Propofol

Lucy2 · Apr 6, 2005

Where I work we use Hynovel/Midazolam and Fentanyl the nurses are able to push these, we do not use propofol, wish we could.

stevierae · Apr 23, 2005

Where I work we use Hynovel/Midazolam and Fentanyl the nurses are able to push these, we do not use propofol, wish we could.

"We, " meaning, the gastroenterology nurses giving IV sedation?

My question to you in one word: WHY?!

sharann, BSN, RN · Apr 23, 2005

Stevierae,

I am not surprised at the nurse at your interview. Those freestanding centers and private offices often(NOT ALWAYS) make their own rules. Can you believe the nerve of her saying the fire dept is just around the corner? 4 minutes for brain death to occur. Propofol as sedation for a case is anesthesia. Period. I am shaking along with you! Scary isn't it? I worked in a place like that except they had an outdated crash cart and noone knew where the oxygen tank was(which is why I left after 4 days)

hollyster · Apr 23, 2005

When I worked CCU propofol was a nurse and pt's best friend. I have used it as a push during procedures performed at bedside(bronchs,endos,bone marrow extractions) always with a DR. present as well as the CCU staff. I felt completely safe and did not feel that I was compromising pts. But we worked with the drug every day, know its side effects and idiosyncratic reactions. Most pts were vented but not all.

I was recrutied to a same day surgery clinic(5 OR suites) peds.from six months to geriatrics. The clinic did everything but open hearts and cranies. As long as the could go home. I was brougt there due to my backround in rescue,the OR and CCU. Once I started the demands made were more than I was comfortable with. I would not do IV sedation with propofol. I agreed to versed/fent/demerol/valium. I was chastised but reminded them that I was not there to do sedation that I was there phase one PACU nurse and the code nurse. They finally relented. I did not realise just how dangerous these outpatient places could be until the day an anesthesiologist called me to do an emergent IO on a eight month old. I grabbed the pedi cart a went into the OR when I got in there it was obvious that there was no emergency. The baby was crying and pink. I ask why they needed an IO and the DR told me that they could not get IV access and I was the only one experienced in doing IOs. I refused and told the DR and the Anesth. that IOs were only for saving a life not to remove a set of adenoids. They cancelled the baby's surgery and I was chastised for not following an order, that I upset the parents because the baby had to be rescheduled at the hospital. I felt that the risks that go with an IO were far greater than the inconvience of the DRs and the pts.

I feel that profit driven medicine is compromising the pts as well as the nurses. We need to take a stand. Just because we have the experience and the competence to do things in one setting does not mean that we should do it in others.

sharann, BSN, RN · Apr 23, 2005

Holly,

Amazing. I am not opposed to propofol being used as a continuous drip for intubated pts in the ICU, just am against pushing it whenever told to do so for someone elses convinience. I have seen experienced aneshtesiologists panic when the propofol dropped their pts airway and they have to unexpectedly intubate. It is not a benign drug. It is a seriously potent and wonderful drug when used correctly.

hollyster · Apr 23, 2005

Holly,
Amazing. I am not opposed to propofol being used as a continuous drip for intubated pts in the ICU, just am against pushing it whenever told to do so for someone elses convinience. I have seen experienced aneshtesiologists panic when the propofol dropped their pts airway and they have to unexpectedly intubate. It is not a benign drug. It is a seriously potent and wonderful drug when used correctly.

I agree with you completely. Love the drug in the unit but I will not push it outside of it. Too many risks. I am not willing to play fast and loose with someone's life no matter how much I have used the stuff. My job is not to increase a company's profit margin it is pt safety. :rolleyes:

misty5 · May 10, 2005

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.

I totally agree. Actually, we just opened up an ASC for endoscopy only here in Texas, and I have pushed for propofol so we are going to Oregon this summer. I am curious if there are any other ASC's in Texas where ther is NAPS being performed.?

stevierae · May 11, 2005

I totally agree. Actually, we just opened up an ASC for endoscopy only here in Texas, and I have pushed for propofol so we are going to Oregon this summer. I am curious if there are any other ASC's in Texas where ther is NAPS being performed.?

Well, hopefully the one in Medford, Oregon will be shut down (or at least the "NAPS" portion of the endo lab will be shut down) before you come.....what the nurses do there constitutes dangerous patient care. I, for one, will breathe a sigh of relief when that facility bites the dust, and my nurse colleagues and I plan to be to be part of the impetus for it biting the dust.

Bunch of endo nurses trying to feel important, taking on a whole lot of extra responsibility without being compensated for that extra responsibility. Why? To increase the doctors' profit margins--doctors who don't even ackowledge said nurses by name.

robrn · May 12, 2005

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.

jwk · May 12, 2005

You provide a classic example of not knowing what you don't know.

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.

Really? What's a small incremental dose? 5? 10? 20? And if you are just giving narcs and benzos, and then sending them home in a haze, then you REALLY shouldn't be giving propofol, since you've already proven you're a danger to your patients.

Propofol patients can be offered a painless procedure.

Propofol has NO analgesic properties. If you're at that point, you're way past conscious sedation - again, a danger to your patients.

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.

Ah, closer to the real reason - a marketing GIMMICK!!! $$$$$

Currently there is a shortage anesthesiologists and crna's.

So the answer is cutting corners and increasing risks to patients?

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.

Hmmmmm, that would be 3 complications in 300,000. TOTAL BS!!!!!

Throughout the years versed is responsible for, many more, poor outcomes during sedation than is propofol.

So you have problems with versed, and you want to move onto 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.

Who the hell is "WE" ? RN's? Give me a break. Anesthesiologists and anesthetists, yes. RN's with a weekend class in conscious sedation? Nope!!

Propofol is great for sedation - in the right hands. Yours aren't it. That's why many state boards of nursing have ruled that it is illegal for RN's to administer propofol. As it should be, except by infusion in a ventilated patient in the ICU.

Read the package insert - the manufacturer's will NOT stand behind you if there is a complication. It will be the FIRST thing they'll point out to the plaintiff's attorney.

CrunchRN, ADN, RN · May 13, 2005

This is a link to a very interesting article on this subject.

Have a great weekend.

http://www.medscape.com/viewarticle/503752?src=mp

stevierae · May 13, 2005

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.

Why would you discharge ANY patient to home "in a narcotic daze?" This tells me something about the caliber of the people RECOVERING these patients. What, do you work at one of those high volume free standing surgical centers where you push them out the back door--practically carrying them because they don't meet the discharge criteria that they woruld be required to in a hospital recovery room (and, in fact, are STILL required to meet, in an endo lab or free standing surgical center--) so that you can use the space for yet another unsuspecting patient, who will also be discharged prematurely, so that you can keep the schedule moving and keep the doctors happy?

Do you actually HAVE designated RNs for recovery, or are you "recovering" them as well as sedating them (to save money?)

Why are you willing to take on so many roles--doing an anesthesia provider's job, in addition to your own--for absolutely no additional monetary compensation, anyway?