dumb conscious sedation questions

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Quick questions about conscious sedation:

1. Does it matter which medication you give first, fentanyl or versed or do you mix them and give together?

2. How much time do you have to wait in between administering them if they are not mixed?

3. Does the patient have to be on a cardiac monitor?

Thanks in advance :)

I brought up my concerns in a letter cc to the DON, CEO and owners of the company. I was told that they understood my concerns and "were looking into it." I have been looking up so much under ASA, ANA, and AMA and am finding that this is illegal! I submitted all the paper work to them and got "were on top of it." Meanwhile looking at the schedule I see there are 3 nurses on for cs. I talked with the other nurses and am recieving a lot of flack about this! I am now being called "mouthy" and a "trouble-maker". My goodness, dont they understand that someones life is at risk here???

In my letter, I put in there the criteria for setting up cs legally. I also put in there that if it continues to happen and no changes are made, that I will be left with no choice but to report this illegal practice. Im not understanding why they think money is more important than someones life! I even brought up the fact that if something happens...your going to loose the money youve been "saving."

Now there are a few nurses who are on my side, but dont want to take a stand with me. The others are plain out against me, and wont even speak to me, and are starting rumors as if this was high school. Im ignoring it..but it does get under my skin! :(

Ive submitted my resume to other hospitals...and am leaving this place. BUT...when I leave, they will still keep up the illegal crap their pulling. I feel like its my duty to do something about this to protect the patients that are coming in to this money-hungry surgery center.

So in a sense its just me fighting for the patients, and Im feeling like I am hitting my head up against a giant brick wall! :banghead:

Who would I contact so this can be investigated? Its a smaller company,not a hospital. I am not sure what steps to take next. They dont care, cus the nurses are not sticking together. And well...were not a team anymore.

I keep telling them that I didnt get into nursing to hurt anyone! And this is not about them...its about the patients rights and safety that I am concerned about!

UGH! just need some advice. :nurse:

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Specializes in PACU, SICU, MICU, Stepdown.

UMMM.... you are not crazy! Propofol decreases cardiac output among other cardiac effects, they should definitely be on monitor....alll monitors! We would never use propofol for concious sedation.....they would not be conscious :) Only on vented pts. Follow your instincts. You can never be to prudent, pt trust us with their lives!

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ChicagoBSN,

Run from your job and report them to the state. That is a MAC case not conscious sedation.

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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 OR, PACU, GI, med-surg, OB, school nursing.

Your first step should be to contact the Board of Nursing and find out if what you are being asked to do is allowed by your Nurse Practice Act. If you can't find the info on the website, you must find it another way. Legally, you are responsible for knowing the limits of your practice.

As a new LPN grad, I would be concerned about doing conscious sedation! In my state, LPNs are not allowed to administer conscious sedation. Good luck!

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Specializes in ED, PCU, Addiction, Home Health.

Magnolia-

#1 - Definitely call your Board of Nursing and find out if your practice act allows you to give those meds. Here in PA, LPN's are NOT allowed to push any IV meds, they can only start IV's and do IV piggybacks, such as antibiotics.

#2 - I also believe needless systems are mandated now........I'm thinking you can no longer use needle access into IV tubing ports.....someone jump in here if I'm wrong.

#3 - MA's, etc can perform certain functions under the "auspices" of the MD. What that means is his office is his kingdom and he can train the janitor to draw blood if he wants - under his direction. I had a run in (long story) with this and a private MD I worked with once and him taking it to extremes.

Dawn

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Specializes in OR, PACU, GI, med-surg, OB, school nursing.

#1 - Definitely call your Board of Nursing and find out if your practice act allows you to give those meds. Here in PA, LPN's are NOT allowed to push any IV meds, they can only start IV's and do IV piggybacks, such as antibiotics.

Good point! I completely forgot about that -- here in VT, LPNs are not allowed to push any med. They can hang meds in a bag, i.e. piggyback, but not push them. Call your BON -- don't delay!

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Specializes in Critical care, tele, Medical-Surgical.

I will not perform a procedure, especially on requiring the assessment skills of conscious sedation, unless I have had my competency validated by a competent licensed professional.

Why doesn't the anesthesiologist administer CS?

Especially with a new grad LPN and unlicensed MAs assisting.

Who will intubate and follow ACLS if needed?

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I forgort about this thread...well heres an update. I quit that place I was working in, in April and got a job in the ER (lovin it there!). I wrote a lengthy letter to the BON here and submitted it. To my understanding ..this place is under investigation!

thanks for the support! I needed it!

Magnolia-pls take the advice u are recieving, here in Illinois an LPN can not push IV medication of any type. I had to go through a ton of training to do CS as well as ACLS and the certification course to become a CSN. I ran from the place I was at ...at top speed. I think you need to find out if the state ure in allows you to do IVPs and if your allowed to sedate. The whole issue on sedating is your placing them under and you never know what reaction the pt will have ...ie a little goes a long way on some pts and others you will have to give a lot more just to get them to relax. If your not careful (even if you are)you can put them under..then whos going to intubate that pt??

Be careful...its a slippery-slope.

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Specializes in neuro, critical care, open heart..
I will not perform a procedure, especially on requiring the assessment skills of conscious sedation, unless I have had my competency validated by a competent licensed professional.

Why doesn't the anesthesiologist administer CS?

Especially with a new grad LPN and unlicensed MAs assisting.

Who will intubate and follow ACLS if needed?

In KY LPN's can push certain meds, but definately NOT CS!!! Too many things can go horrifically wrong!! I guess the MD has trained the janitor to intubate!!:chuckle

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Wow, I had no idea non-CRNA's were doing all of this.

It sounds dangerous and it sounds like a cheap way to go. Avoid having a CRNA or anesthesiologist, make the RN do the sedation and circulate. I will avoid Surgery Centers, knowing this. There is just no back-up help readily available, it sounds like.

Please correct me if I'm wrong.

What do various states BON's say about this?

I guess things go well most of the time and I know things can go wrong even when there is a CRNA but this still is very frightening.

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Specializes in Critical Care.
Wow, I had no idea non-CRNA's were doing all of this.

It sounds dangerous and it sounds like a cheap way to go. Avoid having a CRNA or anesthesiologist, make the RN do the sedation and circulate. I will avoid Surgery Centers, knowing this. There is just no back-up help readily available, it sounds like.

Please correct me if I'm wrong.

What do various states BON's say about this?

I guess things go well most of the time and I know things can go wrong even when there is a CRNA but this still is very frightening.

http://www.bon.state.tx.us/practice/position.html#15.8

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