Our Docs are so time focused lately that they often start procedures before the patient is adequately sedated. Most of them refuse to "wait a minute" for the last dose to take effect and either continue pushing (even if the pt is screaming) or give excessive amounts in rapid succession sometimes over sedating the pt and we have to give narcan in the middle of the procedure. They don't seem to learn from their mistakes and they are rude and intimidating to the less experience nurses.
I'm sure we're not the only endo facility with this problem.
What are other facilities doing to train the docs??????
To me this is another reason to consider learning to administer propofol. The bottom line for the Drs IS $$$$$$. But if we can push the Anesthesologists grubby paws away (they are why some procedure areas CAN'T give propofol) we could do the GI docs a favor by speeding up sedation and recovery time, so they can do more procedures. And then maybe the RN can get a little extra something in the paycheck!
Like everything in nursing....if there is a doctor interested/able to make a buck, then we are not qualified to do it; but if there isn't any profit or any doctors, then we are FORCED to be proficient.
Propofol (Diprivan) is an IV sedative-hypnotic. It is rapid acting and rapid clearing. Currently used almost exclusively by CRNAs and Anesthesiologists. Use is begining to expand to specially trained and supervised RNs.
Illegal? Are you referring to having pts awake? I agree that if a pt is screaming STOP that you should, however the pt should have been told that they will be receiving CONSCIOUS sedation and may be awake. Being unaware (sedated) or awake are completely different from screaming STOP!
We sometimes start while the pt is still awake, but I think my job is to comfort and reassure them that I will treat their 'pain' but not necessarily their consciousness. Remember that at one time all the procedures we currently do in GI were done with the pts completely awake.
We don't have a definite maximum dose limit, the RN can bow out and call for anesthesia anytime he/she is uncomfortable. We do have a maximum sedation level for an RN to manage. The pt must be able to protect their own airway and respond to simple requests like "take a deep breath". If we overshoot the mark no more sedation is given until anesthesia arrives or the pt recovers. I have only ever had trouble with one doc wanting too much sedation without waiting for it to work. He ordered more and I gave it VERY slow push...Pt was under sufficiently before 10% of it was in, and the doc was mollified.
Well I have heard all these complaints before!!!!!!!!!!!!!!!!!Yes GI docs are one of a kind....all they think of is getting to the cecum at any cost to the patient. I have heard patients SCREAM STOP
guess what he stops and says to the patient...I am not doing anything....................what a laugh..... I reallly believe that the docs schedule to many procedures.............come late............want to leave early...............and get to the office to torment other patient...............All most docs see are $$$$$$$$$$$$$$$ signs. Their reimbursement is so poor that they now feel they have to do twice as many procedures to make the same amount of money. Yes most docs do not wait for the sedation to take effect and we have some that will WAIT.......................Maybe in the future we will have better diagnostic tools to see the colon that will not be invasive.....I believe this is on the horizon.....
Here in San Jose the Colon Scan is popular....right now Insurance
company's will not cover the procedure but they will..remember when Mammograms first were available insurance companys would not reimburse that test either...but now they certainly do.....SO this is all I have to say....................................................
just do not go to the doc that allows his patients to SCREAM with pain.....I certainly do not!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
When I had my last (and second in my life) colonoscopy a couple years ago at the VA in San Francisco, the doc promised me beforehand that I would feel NO pain and NO discomfort. When I woke up, I had to ask whether it had been done yet, since I was back (or still) in the original prep room.
It is nice when people actually know what they are doing.
Watch out with that propofol, pt's can easily lose their airway, and the line is very fine with this particular drug. The only way I would ever administer Propofol is if my pt is ventilated (with a rate) or if I have CRNA behind my name. Don't let those Doc's put your license on the line because you are the one administering the meds.
Also, as far as I know there is no reversal drug (like narcan) so if you get in trouble...well, you're in trouble.
Like the others said, MS and Versed work great when used properly.
:roll 
LibraSun
23 Posts
To me this is another reason to consider learning to administer propofol. The bottom line for the Drs IS $$$$$$. But if we can push the Anesthesologists grubby paws away (they are why some procedure areas CAN'T give propofol) we could do the GI docs a favor by speeding up sedation and recovery time, so they can do more procedures. And then maybe the RN can get a little extra something in the paycheck!
Like everything in nursing....if there is a doctor interested/able to make a buck, then we are not qualified to do it; but if there isn't any profit or any doctors, then we are FORCED to be proficient.