Administering Propofol

[Whatthe?]

A friend of mine works in a center that performs gyne surgery (tubals, etc) and in some of the procedures the OB/GYN has the RN administer Propofol instead of an anesthesiologist. She is not ACLS certified and feels confused because giving it is under a doctors orders but she is not certified to administer anesthesia. I was under the understanding that a non-CRNA could not administer Propofol if it is to be titrated. An RN can if it is in drip form at a constant rate such as in the ICU where the patient is vented. I've read different rules on this and the rules are governed by each state individually. I have given conscious sedation before with Versed and Fentanyl under the surgeons orders but not Propofol. Have you ever been put in that position? I would not feel comfortable because of safety issues (no reversal agent for one) but she doesn't feel she can refuse.

[Argo]

Not supposed to do it unless your an Anesthesia MD, DO or CRNA.... I would report the center and not do it.

[prplscrubs]

rns are not allowed to administer propofol under dr orders or not! it is outside our scope of practice and that nurse can get in a lot of trouble!

[fracturenurse]

Argo is right...Not in our scope of practice. She needs to stop that asap....

[Argo]

Let me clarify, AANA and ASA have both written statements that its against their recommendation for anyone but MD/DO Anesthesia or CRNA to use it. It is not actually regulated and a hospital or clinic can write policies stating it is OK for the RN to push it but the clinic would be responsible for the legal repercussions if something went wrong. If there is no policy in place the nurse and MD would be liable. ASA and AANA would testify against them and they would have zero support.

[Heogog53]

Have her consult risk management at her hospital. They'll put a quick stop to it!

[Whatthe?]

I have good news. My friend told me that she looked up the PP for administering Propofol for the clinic she works at and it states that RN's are not allowed to give it, only MD's and CRNA's. So, she has her behind covered and made copies for all the employee's and doctors to read reiterating the policy and plans to discuss it with the MD who signed it.

[Heogog53]

I'm glad there is a policy in hand that clearly defines who can and cannot give propofol.

A long time ago, conscious sedation consisted of giving some versed/valium, a little bit of narcotics, one nurse to monitor the patient, the other to help with the procedure.

During a "conscious sedation bronch", the nurse I was working with was extremely new at giving the meds, very uncertain and the doctor made her nervous. He asked for 2mg of Valium(no Versed then) and she gave 2 ml, which was 10 mg! This patient being a COPD'er, he instantly stopped breathing(I'm sure that most of us would have anyway) and suddenly, in a little tiny "local" room, which wasn't set up for suction, Administering O2 and the like, we have a respiratory arrest! The doc is screaming at the nurse, who is in tears and I'm calling overhead for a crash cart to be brought to the room. I actually remember hearing someone else on the overhead speaker saying, "Did she just call a code for her room?" and my instant response back confirming that WE HAD A CODE situation.

What a freaking mess that was!

The room had previously been a small "junk" room. It had been cleared out to be used for LOCAL cases only. Somehow the doc had pressured the coordinators to get his bronch moved in there, a patient who was too ill to be done in that room.

Luckily for the patient, getting him to the PACU and bagging him for a bit was all it took. Bronchs were never again done in that room, suction and O2 were installed, the nurse quit the next day and the doctor went along with his life...

But that was CS in the 1980's.

I wouldn't dream of pushing propofol instead of an anesthesia professional. I have given propofol while assisting an anesthesia professional.