LibraSun

Guys, I think you should check with your ped Doc. These are abnormal bowel movements and should be discussed with the PCP--not in an online message board. We all know possible causes of stool changes, but we don't know the little patients. It is inappropriate for nurses to try to diagnosis in this arena.

I agree that propofol can cause hypotension, respiratory depression and loss of protective reflexes--as does demerol, fentanyl and versed given in quantities that some GI docs request for 'sedation'. We get unexpected responses from our 'sedation' too, like loss of inhibition when a pt decides he MUST get up off the stretcher during the procedure, or that he should strike out at the people that are 'tying' him down. Like I said, so long as there are doctors available, RNs are not capable to provide the service, but as soon as there is no money/ reimbursement or no providers, we staff RNs are suddenly highly qualified to do what needs to be done. I expect that in 5 years when the demand by babyboomers overwhelms the supply of endoscopy suites and we need to 'speed up' the turn over, the staff RNs will suddenly be able to provide this service. Why wait?

It can be exhausting with people with difficult turns or Drs with less skill, FOR SURE! My boss and I even thought up a compression device, but it seems someone else patented our idea in 1997, but didn't do anything with it!! dang! I wonder if anyone has any helpful hints as to making it easy and comfortable for the nurse and the patient.......

What is the theory behind putting in a rectal tube? That the pt can't pass the air naturally? How do you decide who gets one? I am incredulous that a healthy person would need (let alone tolerate) a rectal tube for a routine colonoscopy. Do you think this has anything to do with the age of the endoscopist?

Wow! Rectal Tubes????? That seems extreme!! I have had 3 colonoscopies by 2 different GI doctors and suites and I have never been placed in any position but supine. Who takes the rectal tube out? and when? Does the pt wake up with the tube still in?

We are a teaching facility, so week days the Attending and fellow are on call. We do 1 weekend in 6 and have a standby oncall for ERCPs. Only RNs are on call and that call is 5pm Fri to 7am Monday.

There shouldn't be so much air left in the colon that it requires the patient to be contorted! Unless there is something obstructing the natural flow (tumor, stricture, etc) the pt should be able to expel any air naturally. However, if your are a teaching facility w/ newbies or unfortunate to have an incompetetent/uncaring attending there may be an unusual and uncomfortable amount of air left which positioning may make more comfortable---but I would hope that this is rare!!

Holy Cow!! Have none of you guys taken ACLS? I would LOVE to be able to give Propofol. The patient wakes up in seconds. It has a half life of 1.8 minutes!!! I would rather bag a pt for 1.8 minutes than give an 85 y/o 85 lb lady 125mcg of fent and 5 mg of versed!!!!!! Then have to reverse her! I understand there is an Endo lab in southern Oregon that trains RNs in GI to administer propofol---would love to go there!!! When I worked in the Midwest as a recovery room nurse we had a procedure room for ECTs, and the Drs started the propofol and we managed it during and post procedure. I NEVER had a problem with airway (if that is the concern)--only with people waking up TOO FAST! Don't sell yourself too short, RNs keep people alive all the time. All the nurses in our GI lab have ICU/ER experience and ACLS. We need to expand our expertise, not limit it. As long as we are appropriately trained and supervised by an MD, there is no reason to fear administering a medication that enhances the patients comfort and safety during procedures.

God, I would love to have MAC for ERCPs. Where are you that they are using anesthesia routinely? We still have to use Fent/demerol and Versed for those horribly loooooong ERCPs!! Our dept only has a tech for scopes. RNs do wires and sedation, which we rotate. How can one work in a GI lab and not do ERCPs?