

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Thanks a lot that is really useful. Has my thread been removed from the Critical Care Nursing forum? I can only see this thread when I look at 'activity' in my personal account. It has disappered from the actual forum. Don't know why? Anyhow thank you.

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Specializes in CRNA.
Thanks a lot that is really useful. Has my thread been removed from the Critical Care Nursing forum? I can only see this thread when I look at 'activity' in my personal account. It has disappered from the actual forum. Don't know why? Anyhow thank you.

It is still in the Critical Care section, just not in the CCU/CVICU that you orginally posted it in. Just click the top on Critical and go towards the bottom of the page and it's there.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Thanks a lot that is really useful. Has my thread been removed from the Critical Care Nursing forum? I can only see this thread when I look at 'activity' in my personal account. It has disappered from the actual forum. Don't know why? Anyhow thank you.
You are in the critical care nursing forum.
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Yes I see it now, Thanks. Your responses really help although I am still anxious and nervous. I am trying to brush up on hemodynamic monitoring too.... so much to learn! However, I am Happy about that because I like pushing myself

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We start and titrate propofol all the time once an MD gives us the order. We only titrate to 70mcg max. The order has to be specific stating we can titrate to a certain RASS score. When we do bronchs we push versed and fentanyl with the doc in the room. If we have a pt on versed or fentanyl we can hang it and titrate it with an order. But I've heard of other states or hospital that can't titrate without a MD in the room.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Yes I see it now, Thanks. Your responses really help although I am still anxious and nervous. I am trying to brush up on hemodynamic monitoring too.... so much to learn! However, I am Happy about that because I like pushing myself
Cath lab is a different animal. You will learn so much...they will teach you. Look at wave forms now.

http://www.pcacc.org/pdfs/2012-presentations/yazdanfar-hemodynamic-review.pdf

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Wow....

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