Conscious Sedation and IV Therapy

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Hi, I am a new LPN graduate that just started working this past April and I have recently started working for a pain management company where an anesthesiologist performs the procedures in the OR two days a week. I have only trained in the OR for a couple of days and he is having my push Versed 2mg (2ml) and Fentanyl 100mcg (2ml) as well. We don't mix them together. My issue is I have always learned in LPN school to push meds over several minutes however the doctor wants me to just push it in fast and I feel incomfortable doing so. He also said I did not have to wear gloves to push and that to me is contaminating the port area since I have to hold it somewhat to push it in. I'm wearing the gloves! We push with an 18g needle :no:and I prefer a needless system. I went on the Georgia Board of Nursing webite for the LPN scope of practice and they don't even have one with a list of what an LPN can legally do. I am a patient advocate and I also refuse to be liable for pushing a med to fast and something happening to the patient just because the doc told me to to so. Also I am not very experienced in starting IV's because we had such a large graduating class I only got to do a few so of course I would not have the experinece in IV push either. The MA's at his office start IV's and they aren't even certified to do so. Any suggestions??? I amd the only LPN in the office, all other's are MA's Should I run like crazy?:) Thanks!

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Specializes in Critical care, tele, Medical-Surgical.

In my state administration of IV medication is not in the legal scope of practice for an LVN

Also conscious sedation requires sophisticated assessment and knowlege of life saving intervention. A competent licensed professional and equipment must be available for immediate intubation if that becomes necessary.

http://www.rn.ca.gov/pdfs/regulations/npr-b-06.pdf

I was an LVN for many years.

If the anesthesiologist would not administer the medication I would have to find another job.

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Specializes in Critical Care.

I'd contact your nursing board directly if the website doesn't adequately clarify your scope.

In Texas, LVNs can, at facility discretion, push IV. However, conscious sedation requires an RN who has demonstrated competence.

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I plan on contacting the board directly. I know I can start IV's but a friend of mine who is also an LPN seems to think an RN should be pushing these meds as well. I would think I should not be pushing Fentanyl either. Sometimes I don't even think the doc's know what the LPN's can and can't do. Thanks for the advice!

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Thanks I agree with you. LPN's in GA can start IV's and hang piggyback meds such as antibiotics etc... I am just not clear on the conscious sedations meds and pain med like Fentanyl. I guess we just don't learn everything in nursing school. Thanks again!

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Specializes in Critical care, tele, Medical-Surgical.

If something were to happen you could be sued and/or lose your license.

Here are some federal guidelines:

http://clinicalcenter.nih.gov/ccmd/cctrcs/pdf_docs/Clinical%20Monitoring/09-conscious%20Sedation.pdf

You only have one license.

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You DEFINITELY ABSOLUTELY need to stop pushing meds. That's a big NO-NO for an LPN, regardless of what the doc may or may not know, IF SOMETHING HAPPENS, YOU will be the one that gets blamed. The doc will just say, he ordered the med and you did it. That's a huge deal at my school. If an instructor found out we did a push med even during the RN year without supervision we'd be out of the program permanently. Also, even if it is in your scope of practice and the doctor is wanting you to do something that you feel is iffy don't do it. If you were an RN I would say you need to look up the med and find out how long it needs to be pushed over, not what the doctor says. If he's wrong, don't do it. As the patient advocate you need to be knowledgeable and question the questionable orders.

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STOP IT NOW!!! LPN'S cant push drugs in almost all states. Esp sedation drugs. Most RN's have to go thru training to be able to do so. As an LPN you can do some things with IV's but you need to go to the 30 hr IV cet class, without that you shouldnt even be touching IV's. You can and will lose your license. If this DR is allowing you to do so what does that say about the care he gives his Pt's? Not saying you cant do it but a lot of training is needed. If he doesnt care about his Pt's trust me he will NOT care about you if anything ever goes to court or the DON!!! Get out!!!

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Specializes in LTC Family Practice.

The GA LPN BON sez:

(7) "The practice of licensed practical nursing" means the provision of care for compensation, under the supervision of a physician practicing medicine, a dentist practicing dentistry, a podiatrist practicing podiatry, or a registered nurse practicing nursing in accordance with applicable provisions of law. Such care shall relate to the maintenance of health and prevention of illness through acts authorized by the board, which shall include, but not be limited to, the following:

(A) Participating in the assessment, planning, implementation, and evaluation of the delivery of health care services and other specialized tasks when appropriately trained and consistent with board rules and regulations; (B) Providing direct personal patient observation, care, and assistance in hospitals, clinics, nursing homes, or emergency treatment facilities, or other health care facilities in areas of practice including, but not limited to: coronary care, intensive care, emergency treatment, surgical care and recovery, obstetrics, pediatrics, outpatient services, home health care, or other such areas of practice; © Performing comfort and safety measures;

(D) Administering treatments and medication; and

(E) Participating in the management and supervision of unlicensed personnel in the delivery of patient care.

As you can see it's pretty vague, in this state there are no additional "IV courses" for LPN's, However, based on your comfort level, I would talk to the Doc and ask for clarification about the facility policy. Note the "secialized tasks when apppropriately trained" section. There is the catch 22, if you feel you've been trained to do a skill then your basically covered. But, I'd make sure I had . I'd also know the facility policy regarding this.

Here is a link by state about scope of practice for LPN's, please note there are several states that don't have a defined scope of practice related to IV therapy and IV medication administration.

http://nursing.advanceweb.com/article/lpns-and-iv-administration.aspx

I'd also contact the BON, they are not generally very helpful, so be fore warned.

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