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Discussion

propofol

The news letter from the NM BON last month had a section regarding anesthesia drugs and the nurse practice act. Regarding propofol it stated that because propofol is an anesthetic agent, only those qualified to administer general anesthesia would be allowed to use it, this sounded nationwide. I work in a CV stepdown, but our CCU uses propofol all the time. Have any of you heard of this new restriction? I keep wondering if i misunderstood the newsletter, but I don't have it anymore.

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I currently am working as an Apprentice Nurse in an ICU and I can tell you the nurses there use propofol ALL the time. Especially in the patients who are having ICP issues.

The new guidelines refer to the use of propofol for conscious sedation, not intubated and mechanically ventilated patients. There have been several cases of nurses giving propofol for conscious sedation in the ER or endoscopy and patients losing their airway.

Hopefully your BON will become more educated as to the uses of this drug and its benefits in certain settings, and will not push for banning it to nurses' use. One has to be cautious using it for conscious sedation in nonvented patients, yes, but banning it except for use by anesthetists seems harsh.

It is too good a drug and has a very short half life...I love using it in my ICU setting. :)

That it does Mom

  • Admin

One of our cardiologists is proposing RNs giving it for elective cardioversions and TEEs (transesophageal echocardiograms). He has literature supporting its VERY safe use in those settings as well as in GI procedural settings.

The RNs who administer it would be, of course, ACLS-certified, and would only administer it with the MD present in the room, as well as with an RT standing by for airway management assist.

As one of the RNs who presently administers Versed and Fentnyl IV for the cardiac procedures, I would not feel it was out of my scope of practice to administer propofol, as long as there was a protocol and dosing guidelines in place, and the MD was present in the room at all times while it was being administered.

I would not monitor the patient any differently than I do now: VS and pulse ox every two minutes (for TEE), including quality and depth of respirations. I'm inclined to say the fear of RNs giving it in an other-than-intubated-in-the-ICU setting, is based solely on past practice and turf (anesthesia personnel have always given it, and thus should be the only ones to administer it). Yes, I know the flaming that will come from CRNAs and Anesthesiologists, with the alternative argument, "if propofol can be given as you suggest, why not everything else???? Where does it stop????" Let me say, I have no desire to invade anyone's turf, nor to practice unethically or unsafely. Safety, in fact, is what drives my support for giving the propofol. It is such a short-acting med that if the pt develops airway management issues, s/he may need to be manually ventilated for a VERY short time, until the med wears off. CRNAs, is this scene flawed? Am I missing something? I would truly love to help with these procedures SAFELY, so the pt is comfortable throughout, doesn't remember anything, is relaxed enough for the probe to pass through and then remain in the esophagus, and then wakens quickly once the procedure is done.

I hope CA BON doesn't follow in NM's footsteps in preventing propofol's use in limited, highly-monitored settings.

Thanks for use of the soapbox. Next???? :) :)

It is such a short-acting med that if the pt develops airway management issues, s/he may need to be manually ventilated for a VERY short time, until the med wears off. CRNAs, is this scene flawed? Am I missing something?

Although, I'm not a CRNA yet, I do hope to be in the near future. I currently use propofol in CTICU all the time and agree with its usefulness. The drug has such a short half-life that I can't imagine why a CRNA or anesthesiologist would have to administer for procedures.

  • Admin

Wow, check out the Gastroenterology specialty section's thread on propofol! Very eye-opening and humbling. I need to re-think a LOT of things before going along with this.

Ohhh noooo. Don't take my Prop away! Love it....we use it all the time. It's fab. AKA: Mothers Milk..... or ...Milk of Amnesia....Yup. Good stuff. Fast acting with short half life. What more could you want? (other than maybe a Prop Lite....no lipids... :) But hey, we can work around that...:)

Y'all don't know what you don't know. That's what makes propofol such a potentially dangerous drug and why the manufacturer states that is for use by anesthesia personnel only or in mechanically ventilated patients in the ICU.

It is a much different drug that anything else you would use. Don't fool yourself into thinking that just because you give a little fentanyl and versed that you're somehow qualified to give propofol. And here's a news flash - ACLS doesn't teach squat for airway management. Do you really think that because you've intubated a mannequin a couple of times in a weekend class that you're qualified to manage an airway when you get them too deep with propofol? That's laughable.

Read the GI thread regarding propofol - you'll get the full gamut of arguments against it's use.

Just remember this - if you go against your nurse practice act, or you go against the explicit recommendations of the manufacturer regarding it's use, and you have a problem, you will have no recourse. It will not matter that the cardiologist was standing there (he's not trained either!) or that your hospital policy allows it or that the GI nurses and docs organization think it is OK or that you've taken a weekend course in conscious sedation and think you know everything. It simply will not make a difference. The attorneys will be salivating, and your malpractice insuror and your hospital's will be asking how many zeroes they should put after the first number in the check to the victim's family.

Y'all don't know what you don't know. That's what makes propofol such a potentially dangerous drug and why the manufacturer states that is for use by anesthesia personnel only or in mechanically ventilated patients in the ICU.

It is a much different drug that anything else you would use. Don't fool yourself into thinking that just because you give a little fentanyl and versed that you're somehow qualified to give propofol. And here's a news flash - ACLS doesn't teach squat for airway management. Do you really think that because you've intubated a mannequin a couple of times in a weekend class that you're qualified to manage an airway when you get them too deep with propofol? That's laughable.

Read the GI thread regarding propofol - you'll get the full gamut of arguments against it's use.

Just remember this - if you go against your nurse practice act, or you go against the explicit recommendations of the manufacturer regarding it's use, and you have a problem, you will have no recourse. It will not matter that the cardiologist was standing there (he's not trained either!) or that your hospital policy allows it or that the GI nurses and docs organization think it is OK or that you've taken a weekend course in conscious sedation and think you know everything. It simply will not make a difference. The attorneys will be salivating, and your malpractice insuror and your hospital's will be asking how many zeroes they should put after the first number in the check to the victim's family.

We ONLY use it for vented patients.

I agree with jwk. In my institution, we use propofol on vented patients all the time. If it's going to be used for conscious sedation, it must be given by anesthesia or by an intensivist. It is a wonderful drug, but I've seen plenty of patients that need their respirations assisted after it's administration, and one that needed to be intubated. I, for one, am thankful that our nurses can't give it on non-vented patients.

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