dumb conscious sedation questions

Nurses General Nursing

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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 :)

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Specializes in L&D, Surgery, Case Management.

The way we do it at my Surgery Center..... Versed 1st followed immediately by Fent. Yes you must use a cardiac monitor. I just hook them up the the anesthesia machine and use all the monitors. These are not dumb questions. I love do moderate sedation. I have thought about CRNA school , however by the time I would graduate I might need a walker!! :banghead:

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Specializes in ER.
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 :)

You didn't ask, so maybe you already know, but...

Always use a cardiac monitor, with O2 sat, RR and BP monitoring every 5 minutes.

Make sure your suction set up is working, and have it ready to go at a seconds notice.

Make sure your oxygen is already hooked up and you have a mask appropriate to the size of the patient.

For kids, have the Peds crash cart at the door.

Have Ambu bag ready.

Have all of that hooked up and ready before you even consider pushing meds. Have all your paperwork filled out and ready as well. You only want to be paying attention to the patient once you start.

You don't want to mix any meds together because you may only have to give a small amount of one or the other and can't if they are mixed.

Always have a running IV, even if it is only KVO, because you don't know when or if you will need to bolus the patient.

You cannot take too many precautions when you have a vulnerable patient who cannot protect their own airway.

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Also make sure you bring your reversal agents (Narcan, romazicon) in to the room...look at the vials ahead of time, have syringes/needles/carpujets ready at hand to draw one of these up and administer if necessary.

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Specializes in ER.

All hospitals have different policies and procedures. YOU MUST read your facilities policy and procedure, and most likely you should be doing this procedure under supervision before performing by yourself.

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we use a 3-lead ekg, b/p, sats with prn o2 max 5mg or 1ml of versed sedates for average 30min long enough to do angiogram of vascular access for hemodialysis and place a central cath, fentanyl we give 25mcg to 100mcg which by the way are a slap in the face of a pt thats on morphine/ativan....QD....lol

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Specializes in Developmental Disabilities, LTC.

:offtopic: This always bothered me during my preceptorship... I was taught during school to push the fentanyl over a certain time period & I was also taught to "stick to my own guns" once I got into the field about what I knew was right vs. the easy way to do things.

During my preceptorship (at a GI health clinic), I was given the opportunity to push the fentanyl - when I pushed it over the prescribed time (over 2-3 minutes) everyone - the m.d. & the r.n.s - told me that was a ridiculous way to do things & that "if we did everything by the book, we'd never get anything done around here."

Thoughts?

Was I being too anal by protesting, or are some things just different in the real world of nursing?

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Specializes in Critical Care, Emergency, Education, Informatics.

Depending on how much Fentanyl you were giving, 3 min might be a bit much, but you def don't "push" it. Fent can cause stiffening of hte chest wall, Only seen it a couple of itmes but it's scary.

One thing that no one has mentioned is ETCO. Pulse ox changes can be a little slow to show danger states. ETCO is a better indicator. If you've got it use it.

But no matter what your do, ake sure your following your facilities policies to the letter. Your on you own if you don't.

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Heres a senario for you all...would love to hear your thoughts. I work in OR, ambulatory setting...where the owner is now requiring the rns to administer conscious sedation. We are all ACLS and took a long class to become a certified sedation nurse. The owner thinks that there should only be one RN at one clinic to be cost effective. He also thinks that propofol is the wonder drug and wants the nurses to push it. I have sat in on the trainings to see whats going on..and frankly Im concerned!

Heres what I observed: One rn in the room, circulating and administering conscious sedation at the same time. The drugs used were Versed 2-5mg, Fentanyl 100-250 mcg, and 50-100mg of propofol. Ok-the pts sats dropped, she bagged the pt and got the pt back up...so essentially nothing happened, but enough to scare the heck outta me! The pts were only hooked up to bp and o2 monitors. Propofol has no reversal agent, so Im not understanding why a nurse would even put herself in that situation.

Im refusing to do the sedation until I look up the INA rules for this...but does anyone else see this as a potentially dangerous situation??

There is only one nurse, so if something happens in the recovery room...shes gotta come out of OR and deal with that situation.

Sounds all wrong to me..but I am the only one putting up a stink about it. The other nurses say that Im causing trouble and to just deal with it. Am I just being a worry wart ..has anyone encountered something like this?

Thanks! :(

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When I first started my job in Pain Management 11 years ago, I was freaked out that the docs wanted me to just "push it". I of course, wanted to do it slowly like I was taught. I push the meds like the docs want. If I have a very old person whom we have never sedated before I will start slowly to see their reaction. Many of the older folks will get just 2mg and then if we know they can handle more and they remember their treatment, they will get a little more the next time.

Several years ago we used to use Versed 2mg/Fentanyl 2cc combo.We mixed it in the same syringe. This was in a Pain Center in the hospital. The doctor switched to just Versed usually 4mg although sometimes 6 mg. Honestly, I am glad we leave off the Fentanyl. IMHO, the Fentanyl was the cause of the incidences of dropped BP's, nausea and low O2 sats. We rarely have any complications with just the plain Versed.

I have pushed thousands and thousands of doses of Versed over the years and have had almost no problems with it. The problems come when you add another med to the mix.

As for Propofol, check your state nursing board. It is illegal for a nurse in my state to PUSH the drug although I can monitor it as a drip.

NO WAY would I ever push that drug. Talk about ramping up the complications/side effects!

Honestly, our patient population does just fine on the plain Versed. Most do not remember anything on 4-6 mg, they think they "go to sleep" or are "knocked out" during the whole thing when actually they follow commands, can carry on a conversation, and get themselves up off the table and then next visit have no recollection of it.

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Specializes in L&D, Surgery, Case Management.

Propofol: I would NEVER administrate it. It is against the nurse practice act of many states. We developed a policy against it at my surgery center so if the doc asks we can just refer to the policy. I use versed and fentanyl and I do push them in fast. Make sure you have the patient on the cardiac monitor, pulse ox and do at least q5 min v/s. Also you need to have your reveral agents ready. I really enjoy doing moderate sedation... if I were younger I would go to CRNA school..

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Specializes in Emergency & Trauma/Adult ICU.
Heres a senario for you all...would love to hear your thoughts. I work in OR, ambulatory setting...where the owner is now requiring the rns to administer conscious sedation. We are all ACLS and took a long class to become a certified sedation nurse. The owner thinks that there should only be one RN at one clinic to be cost effective. He also thinks that propofol is the wonder drug and wants the nurses to push it. I have sat in on the trainings to see whats going on..and frankly Im concerned!

Heres what I observed: One rn in the room, circulating and administering conscious sedation at the same time. The drugs used were Versed 2-5mg, Fentanyl 100-250 mcg, and 50-100mg of propofol. Ok-the pts sats dropped, she bagged the pt and got the pt back up...so essentially nothing happened, but enough to scare the heck outta me! The pts were only hooked up to bp and o2 monitors. Propofol has no reversal agent, so Im not understanding why a nurse would even put herself in that situation.

Im refusing to do the sedation until I look up the INA rules for this...but does anyone else see this as a potentially dangerous situation??

There is only one nurse, so if something happens in the recovery room...shes gotta come out of OR and deal with that situation.

Sounds all wrong to me..but I am the only one putting up a stink about it. The other nurses say that Im causing trouble and to just deal with it. Am I just being a worry wart ..has anyone encountered something like this?

Thanks! :(

The smoke would be coming from my tires as I drove away from this surgery center ... as a nurse OR a patient. :stone

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