propofol

I have pushed it before, but only in the presence of the MD that has ordered it. Some of the cardiologists that I have worked with like Diprivan, because of it's short half-life for elective cardioversions...And the MD understands that they have to remain in the room or at least at the nurses station until the patient is awake...I have never had any problems with it...The patients all wake up in less than 5 to 10 minutes...And I have only used it in conjunction with Morphine or Fentanyl or some type of analgesic...

I have pushed it before, but only in the presence of the MD that has ordered it. Some of the cardiologists that I have worked with like Diprivan, because of it's short half-life for elective cardioversions...And the MD understands that they have to remain in the room or at least at the nurses station until the patient is awake...I have never had any problems with it...The patients all wake up in less than 5 to 10 minutes...And I have only used it in conjunction with Morphine or Fentanyl or some type of analgesic...

You have described a general anesthetic, not sedation. The fact that you have added MS or fentanyl makes it even more dangerous. Once again you prove the point of all of us who are saying it should only be administered by anesthesia providers.

Some of these posts are downright scary!!!!!!! It is quite obvious that some of these nurses do not know all the side effects and unpredictablity of this drug. They do not know what they do not know.

I have pushed it before, but only in the presence of the MD that has ordered it. Some of the cardiologists that I have worked with like Diprivan, because of it's short half-life for elective cardioversions...And the MD understands that they have to remain in the room or at least at the nurses station until the patient is awake...I have never had any problems with it...The patients all wake up in less than 5 to 10 minutes...And I have only used it in conjunction with Morphine or Fentanyl or some type of analgesic...

All I can say is WOW, this is scary.

I agree it is scary. I had propofol as a patient for a Bronchoscopy. I am quite small and the DR. gave me what he thought to be a small dose and I ended up unconcious for three days in ICU. The nurses said that they had NEVER seen that kind of effect before.

Please correct me if I am wrong,

a study published in Pediatrics about 6 months ago compared CS meds and Dip was included The study pointed out that it was a good drug for CS in the ER d/t the rapid onset, short half life and its anti-emetic properties. Also in the ERs that I have worked at, MDs are required to be at the bedside during the adminstration of the meds and during the sedation process. In addition, airway equipment must be present during all sedations since anyone sedated has the chance of becoming intubated. Finally, with a ER nurse dedicated to that pt until the pt has a 9 or 10 score, 3 lead, pulse ox, and other equipment, does that not qaulify as a ICU setting for the duration of the procedure?

All medication adminstration is weighing risks vs benefits, no matter if it is Dip, Tequin, Compazine, or Vanc, and all can have poor outcomes but with close monitoring the adverse effects can be quickly seen to.

Just some MN ramblings

MajorDomo

CONSCIOUS sedation and Diprivan....isn't that an oxymoron?

...maybe I am over simplifying.....

I thought every one would like to read this great article on Medscape published a few days ago appropriately titled for this thread ........Propofol Sedation: Who Should Administer?

http://www.medscape.com/viewarticle/518218_print

You do have to join to read the article but I think alot of us are already subscribers. It is free and they have great articles on all sorts of medical stuff. CEUs too.

Austin

thanks for that documentation. I think I'll print this off and post it anonymously in the break room for thought and comment. I might actually place it in the nurse managers mail box as well for more thought and comment. I am a traveler and they are using Prop for CS- most of the nurses are unaware of the debate going on about using it. They just do whatever the MD says. If someone wants to push proprofol on an unintubated patient- I think they should be aware of the potential problems.

IV push Propofol can only be given with an anethetist present in our facility in MA. It can be given by drip if the patient is vented.

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.

We just reccently had a huge debate about this in my facility. Docs wanted ED RN's to push for CS and we didn't want to. So our pharmacist, The ED director, and the director of nursing got together with the state BON and these are our reguatrions how it is stated in our hopital policy and defined by the state board of nursing for my state (By the way I love using it. Gets the patient taken care of and home much faster):

-Definitions of sedation are defined by intent, not by which drugs are used.

-Minimal Sedation (Anxiolysis) Is a drug induced state in which patients

respond normally to verbal commands, although cognitive function and coordination may be impaired, but ventilatory and cardiovascular functions remain unaffected. There is no special requirements for this type of sedation.

-Moderate Sedation/Analgesia A drug induced depression of consciousness during which patients respond purposefully to verbal commands. Either alone or accompanied by light tactile stimulation. Health care providers managing moderate sedation shall be physicians, registered nurses, or other providers that have met the criteria set forth in the policy. Competency shall be tested once then annually in practice. There must be a minimum of two people at bedside, the RN administering the drug and the physician performing the procedure. In the state of WV nurses can push all sedation drugs.

-Deep Sedation Drug induced depression of consciousness during which patients cannot easily be aroused, but repond purposely following repeated or painful stimulation. All guidlines for moderate sedation must be followed.

-Anesthesia Drug induced loss of consciousness during which the patient is not arousable, even by painful stimulation. The ability to indeoendantly maintain ventilatory function is often impaired.

Propfol The mechanism of action is unknown, has a hindered phenolic compound, is unrelated to any other currently used barbituate, opiod, benzo or imidazole. There is no analgesic effect but an amnestic one. The onset of action is a amnestic one within 30 seconds and has a duration of 3-10 minutes. The WV BON allows Registered nurses to push Propofol. There is no standard dosing by the company for moderate sedation and no national guidelines. One suggested way of dosing is 1mg/kg bolus then 20mg boluses until adequate sedation is reached or 20mg bolus with a 30mcg/kg/min drip titrated to effect. Patients with a regular exposure to alcohol can need much higher doses.

This is just a little of the guidlines at my hospital for using propfol. I am not going to get into the whole thing. I just wanted to get the point across that in my state a RN is allowed to push this drug. The MD does not leave the room throughout the procedure. The patient is hooked up to a monitor and there is intubation equipment at bedside. I have used it at least three times thus far to get shoulders back in. We also use Ketamine/atropine for peds, Versed, Fentanyl, and Etomidate. It depends on physician preference as of to which drugs we use.