propofol

[popbob]

do ya'll push it fo concious sedation?

[BrnEyedGirl, BSN, MSN, RN, APRN]

Wow,.so many views,....my question is from an new to the ER RN,..I left a telemetry/step down unit just after christmas to transfer to ER,..I am now exposed to many drugs I never used in my previous 8 yrs of nursing,..sometimes its just that I simply look the drug up and I feel okay w/giving it,..but some of this stuff I get different info from different people and many contradict each other!! I'm forever hearing "that's the way we always do it, if the Dr orders it, it's okay!!" I'm not so "okay" with that SO,...guess I need to find out what hospital policy says,.what my BON says,.which in my experience is easier said than done,.in the mean time how do I ensure pt safetly on meds I've never used before,.and still be able to function in the ED?

[quecon]

Dear RN Cardiac--if you don"t feel comfortable doing or giving something, don"t do it!! As a past member of a state nursing board, I had to discipline many nurses who did something because "a Dr ordered it or said it was OK" even tho in some cases it was not within a nurses scope of practice.

The day the ED MD ordered Propofol for concious sedation, I refused to give it, when he insisted, I called the head of anesthesiology who came to the ED to back me up. The anesthesiologist offered to give the Propofol if the ED MD wanted it given. (per our hospital policy) I know its troublesome, but you really have to be aware of your P & P, nurse practice act etc, these are the things that will protect you--if you step outside these parameters than you put yoursefl at risk.

[Indy, LPN, LVN]

Wow. Very interesting thread! So being handed a general anesthetic by the anesthesiologist who is about to intubate the patient, and giving for the sole purpose of intubation in a crashing patient... that is something I've done. Once. And it wasn't propofol, it was etomidate. Now I'm seeing why the house supervisor had a fit over an intubation outside the critical care areas in the first place.

Thanks to all those who helped explain some of what we don't know.

[phiposurde]

Wow you guys are strict down there!!LOL We use etomodate in most of our intubation. But I heard the region is thinking of changing that process. I doing recall for wich reason but it what R/T some new studies.

Wow. Very interesting thread! So being handed a general anesthetic by the anesthesiologist who is about to intubate the patient, and giving for the sole purpose of intubation in a crashing patient... that is something I've done. Once. And it wasn't propofol, it was etomidate. Now I'm seeing why the house supervisor had a fit over an intubation outside the critical care areas in the first place.

Thanks to all those who helped explain some of what we don't know.

[mmutk, BSN, RN, EMT-I]

We use Etomidate all the time and we used to give propofol IV in the ER, until the critical care unit complained that they were ***blah blah blah yadda yadda yadda*** and now it's our house policy we can't give it IV push or bolus on a pump.

[TinyNurse, RN]

once again................it depends on the state you are working in and the nurse practice act for that state. i've been in both types of states................

[msjangir]

HI,

in my setup we are using propofol for procedures such as Bronchoscopy , Endoscopy and for ventilated patients.

Mahirn :trout:

[ND76]

I am an ER nurse, and in my facility, I am only allowed to give Propofol as a slow IV infusion to a pt that is already intubated. Now, most of the time, the ER docs will tell us to give 5-10cc bolus, then start the drip. However, a lot of the newer docs don't like to use Diprivan any more, they'll order Ativan, and while I understand it is safer, it is a lot more work on an intubated pt...it just doesn't seem to keep them sedated effectively. So, I prefer it for intubated patients with a good BP.

I do a lot of cardioversions in the chest pain ER, both emergent and scheduled. If the cardiologist wants Propofol, a CRNA or anethesiologist has to come do a complete consultation/H &P, and they only they can administer it. The cardio remains in the room, the CRNA/anesthesiologist monitors the pt during the prodecure, and I push the button on the defibrillator (go figure, the lowest paid person actually gets to use the juice...I guess it's their way of making me feel needed!) Our conscious sedation policy is now very strict, I felt it was way too lax when I first moved to this job, and I pushed for changes. In my previous job (in another state) I actually had to go to a two day class to even be certified to do conscious sedations. I was amazed when I came to my new job and every Tom, Dick, and Harry could push these meds (including Diprivan), and most had no idea what they were pushing or what the potential hazards could be. One nurse was pushing it on a young, healthy pt with a dislocated shoulder from a soccer game, and he went completely apneic, what could have been a routine reduction and DC home resulted in temporary intubation and a overnight hospital stay.

As far as conscious sedation, in the ER, we don't do a whole lot of it, our docs won't do it unless they absolutely have to. For most of them, the drugs of choice are Versed and a pain med, then they want us to give Romazicon and monitor the pt for four to six hours. That's a LONG time to hold up an ER bed after extensive suturing, dislocation reduction, etc. Only one doc likes to use Etomidate with a pain med. Regardless of what they are using, I set up my room the same way: they are in the room right across from the nurses station, the patient is on a cardiac monitor, BP monitor, pulse ox, I am giving 02 continuously, I try to have two lines, the ambu bag is hooked up and ready to go, the suction is hooked up, and ready to go, I have the intubation kit at the bedside with the appropriate sizes ready to go, and I do not leave that patients' side during the procedure or for an hour after they come out of the twilight.

[Dallas_RN, BSN, EMT-P]

I use it on a WEEKLY basis to maintain sedation on an intubated patient, then again I'm in a Level I trauma center where autonomy is very relaxed.

[camoflage]

at the time, we were discussing iv bolus epi as a first line choice for an allergic reaction.

I gotta say from a "new to the board" but experienced practitioner, that it appears that you have some knowledge of pharmacology but you confuse many topics and thus present yourself as less than "well-versed" on several topics.

camo

[TraumaLovinGoofball]

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.

RJ

LOVE etomidate! (now that we finally have a policy to use it with CS)

[ernurse16]

I am a traveler and have seen it used in nontrauma centers throughout the country. In trauma centers we use sedation and paralytics. Propofol is used for CS and for already intubated patients. I personally hate using it as it drops their pressure like a rock. Docs push it, but we bolus the intubated pts. In my present facility they are doing research on using Ketamine and Propofol together as the Ketamine causes hypertension... so they say :)