diprivan

[Ritara]

THE USE OF DIPRIVAN BY A REGISTERED NURSE IS BEING DEBATED IN THE HOSPITAL WHERE I AM EMPLOYED. THE RN'S FEELING ARE THAT DIPRIVAN IS AN ANESTHETIC AGENT AND SHOULD NOT BE ADMINISTERED BY AN RN. DURING PAIN MANAGEMENT PROCEDURES, AN ANESTHESIOLOGIST AND 2 RNS ARE PRESENT. ONE RN IS CIRCULAING THE THE SECOND IS MONITORING THE PATIENT ACCORDING TO THE INSTITUTIONS CONSCIOUS SEDATION PROTOCOL. MANY TIMES THE MDA WILL REQUEST A BOLUS OF DIPRIVAN THE HOSPITAL CONTENDS THAT THIS IS NOT OUTSIDE ARE ROLE SINCE THE MDA IS PRESENT

THE RNS FEEL THAT THE ADMINISTRATION OF DIPRIVAN SHOULD BE BY ONLY THOSE TRAINED IN THE ADMINISTRATION OF ANESTHESIA (CRNA) AND THAT THE MDA PERFORMING THE PROCEDURE AT THE TIME IS A SURGEON AND NOT ACTING AS AN ANESTHESIOLOGIST ANY FEEDBACK

[meandragonbrett]

Ritara,

at my hospital, CRNAs and MDAs are the only ones allowed to give propofol\diprivan.

[neneRN, BSN, RN]

We routinely hang diprivan gtts on vented pts in our ER. The RN is the one who titrates the dosage to effect. But it definitely drops the BP WAY down and you have to really stay on top of VS. It's great that its so rapid acting- adverse SE can be quickly reversed by just slowing rate. I feel very comfortable using it WITH the vents.

RNs are not supposed to independantly bolus the pt as part of titration, but can do so with consent of MD at our hospital.

I don't have any experience using it for conscious sedation procedures though. For these, we use Brevital. In addition to the RN and MD, an RT has to be in the room for airway management. Rarely, the pt has to be bagged for a few minutes with the Brevital. It seems to be a great drug for conscious sedation.

I think I would be okay with the diprivan as you're using it since there is an anesthesiologist present.

[nrw350]

Originally posted by neneRN

We routinely hang diprivan gtts on vented pts in our ER. The RN is the one who titrates the dosage to effect. But it definitely drops the BP WAY down and you have to really stay on top of VS. It's great that its so rapid acting- adverse SE can be quickly reversed by just slowing rate. I feel very comfortable using it WITH the vents.

So by have an IV dripping the diprivan, you are able to keep the patient sedated? How long is it possible to keep the patient unconscious?

Nick

[neneRN, BSN, RN]

Nick-

While a pt is on a vent, they really need that sedation constantly to keep them comfortable, to keep them from pulling out the ET tube, and to keep them from fighting against the vent. I only see these pts from an ER perspective (the first few hours that they're intubated) and I have yet to see a pt who didn't require at least minimal sedation. Most have to be completely knocked out to allow the vent to be effective. Rarely, a pt will be able to tolerate the tube and requires only Ativan.

I really like Diprivan for a number of reasons. Its rapid half life allows you to slow it down/shut it off for a few minutes to assess neuro status. This also allows you to reverse adverse SE quickly or to bump it up for further invasive procedures. The titration (adjusting the dosage) allows you to keep the pt at the level of sedation required for each individual pt.

So, for your question how long can they be sedated- days or weeks, however long they're intubated. I've never worked ICU- I don't know if they continue using the diprivan long term or if they switch to another drug.

Because I'm in the ER, where the pt is initially getting intubated-I usually see the first of the family members to see the pt in this condition-sedated and with tubes coming out of every orifice. I always explain to the family what the equipment is for and why the pt can't respond to them. I've had a few walk in when I'm not in the room, and it's terrifying to them that the pt won't respond. They think the pt is in a "coma" and its hard for them to understand why we're intentionally keeping them in this state. Being on the vent is not something the pt is going to want to remember!

[nrw350]

I can understand that, because I was intubated for 2 surgeries and I remember partially them removing the tube one of those times. Talk about a gag-factor. I wish I did not remember that. I wish I had someone locally to chat with about all this. I find it ver fascinating and amazing.

Nick

[nrw350]

I just remembered something. If you keep a patient sedated for say a week or longer dont you have to like place a tube in them to get them nutritrion? Also, do they have to have a bed pan or something? I would think that those function would continue even though they are sedated.

Nick

[VictoriaG]

I am a whiz at conscious sedation, doing sometimes as many as 7 cases /day. Our docs don't like their patients to moan, so my consciously sedated patients are pretty much unconscious. It took me a long time to learn to titrate Demerol and Versed to just the point where patients are unaware but could still manage their own airway. I would be very comfortable giving Diprivan, it is so short-acting, it would feel safer than Demerol! Besides, I can bag with the best of them!

[neneRN, BSN, RN]

In response to your questions Nick- Pts get a foley cath (to continuously drain the bladder) and nasogastric tube right away; as soon as airway established and pt stabilized.

[spineCNOR]

Hello Ritara,

A good starting place would be to find out how your state's Board of Nursing stands on this issue. They would be the one to determine whether or not giving this drug would be within the scope of practice for an RN in your state.

[zambezi, BSN, RN]

I work in the coronary care unit and the majority of our post heart surgery patients are on diprivan. It is in our standing orders to begin this drip if necessary and titrate to effect. We are not allowed to bolus the patient, however.