radblt

i work in a rural hospital that the administration has decided to reduce the number of rn's in the icu core staffing. currently, we staff with 2 rn's if there are 4 or less patients in the unit. for 5-6 patients we can add one rn, for 7-8 patients we add an additional rn. we also monitor 16 telemetry beds for the facility-there is no monitor tech. while the hospital is not large ( also, is anyone aware of some literature that specifically addresses icu staffing guidelines? we are very concerned for the well-being of our patients as well as our nursing licenses.

Remember when Versed was not approved for use by RN's? Of course, I'm dating myself. Propofol in the ICU setting was just getting popular 10 years ago. Even then, in the intubated patient, some physicians were hesitant to use it. Now, it is steadily moving into the procedural settings-just as Versed did. Even so, at this time, Propofol in the procedural area has to be administered by an anesthesiologist or a CRNA. I believe that with time and education, Propofol will become more widely used than Versed. If one does deliver too much drug-turn it off and support ventilations. The half-life is extremely short and the drug will wear off quickly. Unlike Versed, esp if used with Fentanyl, which could last a couple of hours. Procedural clinics like Propofol because they can turn over patients much more quickly. I love Propofol! I have had a moderate sedation procedure with it-Good stuff!!

In the facility where I work, we do both pedatric and adult moderate sedations. The requirement is that the radiologist has to be present in the department while the sedation is going on. The radiologist is usually in the reading room located near the scanners. Of course, he must assess each patient prior to the sedation as well as write the orders needed for the procedure. Very rarely do we come across an adult that needs true moderate sedation. Most of the time anxiolysis will do. It is often given in the IV form--Valium, Ativan, or Versed (alone). Pedatric patients under 2 are usually sedated with oral Chloral Hydrate at 75mg/kg up to a max of 125mg/kg. Children over the age of 2 normally receive IV Versed, and Nembutal (2mg-7mg/kg titrated). Adults requiring moderate sedation usually receive Versed and Fentanyl IV. I hope that this is helpful!:)