RN doing conscious sedation non-intubated patient

Nurses Safety

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I am an RN Circulator. We have a surgeon that does pain injections. I am the anesthesia for the cases. I hook them up to all the monitors at the anesthesia machine and monitor them during the case. I push fentanyl and Versed. So my question is Do you think I should bed doing this? Would you push these drugs? Thanks for any feedback...:uhoh3:

Specializes in OR.

How long have you been a circulator? I am a circulator too. it is part of my job description to do conscious sedation using versed and fentanyl. Every nurse where I work is able to do conscious sedation cases.

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Most hospitals require nurses to have documented competency in moderate/conscious sedation as well as have ACLS if administering sedation will be a part of their job description. Even if the surgeon is present, if he's occupied with the procedure, as the person who administered the medication, it'll be your job to monitor the patient and intervene if necessary. In the cath and EP labs I've worked at, sedating and monitoring patients were a big part of the nruses' responsibility.

I totally agree with this poster. It is in the scope of practice for an RN to administer conscious sedation (usually meaning Versed and Fentanyl), as long as they have proven competency and are ACLS certified. I work in a non-invasive cardiology lab where we (the nurses) are responsible for giving Versed and Fentanyl during TEEs, as well as monitoring the patient and documenting EVERYTHING. Of course it's always a good idea to check with your state's board of nursing.

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Specializes in ICU/ER.

Wow this post is kind of making me nervous. Last week I had to increase the propofol twice then when that didnt work give 2 bolus propofol of 3mg each. Then when that didnt work give 5mg of versed. It was given of course with Drs orders over the phone. I was not able to talk to the Dr myself as I was holding the ET tube against the patients lips.

The patient was clamped down on the ET tube, no bite bar in place and we couldnt secure it.

Iam a new nurse. Not ACLS certified yet. I did have an ACLS RN in the room assisting me, as well as our house supervisor.

But with 9000 some drugs now available, how do we know which ones we can give and which ones we cant?

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Specializes in critical care; community health; psych.

I've pushed propophol for procedures as an ICU RN. Versed, fentanyl and paralytics too. Paralytics and versed were always pushed for procedures in the presence of an attending physician. We took special classes on all these drugs and were certified by the facility as competent in their administration.

I think it all depends on the Nurse Practice Act for your state. Many RNs from our unit went on to become nurse anesthetists.

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Specializes in L&D, Surgery, Case Management.
i think you know very well what the answer to your question is.

1)you are operating outside of your scope of practice, 2)if you hurt anyone you will go to jail 3) you are saving the surgeon a lot of money which does not make it right.

the job you are doing is called anesthesia, and nurses who perform anesthesia are call anesthetists. they usaually have a masters degree in anesthesia and certification. but you know this. be careful okay? use your noggin- you know the right answer....

i never administer propofol.... only versed and fentanyl. i have been inserviced and passed the test for moderate sedation. i do not believe " jail " is a issue. i am in texas and i can not find any reference stating that is outside of my scope of practice......... anyway i would appriciate any link to any information that i am outside my scope of practice. thank you for your response...

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Specializes in L&D, Surgery, Case Management.

Total of 12 years.... however I have only been doing moderate sedation for about 6 months. I love it. I am ACLS / PALS certified and did have training and testing.

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Specializes in cardiac/critical care/ informatics.
Most hospitals require nurses to have documented competency in moderate/conscious sedation as well as have ACLS if administering sedation will be a part of their job description. Even if the surgeon is present, if he's occupied with the procedure, as the person who administered the medication, it'll be your job to monitor the patient and intervene if necessary. In the cath and EP labs I've worked at, sedating and monitoring patients were a big part of the nruses' responsibility.

Ditto

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Specializes in L&D, Surgery, Case Management.

funny you should mention having a circulator. we had only been using a "tech" to assist / " circulate " for the surgeon until about a month ago. jacho...... now there is a circulator in the room with me on all cases!!! i did not like having to do both r/t safety issues.

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This is a very interesting discussion. I practice in a third world country and work in the OR. I have administered Fentanyl and Versed, Propofol only if there is an anaesthetist present. And only because his hands are tied up during intubation.

We do not have a nurse anaesthetist, and even if I do have PALs certification my supervisor would never allow me to intubate.

I do not even give Pethidine 100 mg IV. or Morphine more than a certain dosage. You always have to assess, assess assess.

I have always learnt that if you do not feel comfortable about something you do not do it. You put yourself at risk for error.

Do not do other people's job for them. If you are so good go get certified.

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Specializes in OB, M/S, HH, Medical Imaging RN.

i work in medical imaging, ct specials and i do conscious sedation for ct guided biopsies and yes it is allowed by my state and yes it is in my scope of practice.

we have to take a half day class before we orient to do conscious sedation but that's not required by the state, but i'm glad my hospital is consciencous.

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Specializes in OB, M/S, HH, Medical Imaging RN.
i think you know very well what the answer to your question is.

1)you are operating outside of your scope of practice, 2)if you hurt anyone you will go to jail 3) you are saving the surgeon a lot of money which does not make it right.

the job you are doing is called anesthesia, and nurses who perform anesthesia are call anesthetists. they usaually have a masters degree in anesthesia and certification. but you know this. be careful okay? use your noggin- you know the right answer....

:nono: not true! it's legal for rn's to perform "conscious sedation" which includes versed and fentanyl.

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Specializes in EMS, ER, GI, PCU/Telemetry.

heres a question for you guys... i work in an outpt endoscopy clinic and work with 2 RN's. neither of them are ACLS certified, and i am (paramedic), so they push the drugs and i monitor the patient and am on standby for any kind of emergency (while snaring polyps in the mean time). i told my boss i didnt think this was a very safe practice, and i wanted them to be ACLS cert too, because i have to bounce back and forth between procedure rooms and monitor the recovery room (there are only the 3 of us and a CNA) and she said it was no big deal because there is a physician in the area at all times.

what do you guys think?

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