GI Diprivan thread

Just in case anyone is interested, I was told today by a FNP who attended the TNA (Tenn Nurses's Association) national conference that the anesthetists in the state of TN got a resolution passed giving their position statement that Diprivan should only be administered by anesthesia, period. Very interesting, I'm going to check out the website on TNA and the nurse anesthetists position for myself, as she was also saying they are even against using it in the ICUs for vent pts.

She said this comes from the CRNAs viewpoint that it is not that they don't feel RNs are trained/professional enough to administer the drug, simply that they are not trained to manage the airway if problems occur. I told her I did not think that part was correct (about banning use in ICU settings) becuase pts on the vent w/ ETT in place have an airway maintained. Any CRNAs/SRNAs in Tennesse have any additional comments or views on the subject? I just thought it was pertinent since there was such a debate about it in the GI forum.

Also interesting to me, was that someone quoted the stat that approx 98% of CRNAs are members of their professional organization, the AANA, and that they have more pull if you will to get things passed at such conferences. I think that speaks well for CRNAs and hope that in the future they continue to be so active. It really makes a difference for the profession/specialization of CRNAs.

we are using diprovan ALOT in the er lately. i have to admit the first time i gave it i was unfamiliar with it. i started at a new er and my preceptor at that time said it was okay to give the patient a "drink" and let if flow freely for a few seconds. since that time (4 years ago) i've done some research. our doc's still love to give the med and i must admit it does give some fab results but i always have that fear in the back of my mind. and believe that it should really only be given when the patient can be VERY closely monitored.

kim

preceptor at that time said it was okay to give the patient a "drink" and let if flow freely for a few seconds

just out of curiosity, what did your preceptor say to do if the pt quits breathing and their airway obstructs and cant be ventilated by mask?

I assumed the poster was speaking of vented patients? Bolusing propofol is a common ICU practice although specifically forbidden at my hospital.

Are you flipping kidding me?!?

If your preceptor is telling you to give an ER patient a "drink" of propofol, s/he should be counseled/disciplined and you should be assigned a new preceptor. I'm wigged out even thinking about it. Has your preceptor considered the implications of a full stomach or a traumatic injury to the airway that makes ventilation and intubation difficult - if not impossible?

No excuses. That is a profoundly dangerous and cavalier practice with propofol.

What would happen if that propofol was on a straight macrodrip running into a 16g AC with fluids wide open? In a few seconds, your patient has just received an intubating dose of a hypnotic with profound myocardial depressant effects. Now what?

I'm not ripping on you at all. I was a critical care nurse for over a decade, and I had my share of idiot moments at the bedside. But I knew my limits. I only wish other nurses who want to play with anesthesia drugs would do it the right way - GO TO CRNA SCHOOL!

Are you flipping kidding me?!?

If your preceptor is telling you to give an ER patient a "drink" of propofol, s/he should be counseled/disciplined and you should be assigned a new preceptor. I'm wigged out even thinking about it. Has your preceptor considered the implications of a full stomach or a traumatic injury to the airway that makes ventilation and intubation difficult - if not impossible?

No excuses. That is a profoundly dangerous and cavalier practice with propofol.

What would happen if that propofol was on a straight macrodrip running into a 16g AC with fluids wide open? In a few seconds, your patient has just received an intubating dose of a hypnotic with profound myocardial depressant effects. Now what?

I'm not ripping on you at all. I was a critical care nurse for over a decade, and I had my share of idiot moments at the bedside. But I knew my limits. I only wish other nurses who want to play with anesthesia drugs would do it the right way - GO TO CRNA SCHOOL!

She (?) did say this was four years ago. Knowledge about propofol has changed and hopefully the preceptor has changed with it.

She (?) did say this was four years ago. Knowledge about propofol has changed and hopefully the preceptor has changed with it.

Rn29306,

You're right that the resolution came through the TANA. The person I spoke with was discussing how the TNA convention went in whole, and that was one of the big things she remembered right off- that the resolution had been discussed and passed. Like I said, I told her I didn't think the part about vent pts was correct, she of course said she is a FNP with a different focus of nursing and that she only got the gist of the argument of Diprivan's use.

