patsue53

Noone receiving sedation should be allowed to drive home. Our patients are told they are not to drive for 12 hours. If they don't have a driver we allow them to use a delivery service that charges $15.00 each way and will walk them to the door and make sure they get in okay. It's not ideal but it's better than putting them in a cab that will just drop them off at the curb. I have seen an obnoxious, type A control freak get outside and put his hand out to his wife who handed him the keys and they got into separate cars and drove away. It was awfully tempting to take down his license plate number and call the police to report him driving under the influence!! :angryfire I've also been read the riot act by a physician-patient who was incensed that she could not drive for 12 hours. She was told that she would need a driver but was not told that she couldn't drive all day and we were screwing up her plans for the day!!

We use SPOT too. Mixing that india ink is nasty. I'd say make yourself a hero and introduce your new unit to SPOT!

Hey Janet, who are you calling old!? :chuckle I'm 50 years old, I've worked in Endo for 8 years and held my CGRN for almost 5 years. Colons and Endos on healthy or slightly sick individuals don't require an anesthesiologist. A little sedation will do the trick and you can easily administer that. In our hospital you have to pass a conscious sedation test and be ACLS certified. Watch the O2 sats and blood pressure and don't let the docs hurry you when you're administering meds and you'll be just fine. I'm sure you must have learned to start IV's in nursing school...it's just a matter of brushing up on your skills...maybe you could spend a day admitting patients to outpatient surgery. That'll get your IV skills up to speed in no time. Good luck and enjoy! :)

We usually just tell our patients that it will be easier to expel the air if they stay on their left side.......but then I tell mine that they can lay however they're comfortable. We don't have a written policy about it. I kind of look at it as one of those issues that the patient should be allowed to control....they'll fart if they need to, we don't need to give them instructions in the fine art of it.

I think you should review the definition of conscious sedation....or moderate sedation which I believe is the current preferred terminology. All the RN's in our department are required to be ACLS certified in case a patient has an adverse reaction to the medications or procedures. This does not give us license to administer deep sedation or general anesthesia. Indeed, administration seems to find a loophole to allow RN's to perform tasks and administer medication that was previously prohibited in order to save money and ease budgets. But there state nurse practice acts that prevent them from crossing certain lines. Some states do allow RN's to push Propofol. I think it's a huge mistake. There are nurse anesthesists and anesthesiologists who have received more training and education, who make a heck of alot more money than I do and they should be administering these dangerous drugs, not I. In 7 years in endoscopy I've only had to bag 2 patients as a result of their sedation......one was a 97 yo bronchoscopy patient who had had 2 of versed and the other was a 76 yo patient who had had 25 demerol and 3 of versed. Reversal agents brought them back in no time. Thank God I had reversal agents to give. I was at a GI nurses conference on Saturday where this issue was addressed by one of the speakers who happened to be Jo Wheeler-Harbaugh, the current president of the SGNA. She is very much against having RN's in the GI lab push propofol. Our lab follows SGNA guidelines. Propofol is a great drug. When the anesthesiologists adminsiters it I appreciate its properties.

This article explains it better than I can. I know that it causes respiratory distress with cyanosis and when blood is drawn it looks like chocolate milk. It's treated with IV Methylline blue. I've never seen a case of it...hope I don't! http://www.caep.ca/004.cjem-jcmu/004-00.cjem/vol-3.2001/v31-051.htm There are also environmental issues that cause chronic cases of it, but I guess that's another forum. LOL

We've all been trained in recognizing and treating methemoglobanemia but I've never seen it. I think it's very VERY rare. I'm surprised your docs have stopped using Cetacaine because of it. Do you spray with something else?

Never done an ERCP? There are days when I wish I could say that! LOL There's alot of technical skill and coordination involved with wires in an ERCP. The medicating is conscious sedation, but gets a little tricky because it usually takes more than your normal endo procedure. We have one doc who has gone to MAC anesthesia with all ERCP's after having 2 patients code in 2 weeks! (believe me that's not the ordinary. We dont' have 2 codes in a year in our dept.) What about esophageal or anorectal manometry? Eso Manometry is becoming my favorite part of my job. (except for days like today when the lady dry swallowed continuously throughout the study. grrrrr)

HI Amy...thanks for asking! :) I've been working in GI for about 7 years now. I've had my CGRN for 4 years. I really love it, but do get tired of the call. I don't mind Saturday's so much because we're only open from 8 to noon on Saturdays. There's the potential for working in a free-standing clinic within the next year or so, but I'm not sure I want to do just butts and guts. I really like the esophageal manometry, 24 hour pH studies because they offer autonomy as well as skill and knowledge. And even though ERCP's can be stressful there's a certain amount of self-satisfaction in a job well done. Especially when you can save a patient from a big surgery. Does your clinic pay as well as the hospital? The doctors opening the new clinic have been heard to say that they don't expect they'll have to pay as much as the hospital because there won't be call and weekends. Anyway...good to get to know you. I'll try to check into this forum more often.

