Is Indiana RN allowed to give Ketamine for procedural sedation ??

Cali Nurse · Sep 5, 2005

I'm sorry. It seemed like the EDinNC post was saying that if we can push parayltics for an RSI, and then monitor/sedate the pt once vented, that giving ketamine, a drug which is used commonly in CS should be in our scope of practice. That's why I made the comment. I didn't mean to offend.

I re-read my post. I said RNs pushing paralytics for intubation was comparable as pushing propofol for CS. No one ever said anything about giving paralytics for CS. READ THE POST.

RNCENCCRNNREMTP · Sep 5, 2005

I am a nurse (and a medic) in Indiana. I am allowed to push whatever drug the doctor orders me to push. If the doctor wants me to push etomidate and succinylcholine for RSI, then I will do it, all the while monitoring patient responses, the monitors for saturation and rhythm changes, applying cricoid pressure and using primary and secondary tools to confirm intubation.

For sedation I have pushed, at the order of the bedside attending MD, methohexital, ketamine, propofol and more, all the while monitoring the patients airway and breathing, vitals and monitors and response to the drug and to the painful procedure.

I do not need to know how to intubate to give these drugs (even though I can and do intubate as a medic) because I am not giving the drugs in a vacuum. I am preparing the patient for a procedure that either requires them to be sedated AND paralyzed or just sedated, but they are not given until the MD is there to do it (or if I have my ETT ready out in the field).

William_SRNA · Sep 5, 2005

You are wrong if you think because a Dr. orders it you can give it. You are not governed by a physician but rather nurse practice acts.

I am a nurse (and a medic) in Indiana. I am allowed to push whatever drug the doctor orders me to push. If the doctor wants me to push etomidate and succinylcholine for RSI, then I will do it, all the while monitoring patient responses, the monitors for saturation and rhythm changes, applying cricoid pressure and using primary and secondary tools to confirm intubation.
For sedation I have pushed, at the order of the bedside attending MD, methohexital, ketamine, propofol and more, all the while monitoring the patients airway and breathing, vitals and monitors and response to the drug and to the painful procedure.
I do not need to know how to intubate to give these drugs (even though I can and do intubate as a medic) because I am not giving the drugs in a vacuum. I am preparing the patient for a procedure that either requires them to be sedated AND paralyzed or just sedated, but they are not given until the MD is there to do it (or if I have my ETT ready out in the field).

RNCENCCRNNREMTP · Sep 6, 2005

You are wrong if you think because a Dr. orders it you can give it. You are not governed by a physician but rather nurse practice acts.

I have researched Indiana's Nurse Practice extensively (for other reasons than what drugs I can give). It does not say squat about what skills or drugs a nurse can or cannot do, it is very non-specific.

mak2 · Sep 6, 2005

Hoop jumper, I am not sure I follow you, any time you do CS you should be prepared to intubate. What is it you are talking about. Do you work on a unit without monitoring available?

chip193 · Sep 6, 2005

In MA we routinely give the RSI meds while the ER MD is ready to intubate. We also do CS (but we do not use propofol for it!) mainly with opiates and benzos.

While I can intubate (a medic in NY), I do not intubate in MA. That falls on my ER MD and my hospital policies.

Chip

LuvDaTrauma, BSN, RN · Sep 6, 2005

I gave Atomidate tonight for CS. I have pushed Diprivan while the ED doc stood there ready to intubate. I have give ketamine IM. I have done numerous check offs to do this. We routinely do CS in my ER and we all have to be up to date. I would NEVER give these drugs without my doc standing right there beside me ready to intubate, reduce fx, etc. My nurse practice acts cover this and my hospitals policies say that I can.

MassED, BSN, RN · Sep 6, 2005

Do you honestly think you are "qualified" to push paralytics? What in your education has taught you to assume airway control and maintenance? That's right, nothing. 5 minutes at the airway station for ACLS doesn't really count either. Nurses are not taught airway management outside of CRNAs and Flight RNs. This is along the same lines of nurses pushing propofol for non-vented patients for CS. If you, the RN for that patient, can't manage what the medicine causes, then you shouldn't be pushing the drug. Nurses give this medicine as MDs are standing there waiting to intubate and your license probably rests on the MD's ability to successfully intubate or at least adequately ventilate that patient.
Nurses are not numnuts or idiots. They are the backbone of healthcare and patient care / advocacy. Nurses watch the care that other practitioners prescribe like a hawk and rightly so. I am a former ICU / ED/ critical care transport nurse so I know how things are in a hospital... So don't take this as a rant about nursing in general, but..
Nurses do not manage airways, bottom line. So nurses being "qualified" to give paralytics or other medicines listed as general anesthetics........that's a laughable concept.

nurses don't manage airways?? What??!! Where do you practice? We are taught ABC's above all else.... what is A?? This includes the management of that airway. Depending on where you work, RN's can intubate. (Even Paramedics can manage an airway) There are reversal agents for meds we push, as well.

MassED, BSN, RN · Sep 6, 2005

I'm sorry. It seemed like the EDinNC post was saying that if we can push parayltics for an RSI, and then monitor/sedate the pt once vented, that giving ketamine, a drug which is used commonly in CS should be in our scope of practice. That's why I made the comment. I didn't mean to offend.

yep, that's what I meant.

MassED, BSN, RN · Sep 6, 2005

Do you work in an ED now? You appear to have a hostile attitude that is very apparent in your posts. That's the kind of stuff we do NOT need, it is all to wide spread in our profession, especially in the ED. Keep it to yourself.

nursemomruns · Sep 6, 2005

I have researched Indiana's Nurse Practice extensively (for other reasons than what drugs I can give). It does not say squat about what skills or drugs a nurse can or cannot do, it is very non-specific.

RNCENCCRN is correct. There isn't anything in the INPA that says what drugs a nurse can or can't give. What it does say is that you have to have the experience and education to do what you do. So, if a nurse has been trained to give Ketamine in the ER, and is following the institution's policies, he/she may give Ketamine. Also, I have worked in three different ER's in Indiana and have given Ketamine at two of them.

As far as managing an airway goes - There are ways, other than "five minutes at an airway station in ACLS" that allow an opportunity to learn intubation - for example, an advanced airway management course. Depending on where you work and the circumstances involved, you may or may not intubate as a nurse.

nursemomruns · Sep 6, 2005

Better check your Nurse Practice Act.

You can order a copy of the Indiana NPA at

http://www.in.gov/pla/bandc/isbn/statruls.html

It will cost you all of three bucks.