Propofol

Specialties Gastroenterology

Published

I wondered if anyone of you as RN's

use propofol? Only the anesthesia

people are using it. When anesthesia

is used they use propofol. We as Rn's are pushing the Demerol, Versed, Morpheine, Nubain,elc.for conscious sedation. We

are not "allowed " to push propofol or

really any Fentanyl. Is this typical?

Or are we as RN's being overruled or

not allowed to push such drugs..........???

We usually use Demerol and Versed.

but propofol requires a nurse anesthestist or an anesthesiologist.

Is this common????

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Please keep focused on the topic and keep language friendly. Thank you!

:balloons: In Colorado only a anesthesiologist can administer Propofol and I am glad. I do conscious sedation everyday but I do not want to give Propofol. We use versed and sublimase.

Hi- I'm still putting off my colonoscopy and it is due (family hx colon cancer-father died at age 53, and I am 53). Can you tell me more re the sublimase? By the way, I would not personally do Propofol without a CRNA or anesthesiologist attending. I know for a fact that I'm a hard intubation.

We use propofol gtts for INTUBATED pts in my med/surg ICU. It's a godsend, since pt's can be sedated or awoken within minutes. Our protocol allows us to use it for 8 hrs & then switch to a versed gtt, unless otherwise ordered by the MD. As for conscious sedation with quick bedside medical procedures, nurses are not permitted by law to push propofol in my state (WA) -- only anesthesiologists. I'm not sure if this is true in other states.

Hi- I'm still putting off my colonoscopy and it is due (family hx colon cancer-father died at age 53, and I am 53). Can you tell me more re the sublimase? By the way, I would not personally do Propofol without a CRNA or anesthesiologist attending. I know for a fact that I'm a hard intubation.

Sublimase is fentanyl, often a cornerstone for traditional conscious sedation.

Its a general anesthetic.

Counterpoint: Georgia BON alligns itself with the ASA and AANA and is against nurse administered propofol and relies on anesthesia providers to administer this general anesthetic. A precendent has been set for this state. Now GA hospitals are changing their rules. Tit for tat.

edited out inflammatory language content

Must agree with the counterpoint above. I just ask that you always remember that there are lies, damn lies, and then there are statistics. Well done research should form the basis of quality care choices for all providers but remember---somewhere around 30 million anesthetics are done each year with only a few thousand serious untoward events --numbers that are not statistically significant, but I suspect you would have a very hard time convincing those who were injured or lost members of their families to death or prolonged morbidity, that their experience wasn't significant. You can do a million "routine" sedations with propofol, but it only takes one bad event to wipe out all that went before. It can happen to any of us, but even the best prepared nurses do not have the skills and legal scopes of practice of CRNAs and MDAs. Just not sure why you would want to have to defend the use of an anesthetic agent (stated in drug package insert and PDR) for sedation in a potential court action. Just an alternate viewpoint supported by over thirty years of anesthesia administration and experience as a researcher and teacher. You folks in Oregon, be sure and keep your current !

To become paralyzed by the thought of what might occur, is equivalent to doing nothing toward better patient care. I applaud the hospitals that are willing to exercise, and support, the best practice of their nurses. Recently our hospitals insurance carrier was changed. The nurses that administer IV sedation were interviewed for many hours. The insurance carrier was very satisfied with the way IV sedation is done at our facility.

I agree if you treat "a million" patients with propofol you will most likely have a bad experience. I also believe that if you give " a million" doses of ____ (fill in the blank) you will have a bad experience. It is thinking like that, that doesn't allow for advances in health care that can reduce risk and decrease mortality.

With propofol the procedure is painless and effective. If I can participate in a procedure that may save the life of a patient that is terrified of a painful procedure. You ask is it worth it? Yes, I believe it is.

Training in the area of sedation is a must, ACLS, ED experience is preferable. However to have an anesthesiologist or crna on every case is not practical, not feasible and fiscally irresponsible.

To become paralyzed by the thought of what might occur, is equivalent to doing nothing toward better patient care. I applaud the hospitals that are willing to exercise, and support, the best practice of their nurses. Recently our hospitals insurance carrier was changed. The nurses that administer IV sedation were interviewed for many hours. The insurance carrier was very satisfied with the way IV sedation is done at our facility.

I agree if you treat "a million" patients with propofol you will most likely have a bad experience. I also believe that if you give " a million" doses of ____ (fill in the blank) you will have a bad experience. It is thinking like that, that doesn't allow for advances in health care that can reduce risk and decrease mortality.