In 1996 my father was dying of lung cancer. The nurse at the cancer center called and asked my stepmother to please bring in my father's medications as she needed some information off the bottles. My step-mother questioned her as to why she couldn't obtain this information from the doctor or the chart, but the nurse insisted that she needed to see the label on the bottle. The MScontin had just been refilled. Because it was so expensive my stepmother counted the tabs when she had the prescription filled to make sure the pharmacy hadn't shorted him. She took the bottle to the cancer center where the nurse took it into another room to "write down the information." When my stepmother got home she recounted the pills and there were 13 missing. She immediately called the nurse and accused her of stealing the morphine. The nurse denied it....but offered to pay her for what was missing! My stepmother took the necessary steps to report this to the hospital administration and eventually the nurse confessed and was admitted to rehab. This hospital now has mandatory random drug testing for all employees. Yes, addiction is a disease and should be dealt with as such. But I still feel justified in being angry with a nurse who steals from a dying man. I do not believe that woman should have retained her position. Her actions were deceitful, unethical and illegal. If I were to relive this incident it would have been reported to the police before it was reported to the hospital administration.

I think this subject has been handled very well. The reasons for wearing gloves and hand-washing have been thoroughly explaned and defended. Why any nurse in this day and age would expose themselves and risk their co-workers and patients by not gloving-up is beyond me. It's irresponsible and dangerous. To those who are afraid of contracting a latex allergy (or already have) I say this: There has been a great deal of research and experimentation to come up with a good latex free glove. The hospital where I'm employed is attempting to remove as much latex as possible. Latex-free gloves are now the standard glove in every patient room and every procedure room. They're purple and gaudy but they're comfortable, fairly stretchy, and actually great educational opportunities when patients questions our purple gloves.) If your facility is not forward-facing enough to be following the trend toward latex free then it's up to you to demand a latex free glove for your own safety. While you're at it you might also go to your administration and ask why your facility is not protecting patients and staff by removing latex from as many areas as possible. There's no valid excuse for not wearing gloves in situation with the potential for exposure to body fluids. Has anybody NEVER grabbed what they thought was a dry sheet only to realize they're handling someone's urine? :uhoh21: Protect yourselves and protect others. Wear GLOVES!

I work in a hospital lab and our open ours are 7:30 to 4:30 (I think....doesn't really seem to matter what our hours frankly.) But we have nurses starting at staggered times starting at 6:30 and the latest shift starts at 9:30. Then the "on call" team takes over. Like others that have posted, these are supposed to be emergency cases but often are cases tacked on at the end of the day for physician convenience. We have an RN and an LPN in each procedure and this policy is strictly adhered to. It is not safe for the RN administering conscious sedation to be running around assisting the physician. ddcile, our physicians are in the process of opening their own clinic and I'm afraid that we're going to be in the same boat as you are. It's a good year and a half or so down the road, but at a recent meeting with staff and administration it was hinted at that we will have to be more "flexible"with our lab hours. This does not make me or any of the other staff happy at all! Of course at this point we don't even know who that staff will be since obviously our superbusy lab is going to be losing a great deal of business and the staff will have to be cut. ....but I digress. We take call every 8th weekend and 1 night every couple of weeks. This varies with how many teams we have. This will also change when the staff count changes. Right now it's ideal....but who knows what's down the road. oh well...life is about nothing if it's not about change.

Only anesthesia administers Propofol in our endo lab and like ButtRN I'm more than thankful! We typically use versed and demerol...occasionally fentanyl...and morphine or nubain if the patient is allergic to demerol. Propofol is very powerful. It's a great drug but I'll let the Anesthesiologists take the liability thanks! :)

geeceejay, the numerical markings on the scope are guidelines and NOT definitive place markers. After you've been in the field for a while you'll be able to recognize (most of the time, but not always especially in the colon) the anatomical differences. For instance the tissue of the esophagus is usually very pale compared to the pink stomach tissue. You can see the differences when you get to the GE junction or Z-line. The stomach has rugae and is very pink. When you go through the pyloris into the duodenum you'll notice the tissue takes on a velvety nature and the folds are different than in the stomach. The colon is more difficult but the lumen in the transverse colon typically takes on a triangular shape. When you see the large shadow of the liver you know you're at the hepatic flexure. The splenic flexure is usually at 50 to 60cm when the scope is straight and not looped...but everyone's anatomy is different so that's not a surefire thing. The cecum of course has the telltale appendacile (sp) orifice and is visualized after passing the ileocecal valve. Hang in there. You've probably figured most of this out by now since your post is a month old. It will all become old hat to you soon. And welcome to GI nursing!

My co-worker had to cath a male patient in his 50's who of course had to have an enlarged prostate. So she asks for help and they go into the room to insert the cath. After a while we hear the guy hollering in agony and peek in to see if there's anything we can do. The guy is writhing in agony as my friend is attempting to insert the cath and she's saying over and over again "I'm sorry Dick, I'm so sorry Dick. Oh Dick, I"m SO sorry!" We were pretty shocked at this until we realized the guy's name was Richard. TEEHEETEEHEE