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I think that our unplanned extubations have gone up as well.
"Unplanned extubations"? I prefer to call them patient-directed spontaneous breathing trials.
I agree that the propofol substitutes just don't seem to work as well as the white stuff. You can crank & crank up the drip rates on versed/fentanyl, and still end up with a pt fighting against soft restraints and extubating themselves (usually happening at shift change).
I've not seen Propoven in my ICU. We still have a very limited supply of 100ml Propofol & Diprivan bottles. Not sure if the Propoven is being used in other units. I suspect that it may be, since I helped out with a PEG placement last week, and one of the endo nurses mentioned that the new version of propofol contained peanut oil.
Is this just a regional problem, or are other hospitals having a hard time getting an adequate supply of propofol? Ours is mostly on lockdown and what we have is allocated to the OR. They won't let the ICU doctors order it for ventilated patients because of the shortage. It's been a few months, and it's gotten really tiresome. The fent, versed, ativan, precedex gtts (whatever) just aren't as good. I think that our unplanned extubations have gone up as well.
I'm from the midwest, and we have a propofol shortage here, too. We're also no longer getting D50 in the prefilled syringes----now it comes in a bottle and has to be drawn up. Ditto for prefilled epinephrine syringes. And, at various times, we've had trouble getting Dilaudid in the Carpuject cartridges. Seems like there's always a shortage of one drug or another lately.
Interesting about the amps of Epi. Do you think that the docs are OK with that since in the ACLS algorithm you can only use vasopressin once? (not that the docs can't use it more, but with the new interns using their little flow sheet cards, it might get interesting)
In our unit we are almost exclusively using the Versed/Fentanyl combo that works pretty poorly IMHO. We have a very limited amount of propofol in the pyxis; it just sits there daring us to use it through the clear doors!
In our unit we are almost exclusively using the Versed/Fentanyl combo that works pretty poorly IMHO. We have a very limited amount of propofol in the pyxis; it just sits there daring us to use it through the clear doors!
If we had it, we would use it ... they pulled it off our shelves, and pharmacy won't dispense.
well, shoot, dont I feel just peachy now. not out there working (currently working on my pre-reqs for lpn to bsn, UGH), so I didnt know there was a shortage. someone very near n dear to my heart (lol) is having a "procedure" this friday, supposedly under the "please knock me out cold" comfort of this drug. crap crap crap.
hmmmm, should be interesting to see what will actually be used. I think this falls under "nurses & doctors can be the worst patients".
CNL2B
516 Posts
Is this just a regional problem, or are other hospitals having a hard time getting an adequate supply of propofol? Ours is mostly on lockdown and what we have is allocated to the OR. They won't let the ICU doctors order it for ventilated patients because of the shortage. It's been a few months, and it's gotten really tiresome. The fent, versed, ativan, precedex gtts (whatever) just aren't as good. I think that our unplanned extubations have gone up as well.