Anyway, I guess the main reason I though it was pertinent is because I got the feeling from people who are not anesthesia (CRNA, SRNA, or hoping to be one) that some nurses think anesthesia standing their ground on issues like this is because they want to feel powerful or feel like they're smarter than the other nurses. I know, as everyone else here, this is not the case. I think it is good that the TANA is also speaking out and saying it is a patient safety issue only, nothing else. The reason it takes the extra years of experience and education to be a CRNA, FNP is because that's what it means to be advanced practice nurses- they have the qualifications to do things RNs do not. We debate enough on this board the appropriate ways to use the drug, and we have pts who are monitored closely, ventillated, intubated (in ICU, not sure about other facilities ER capabilities).

I just think there is difference between CRNAs on a discussion board say "it's wrong, it's wrong", and give reasons against using Diprivan a certain way, but other nurses don't listen; and then the TANA say it's wrong, and have the power to get legislation through to that effect. Change happens quicker when bigger groups like that become involved. Also interesting to note, the new certifications for MSNs are now APC-BC = Advanced practice nurse-board certified. That sucks! I would want people to know I'm CRNA, FNP etc. One nurse told me that's the point, MDs just write MD, not neurologist, endocrinologist, etc. that we are trying to go to a "medical model". I thought to myself, do we want to be nurses or doctors? We can advance our independence without trying to change to be more like the medical field, IMO.

Rn29306,

You're right that the resolution came through the TANA. The person I spoke with was discussing how the TNA convention went in whole, and that was one of the big things she remembered right off- that the resolution had been discussed and passed. Like I said, I told her I didn't think the part about vent pts was correct, she of course said she is a FNP with a different focus of nursing and that she only got the gist of the argument of Diprivan's use.

Anyway, I guess the main reason I though it was pertinent is because I got the feeling from people who are not anesthesia (CRNA, SRNA, or hoping to be one) that some nurses think anesthesia standing their ground on issues like this is because they want to feel powerful or feel like they're smarter than the other nurses. I know, as everyone else here, this is not the case. I think it is good that the TANA is also speaking out and saying it is a patient safety issue only, nothing else. The reason it takes the extra years of experience and education to be a CRNA, FNP is because that's what it means to be advanced practice nurses- they have the qualifications to do things RNs do not. We debate enough on this board the appropriate ways to use the drug, and we have pts who are monitored closely, ventillated, intubated (in ICU, not sure about other facilities ER capabilities).

I just think there is difference between CRNAs on a discussion board say "it's wrong, it's wrong", and give reasons against using Diprivan a certain way, but other nurses don't listen; and then the TANA say it's wrong, and have the power to get legislation through to that effect. Change happens quicker when bigger groups like that become involved. Also interesting to note, the new certifications for MSNs are now APC-BC = Advanced practice nurse-board certified. That sucks! I would want people to know I'm CRNA, FNP etc. One nurse told me that's the point, MDs just write MD, not neurologist, endocrinologist, etc. that we are trying to go to a "medical model". I thought to myself, do we want to be nurses or doctors? We can advance our independence without trying to change to be more like the medical field, IMO.

Are you flipping kidding me?!?

If your preceptor is telling you to give an ER patient a "drink" of propofol, s/he should be counseled/disciplined and you should be assigned a new preceptor. I'm wigged out even thinking about it.

I'm not ripping on you at all. I was a critical care nurse for over a decade, and I had my share of idiot moments at the bedside. But I knew my limits. I only wish other nurses who want to play with anesthesia drugs would do it the right way - GO TO CRNA SCHOOL!

i agree. as i said it was 4 years ago,i was a brand new er nurse and watched as she gave the bolus. she did have an ambu bag at the bed side for resp failure but honestly i don't believe she knew all the ramifications of giving the drug. Needless to say, she has precepted many people after me and this year she left to go to be a nurse practitioner. How scared are you now?