Propofol

[czipp]

I wondered if anyone of you as RN's

use propofol? Only the anesthesia

people are using it. When anesthesia

is used they use propofol. We as Rn's are pushing the Demerol, Versed, Morpheine, Nubain,elc.for conscious sedation. We

are not "allowed " to push propofol or

really any Fentanyl. Is this typical?

Or are we as RN's being overruled or

not allowed to push such drugs..........???

We usually use Demerol and Versed.

but propofol requires a nurse anesthestist or an anesthesiologist.

Is this common????

[nurselemmon]

I was an ED nurse in a level I trauma center for 5 years, the OR for 3 years, and then the SICU in the same hospital for another 5 years before I became a crna. We used propofol daily without any issues. It is an extremely safe medicaion. I think it is crazy for any high functioning ED or ICU not to have propofol available or sedation, especially with severe trauma patients that require intubation! These nurses should be trained on the use of these drugs, and the use of the ramsey scale to be in compliance with sedation reguations. It is not that difficult to titrate a propofol drip, no more than a nipride or levoped drip. Titrate to the desired effect...if the patient becomes unstable, stabilize the patient. This is for patient safety and patient care. How safe it is for an anxious patient to be trying to dislodge his tube or trying to get out of bed with multiple traumatic injuries? I do not want to downplay the work of my profession, but let me say this... certain high functioning departments are prepared to handle almost any emergent situation if it arises with the use of certain sedative agents. The emergency physicians I have had e pleasure to work with intubated sometimes more than 10 patients a day. I am not talking about patients with stable VS, "Here take a few deep breaths," patient is relaxed, now intubate! I am talking about gashes through the throat, bullet wounds next to the trachea or anaphylaxis with a swelling throat on a 400+ pounder. You are trying to say that a patient who needs sedation with a crash cart next to him, on a monitor, with a physician neaby, and a nurse that pushes drugs through code situations left and right is not equipped enough to handle a patient that becomes extremely hypotensive, or even goes into Vtach or Vfib??? What can we do that this team cannot do? Really?

I thought I was high and mighty for a while after I graduated from the CRNA program, but I now realize that it only takes 2 1/2 more years of school and any nurse with some ICU experience can become a crna. It is simple as that! instead of being so cocky, we shoud be thankful that we can come out of a 2 1/2 year program making $75/hr. Keep your mouth shut before everyone realizes how overpaid we really are!

TLL, crna

[nurselemmon]

I was an ED nurse in a level I trauma center for 5 years, the OR for 3 years, and then the SICU in the same hospital for another 5 years before I became a crna. We used propofol daily without any issues. It is an extremely safe medicaion. I think it is crazy for any high functioning ED or ICU not to have propofol available or sedation, especially with severe trauma patients that require intubation! These nurses should be trained on the use of these drugs, and the use of the ramsey scale to be in compliance with sedation reguations. It is not that difficult to titrate a propofol drip, no more than a nipride or levoped drip. Titrate to the desired effect...if the patient becomes unstable, stabilize the patient. This is for patient safety and patient care. How safe it is for an anxious patient to be trying to dislodge his tube or trying to get out of bed with multiple traumatic injuries? I do not want to downplay the work of my profession, but let me say this... certain high functioning departments are prepared to handle almost any emergent situation if it arises with the use of certain sedative agents. The emergency physicians I have had e pleasure to work with intubated sometimes more than 10 patients a day. I am not talking about patients with stable VS, "Here take a few deep breaths," patient is relaxed, now intubate! I am talking about gashes through the throat, bullet wounds next to the trachea or anaphylaxis with a swelling throat on a 400+ pounder. You are trying to say that a patient who needs sedation with a crash cart next to him, on a monitor, with a physician neaby, and a nurse that pushes drugs through code situations left and right is not equipped enough to handle a patient that becomes extremely hypotensive, or even goes into Vtach or Vfib??? What can we do that this team cannot do? Really?

I thought I was high and mighty for a while after I graduated from the CRNA program, but I now realize that it only takes 2 1/2 more years of school and any nurse with some ICU experience can become a crna. It is simple as that! instead of being so cocky, we shoud be thankful that we can come out of a 2 1/2 year program making $75/hr. Keep your mouth shut before everyone realizes how overpaid we really are!

TLL, crna

[michaRN, RN]

here in UK-ICU where i worked we used propofol with intubated patients and RN can even give boluses but u have to watch the blood pressure..so far no problems at all...