Diprivan: push or not to push

[time4meRN]

So, here's the question of the day in our ER. I work in Ohio, can't find the answer in the OBN web site. Can we push anesthesia meds or not. Our consious sedation comp. says we can never push Diprivan. Our Docs say, no, as long as it's moderate to light sedation or in an intubation (emergent)...it's ok. Every nurse has a different answer. It used to be we could " titrate" the med by using the pump. You know use 999 for a total of 5 ml. to a ramsey of 4 to 5. But our new pumps will keep the memory that we are using an anesthesia med. So , nurses are getting ywritten up when the infor is down loaded and high titration levels are found. So my opinion is that I don't push any anesth. med. I leave it up to some one else. Any one have info or where to find the info. We were told that the hospital has checked it out, and it's OK with them. But, I don't much care if it's ok with them, If the Ohio Board of Nursing says no than it's plain and simple, it means no.

[Magsulfate, BSN, RN]

. I would be much more comfortable giving big ole honking ativan boluses on a vent patient than I would pushing diprivan.

Do you realize that diprivan has a very short half life, you can watch a patient, turn off the drug and in a matter of 5 minutes the diprivan has wore off. But on the other hand, Ativan lasts for HOURS and in my opinion is a much more dangerous drug than Diprivan when used to sedate someone. You can't bring a patients BP up by just "turning off" the Ativan, like you can with Diprivan.

[Magsulfate, BSN, RN]

The Ohio BON allows propofol IVP to be given by RNs. I would not give propofol IVP to somebody who is not intubated or about to be intubated. Yes, it has a short half life and wears off quickly but some people are extremely dose sensitive (much more than giving fentanyl and midazolam). I've seen people needing to be bagged after as little as 20-30mg.

This is correct,, it can be powerful in some people, thats exactly why it should be used only with a doctor who can intubate, but those who are already intubated,, BRING ON THE DIPRIVAN! lol

So, why would any nurse push diprivan without a physician/anestesiologist present? They wouldn't. Or if they did, it would be very stupid. What is wrong with the nurse, who is educated on propofol, push 1cc-3cc/10-30mg, as per doctor's orders, while said doctor is present and has intubation kit nearby and bvm in hand just in case..... what is wrong with the nurse doing this? If the facility has policies and procedures for it, along with competency tests.. I can't see what everyone is afraid of. There are other conscious sedation drugs that are much more dangerous that propofol.

[FlyingScot, RN]

Your point is well taken EastTexas and permit me to take it a step further. Any drug given by an untrained or uneducated RN can be dangerous. We seem to be putting so much emphasis on Propofol here but really even the most innocuous medication in the hands of someone who knows nothing about it can have disaterous results. I have the same responsibility to my patients when I give them Tylenol that I do when I give them Propofol. Being afraid of a drug serves no purpose unless it motivates you to educate yourself. Having a healthy respect, on the other hand, protects both the nurse and the patient.

[kessadawn, BSN, RN]

i also work in ohio, and i am trained by my hospital to do conscious sedation, i work in picu. i am allowed to run a diprivan continuous infusion, give a bolus from the pump over several minutes, but never, ever am i as a bedside rn permitted to push diprivan. if the doc wants it pushed, they'll ask me to draw it up, and they push it themselves. now, i believe this is hospital policy, not necessarily state policy, but maybe it's this way because i work in a pediatric hospital. imo, diprivan is dangerous, and i don't care how short the half-life is supposed to be, i've seen kids take forever to come out of a diprivan fog. adults as well. seems like if a patient will be sensitive to diprivan, they are really sensitive. it's only used in units who can intubate at the drop of a hat in my facility, and always with a doc around, as well as all the the proper equipment.