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Trendelenberg has been out for quite sometime. The baroreceptors in the aortic arch and the chemoreceptors in the carotid respond to low volume . and low O2 levels by initiating the body's compensatory mechanisms By putting patients in Trendelenberg, the increased blood flow to these receptors tell them "everything is OK" and the cempensatory mechanisms stop. The other issue is that Trendelenberg presses all the abdominal organs against the diaphragm making it difficult for the patient to breath. The recomended position is "modified Trendelenberg" in which the legs are raised 8-12 inches, this will allow enough blood to return to the central circulation without the above undesired effects.:redbeathe

Dear RN Cardiac--if you don"t feel comfortable doing or giving something, don"t do it!! As a past member of a state nursing board, I had to discipline many nurses who did something because "a Dr ordered it or said it was OK" even tho in some cases it was not within a nurses scope of practice. The day the ED MD ordered Propofol for concious sedation, I refused to give it, when he insisted, I called the head of anesthesiology who came to the ED to back me up. The anesthesiologist offered to give the Propofol if the ED MD wanted it given. (per our hospital policy) I know its troublesome, but you really have to be aware of your P & P, nurse practice act etc, these are the things that will protect you--if you step outside these parameters than you put yoursefl at risk.

Does anyone anywhere have a competency program in place for nurses who use propofol?? In our hospital, nurses can administer an IV drip to intubated patients only. A few ED docs have wanted to give it for concious sedation, but our anesthesiology dept will not allow that. With propofol. there is a fine line between concious sedation and deep sedation. All of the literature I've read calls for nurses to be "certified" (thru competency at least) in the use of Propofol even if it is for the intubated patients. There is even a question as to whether our malpractice insurance policies will cover us if nurses are giving anesthetic drugs. Please, if anyone has a competency program let me know.

I was "talked into" buying a Pure tone stethescope a couple of years ago--I wouln"t get another one if they gave it to me. When I questioned the representative the next year regarding its poor quality, he told me I "probably didn't know how to use it properly"!!! :uhoh21: