robrn

i am glad your hospital is interested in this procedure it is saving lives. if you write to [email protected] i will send you the protocol and procedure. we are very proud of our results. to date we have done 45 fecal transplants 43 successful. i am pleased to say i'm speaking at sgna this year about fecal transplants.

Yes there are GI Docs that do Fecal Transplants in OR, CA, NV. Dr Schleinitz Medford OR. Dr Stollman San Francisco, CA. Dr Gao Carson City NV. If you can find a GI Doc that will do this procedure in your area I can send them our hospital protocol and procedure.You are going down the right track in pursuance of fecal transplants. They are 95% to 98% effective in curing recurrent C-Diff. Rob C

I am happy to report that we have done 10 fecal transplants. All 10 have been successful 100%. Unfortunately I’m becoming the "king of poop”.

We are on our way to doing fecal transplants for c-diff patients. Our protocol is in place and the IRB (instructional Review Board) has given us the OK. Stool transplants still remain the definitive care in patients with recurrent C-diff.

We have done a fecal transplant with great success. However our hospital has subsequently asked that we never do this in the future. As we have no protocal for the procedure. Does anyone know of protocals or best practice articles that I could present to our administration?

To become paralyzed by the thought of what might occur, is equivalent to doing nothing toward better patient care. I applaud the hospitals that are willing to exercise, and support, the best practice of their nurses. Recently our hospitals insurance carrier was changed. The nurses that administer IV sedation were interviewed for many hours. The insurance carrier was very satisfied with the way IV sedation is done at our facility. I agree if you treat "a million" patients with propofol you will most likely have a bad experience. I also believe that if you give " a million" doses of ____ (fill in the blank) you will have a bad experience. It is thinking like that, that doesn't allow for advances in health care that can reduce risk and decrease mortality. With propofol the procedure is painless and effective. If I can participate in a procedure that may save the life of a patient that is terrified of a painful procedure. You ask is it worth it? Yes, I believe it is. Training in the area of sedation is a must, ACLS, ED experience is preferable. However to have an anesthesiologist or crna on every case is not practical, not feasible and fiscally irresponsible.

For continued updates on our progress and more about sedation with propofol, get the facts. Don't rely on outdated opinions or professional biases. Visit Dr. John Walker's web site http://www.drnaps.org. Dr. Walker has spent exhaustive research and development of sedation for procedures in both the inpatient and outpatient setting. We look forward to many years of good sedation and very good patient satisfaction in our GI lab

Thursday 2-9-06, the Oregon Board of Nursing Unanimously agreed that sedation with propofol is both safe and effective when given by RN's in the procedural arena. I would like to extend my thanks to all those who supported us during this turbulent time. We are seeing evidence based nursing in practice.

Thursday 2-9-06, the Oregon Board of Nursing unanimously agreed that sedation with propofol is both safe and effective when given by RN's in the procedural arena. I would like to extend my thanks to all those who supported us during this turbulent time. We are seeing evidence based nursing in practice.

If you are interested in a very good prospective study of nurses giving propofol for sedation. Check out Gastroenterology November 2005, volume 129 Number 5. I would also like to suggest contacting Dr. John A. Walker director of NAPS (Nurse Administered Propofol Sedation) for suggestions and approaches to overcoming adversaries to a better, and safer, way of administering sedation. The evidence is in and the answer is NAPS.

Regarding nurses administering propofol. I seem to be reading a lot about economics, turf battles, and archaic philosophies. Such as nurses should not give propofol because nurses never have. Rarely do I read about patient outcomes, patient satisfaction or patient safety. So lets address just a few of these. I think that it is much safer to give the 80yo frail patient small incremental doses of propofol for a procedure, than giving boluses of narcotics and benzos then allowing that patient to go home in a narcotic daze only to fall and break something. Propofol patients can be offered a painless procedure. If one patient will come to our facility because of that, and we remove a pre-cancerous polyp I'm happy. This scenario has happened. Currently there is a shortage anesthesiologists and crna's. With the ongoing study of nurses giving propofol in the USA and other countries both inpatient and outpatient. The complication rate is less than 0.001% based on 300,000 patients that received sedation. Throughout the years versed is responsible for, many more, poor outcomes during sedation than is propofol. We remain on the leading edge of procedural sedation, by offering a safer, smarter and better way of sedating patients. Nursing is moving to evidence based practice and I think the evidence is clear propofol sedation is rapidly becoming recognized as a safe and effective means of administering sedation.

We use propofol for sedation and our MD's guarantee a painless procedure. To this date we have had no complaints, from our patients. We start with 30 to 50 milligrams of propofol then give incremental doses of 10 to 20 milligrams depending on the patient's response. Propofol is very predictable fast acting and rapidly dissipating. I have found Versed and Fentynl doses are all over the map, depending on the patient's previous exposure to benzos and narcotics.

I know of 6 couples that are both RN's that work in the same hospital some in the same unit. With about 70 years of marriage between them. A few couples have traveled together and they loved it. The couples I know seem well adjusted to each other's roles and respect their individuality. A hospital is big enough place for both of you to work, and remain your self. Besides it gives you someone who understands the view from the other side of the rail. God bless you and good luck.

Librasun, Thanks for your support in the use of propofol for sedation. I am a nurse that works at the GI lab you described in southern Oregon. With proper monitoring (EKG, SAO2, NIBP and ETCO2) Propofol is not only safe but also very effective. For instance narcotic using patients (we never see them) need large amounts of narcotics and benzos just to control the patient. If we are into an ERCP for 30 to 40 min nothing is more frustrating then having a patient twist and turn dislodging the cannula the MD just got into the duct. Our administration of propofol is small incremental doses in which the patient's airway is not compromised and total comfort is achieved. I can't say that patients don't desaturate but I haven't noticed a discernable difference in patients receiving propofol as compared to Fentynl and Versed. Here we don't just use propofol, as the MD's that do, must be credentialed in deep sedation. Some of our MD's are not, and don't use propofol so I have a pretty good grasp on the use of both. If we give our patient instructions prior to the procedure with Versed there is a retrograde amnesia. With propofol there is no retrograde amnesia, and as a bonus the patient is wide-awake about 15 min. after the last dose of propofol. In conclusion propofol is safe and effective in the GI lab setting when used by properly trained RN's, MD's and well monitored here in southern Oregon we have administered propofol to about 25,000 patients without any adverse effects. I encourage you to visit http://drnaps.org for more Information about training and Nurse Administered Propofol Sedation. Thanks again for your support. sorry I first placed this as a new thread and it isn't.

Librasun, Thanks for your support in the use of propofol for sedation. I am a nurse that works at the GI lab you described in southern Oregon. With proper monitoring (EKG, SAO2, NIBP and ETCO2) Propofol is not only safe but also very effective. For instance narcotic using patients (we never see them) need large amounts of narcotics and benzos just to control the patient. If we are into an ERCP for 30 to 40 min nothing is more frustrating then having a patient twist and turn dislodging the cannula the MD just got into the duct. Our administration of propofol is small incremental doses in which the patient's airway is not compromised and total comfort is achieved. I can't say that patients don't desaturate but I haven't noticed a discernable difference in patients receiving propofol as compared to Fentynl and Versed. Here we don't just use propofol, as the MD's that do, must be credentialed in deep sedation. Some of our MD's are not, and don't use propofol so I have a pretty good grasp on the use of both. If we give our patient instructions prior to the procedure with Versed there is a retrograde amnesia. With propofol there is no retrograde amnesia, and as a bonus the patient is wide-awake about 15 min. after the last dose of propofol. In conclusion propofol is safe and effective in the GI lab setting when used by properly trained RN's, MD's and well monitored here in southern Oregon we have administered propofol to about 25,000 patients without any adverse effects. I encourage you to visit http://drnaps.org for more Information about training and Nurse Administered Propofol Sedation. Thanks again for your support.