do ya'll push it fo concious sedation?
Nov 26, 2005
We don't use it for CS. We use Versed here in Fort Worth.
I'm a traveler and have seen Propofol used for Concious Sedation. I am not fond of this. Usually I prefer Versed, or Ketamine (though ketamine does get squirrley sometimes.)
I actually will not do CS with Propofol. So, at my current facility, when I get a CS patient, if the MD wants to used it, the patient gets another nurse.
Edited to correct where I put Midazolam, instead of Prop. I guess its about time for sleep, just got off my 4th shift in a row of nights LOL.
austin heart, BSN, RN
Specializes in ICU.
Do a search and there is a great thread with a TON of info on pushing diprovan. I think that it is the GI Nurses section.
From what I understand, pushing Diprovan in bolus form is considered general anesthesia and is out of the scope practice of the RN and requires an anesthesiologist or CRNA, or it is in Texas anyway.
traumaRUs, MSN, APRN, CNS
Specializes in Nephrology, Cardiology, ER, ICU.
Has 27 years experience.
At our ER - the doctors can push it, RN's can't. You must be prepared to immediately intubate and be able to get an airway immediately. We only do it very occasionally for a hip or shoulder dislocation.
I won't push it either, even though in my state technically I could. Sure, I've got ACLS, but I couldn't put in an airway. I think it's foolish that any nurse who is not a CRNA is doing this. Unlike Versed or fentanyl, there's no reversal agent for propofol.
I push propofol in my ICU, but only on vented patients.
That's different; you've got an airway established.
Only docs push it in my dept in London. Interesting to see its also used for shoulders and hips, we use midaz for that :)
Altra, BSN, RN
Specializes in Emergency & Trauma/Adult ICU.
Nov 27, 2005
Propofol can only be used on intubated pts. at my facility, not for moderate sedation. For tubed/vented pts. we RNs can & sometimes do push a bolus in addition to the drip.
Dixielee, BSN, RN
Specializes in ER.
Has 38 years experience.
Nov 28, 2005
As a traveling ER nurse, that is generally the policy I have seen. In my current facility, there must be 2 MD's in the room when it is used. Even tho the RN is doing the monitoring and documentation, they want the MD doing the procedure to be backed up by one in case immediate intubation is needed. Sometimes it can get crowded in the room! We do use a lot of IV fentanyl and versed, with ketamine IM on kids a lot.
teeituptom, BSN, RN
Specializes in ER, ICU, L&D, OR.
We are using it more and more for a slightly deeper concious sedation, works wonderously well.
So does Brevitol
Specializes in ED, tele, med/surg/ortho, LTC.
Has 8 years experience.
We are using it more and more for a slightly deeper concious sedation, works wonderously well.So does Brevitol
(wistful sigh) Ah, Brevitol. How I miss thee...
NRSKarenRN, BSN, RN
Specializes in Vents, Telemetry, Home Care, Home infusion.
Has 43 years experience.
Nov 29, 2005
asa files comments on fda propofol petition
asa's letter urges fda to retain the warning label limiting the use of propofol to clinicians trained in the administration of general anesthesia and not involved in the conduct of the surgical/diagnostic procedure.
[color=#990000]asa letter to fda
[color=#990000]attachment 1 - statement on safe use of propofol
[color=#990000]attachment 2 - practice guidelines for sedation and analgesia by non-anesthesiologists
[color=#990000]asa analysis - propofol by non-anesthesiologists (excel file)
submitting comments to fda on propofol labeling
the fda will continue to accept comments until december 27, 2005. you may submit comments either by mail to:
division of dockets management (hfa-305)
food and drug administration
5630 fishers lane, room 1061
rockville, md 20852
be sure to include the docket number 2005p-0267
or submit electronically on the [color=#990000]fda's website.
Specializes in Critical Care,Recovery, ED.
Has 40 years experience.
Airway complications and hypoventilation are not the only potentially dangerous side effects of propofol. I prefer versed/ fentanyl for cs. Propofol should be a pure anesthesia agent when used for surgical/ortho interventions.
Long term vented patients on infusions and bis monitoring are a different situation.
rjflyn, ASN, RN
Specializes in Emergency.
Has 23 years experience.
Also theres always Etomidate. As for Diprovan I have only seen it pushed a couple times and both a CRNA from OR came and did it. It is wonderful for keeping vented patients down however.
This is from a patient's point of view, so I'm not an expert. I had propofol for the first time for conscious sedation for a D&C (wasn't offered a narcotic and didn't know to ask). The doctor used a local at the cervix and I didn't experience any pain. I did have some amnesia but was quite uncomfortable in a way that's difficult to explain. I've had the same procedure done a couple of times in the past without a problem. Although propofol avoids that drug hangover, I think narcotics give a better sense of well being. I would definitely not want propofol again for conscious sedation. In fact, the experience was so unpleasant, I would think twice about propofol for anything.
Specializes in Emergency Nursing Advanced Practice.
Has 30 years experience.
We use propofol a great deal for our CS procedures (as well as for our vented pts in ED).
Works great, doctor is at bedside at time of administration, all equipment set up to manage any airway issue (none yet except very infrequent and brief bag/mask ventilation [VERY BRIEF]).
We also can use ketamine (use a lot for kids) and brevital (use a lot with cardioversions) with same caveats as above (MD present and equipment at the ready).
Nov 30, 2005
I'm a traveler and have seen Propofol used for Concious Sedation. I am not fond of this. Usually I prefer Versed, or Ketamine (though ketamine does get squirrley sometimes.)I actually will not do CS with Propofol. So, at my current facility, when I get a CS patient, if the MD wants to used it, the patient gets another nurse.Edited to correct where I put Midazolam, instead of Prop. I guess its about time for sleep, just got off my 4th shift in a row of nights LOL.
Have only used it in drip form for intubated patients. In the states I've worked in it was not in the nurses scope of practice. Don't blame you,would never give it push,but would be willing to be a stand - -by.
Yes, I'm willing to document or what not, but I am not willing to push it. When I did ICU, used it all the time for sedation, but on vented patients which is a completely different things than needing to put little johnnies elbow back into place.
Of course at one place there was no limit put on the dose of Ketamine and the MD kept telling me to push more and more, so I finally handed him the bottle and the syringe and told him I was uncomfortable with the amt. Surprisingly he agreed and pushed the drug, and the kid did fine. I discussed with the NM and in about 6 days flat there was a new policy with limits....
Sometimes I feel like such a stickler, but I want to keep my license.
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