Propofol used for palliative sedation

Nurses General Nursing

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I've been an Oncology Rn for over 6 years in a 100 bed rural Mt hospital. Every so often our ONC floor will treat a pt that has horrible pain, whether from massive mets, progression of their disease, ect...These pt's are on large doses of PO and sometimes even IV meds prior to hospitalization. As you can imagine, it is very difficult to obtain adaquate pain control with IV Dilaudid, Ativan, and even Phenobarbital.

As far as I know, Mt does not allow Propofol as a medication that I can use on the floor. If the pt is intubated and ventilated in an ICU then it may be used for sedation. I would like to know how many of you have used Propofol in palliative sedation? What state is it legal in, and what kind of education did you attend to be able to use this drug?

Thank you

-T

Have never seen propofol used on a floor in any of the states I've worked in. It is an OR/procedure med or used for the vent pts in the unit.

I would not give this drug on the floor.

Specializes in Spinal Cord injuries, Emergency+EMS.

seen Ketamine used in palliative care but never propofol

Specializes in Corrections, Cardiac, Hospice.

We have used a combination of sub q Morphine and Ativan and had wonderful results for pallitive sedation.

we've used propofol in palliative sedation (mass) when pt has shown refractory symptoms to all other interventions.

ongoing inservices on the job with close supervision by md.

implications are not the same in eol care vs endoscopy or any other unit where goal is to sustain life.

again, this is only used as a very last intervention, for intractable, refractory suffering.

leslie

Specializes in ER/EHR Trainer.

We use propofol alot in the ER, I know they are using more and more Fentanyl drip PCA in palliative care. The hospice we used for my father in law no longer uses iv anything. Everything is oral, or transdermal-they were amazing!

Maisy

we've used propofol in palliative sedation (mass) when pt has shown refractory symptoms to all other interventions.

ongoing inservices on the job with close supervision by md.

implications are not the same in eol care vs endoscopy or any other unit where goal is to sustain life.

again, this is only used as a very last intervention, for intractable, refractory suffering.

leslie

What kind of training did you have Leslie to allow you to use Propofol? Can you actually spike and hang the drug or does the MD? Thanks

-T

We use propofol alot in the ER, I know they are using more and more Fentanyl drip PCA in palliative care. The hospice we used for my father in law no longer uses iv anything. Everything is oral, or transdermal-they were amazing!

Maisy

I have heard that fentanyl is becoming increasingly popular with EOL patients. And it amazes me how well hospice nurses can control pain without the use of IV meds. Can't say I really understand it, with all the central catheters our pt's use.

-T

What kind of training did you have Leslie to allow you to use Propofol? Can you actually spike and hang the drug or does the MD? Thanks

-T

our hospice pharmacy has workshops/seminars sev'l times throughout the year.

for palliative sedation, we've had a naps rep inservice us.

all the nurses have spiked/hung the propofol and titrate it to effect.

just make sure the pt is dnr.

i know that sounds silly, but there are eol pts who still insist on being full code.

leslie

Specializes in Hospice.

I've used it, too.

Once in a pt with a rapidly growing tracheal tumor that was occluding her airway ... she was slowly strangling to death.

No way did I want her to wake up and go through that consciously!!

As leslie said, it's strictly a last-ditch option for the relief of intractable suffering. The ethical issues, as you can imagine, are intense.

The pt I mentioned arrived from ICU with the propofol already hung and died before the bag needed to be changed. I basically had the report from the ICU nurse to go on ... no inservices or unit P&P on the subject.

In the very few cases where we've initiated palliative sedation, we used a continuous subcu or iv ativan drip.

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