With propofol the procedure is painless and effective. If I can participate in a procedure that may save the life of a patient that is terrified of a painful procedure. You ask is it worth it? Yes, I believe it is.

Training in the area of sedation is a must, ACLS, ED experience is preferable. However to have an anesthesiologist or crna on every case is not practical, not feasible and fiscally irresponsible.

I think you missed the major point--I have been involved in the proper education of nurses to do IV sedation for over 10 years, so I hardly think you can say that I am holdng back progress in RN role development. I have no problem with RNs properly administering sedation---but propofol is not a sedative. It is an anesthetic and that creates a different set of issues. The JCAHO standards for sedation state that the person doing the sedation should be able to rescue the patient from one level deeper than the level they are trying to achieve. Patients are on a continuum from sedation to general anesthesia once sedatives have been given. To give propofol to patients as you describe indicates the presence of a level deeper than moderate or even deep sedation. Managing a deep sedation that progresses to a general anesthetic s no longer within the scope of practiceof an RN unless that person is a CRNA. I agree that it is not practical to have an anesthesia provider for every sedation--nor is it necessary. Nurses should seek opportunities to expand their scope of practice, but there have to be limits, otherwise the increased risk of liability may do more harm than good to the profession. WHen we do things we do not totally understand the overall import or potential consequences of we reinforce the position often used by physicians when they are fighting anyexpansion of our professional role---"they don't know what they don't know". We have to set the limits because it is to the economic advantage of the physicians/facilities to have RNs do additional duties---and unfortunately concern for $s can often override the proper development of RN role growth. Just some things to think about.

With propofol the procedure is painless and effective. If I can participate in a procedure that may save the life of a patient that is terrified of a painful procedure. You ask is it worth it? Yes, I believe it is.

How about this...Is it worth it for a patient to receive an adequately prepared and clincal savvy provider? Yes, I believe it is.

Your above statement shows you lack the pharmacologic understanding of a drug you are such a proponent of. Propofol lacks ANY analgesic properties. Hypnosis is not analgesia.

This is unbelievable.

To become paralyzed by the thought of what might occur, is equivalent to doing nothing toward better patient care. I applaud the hospitals that are willing to exercise, and support, the best practice of their nurses. Recently our hospitals insurance carrier was changed. The nurses that administer IV sedation were interviewed for many hours. The insurance carrier was very satisfied with the way IV sedation is done at our facility.

I agree if you treat "a million" patients with propofol you will most likely have a bad experience. I also believe that if you give " a million" doses of ____ (fill in the blank) you will have a bad experience. It is thinking like that, that doesn't allow for advances in health care that can reduce risk and decrease mortality.

With propofol the procedure is painless and effective. If I can participate in a procedure that may save the life of a patient that is terrified of a painful procedure. You ask is it worth it? Yes, I believe it is.

Training in the area of sedation is a must, ACLS, ED experience is preferable. However to have an anesthesiologist or crna on every case is not practical, not feasible and fiscally irresponsible.

Clueless on so many different levels.

You want to use propofol, in an ED, for a procedure that may "save the life of a patient that is terrified of a painful procedure". Right. There is NO procedure in the ER to "save the life of a patient" where propofol is indicated. NONE. And as already stated, there are no analgesic properties to propofol. If you're giving enough that they're not responsive, IT'S A GENERAL ANESTHETIC!!!.

"ACLS preferable"? What a joke.

"Fiscally irresponsible"? Again, what a joke. We do what's best for the patient, period.

It also amazes me that any carrier would happily go along with RN's giving sedation with propofol. Talk about fiscally irresponsible. That package insert warning on propofol is all that ANY attorney needs to get a settlement with lots of zeroes in the number.

Specializes in ER, PACU, OR.

We do in PACU at times. Also I float to the pain center. They use it all the time for spinal blocks. Propophol is dose based, and wears off quickly. I believe you can only use it here, if the pt is intubated or anesthesia is present.

I need help with Propofol. I am a pharmacist in on a medical surgical floor.

We are using Propofol DRIPs for sedation in vent patients. Does anyone have any information on propofols use with vent patient and medical sugical floors? We have ACLS nurses, monitoring, code carts and MDs versed on it use what else is needed? or is it contratindicated total on a "Med-Surg" unit.

Thanks, VInce

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