Sketchy propofol dosing

[canoehead, BSN, RN]

I was assisting with a conscious sedation and wasn't giving the drugs fast enough so the doc took the syringe and injected about 200mg in less than 10 minutes, with 200 Fentanyl and 5 Versed. RT at the bedside. The patient stopped breathing...I was watching and there was no chest movement. He had been well washed out with O2 before the procedure so his sats stayed up. I pointed out the apnea, but both RT and MD noted the great sats and let the apnea continue for a good minute (felt like forever to me).

Are they right that the apnea is fine as long as the sats are good. The brain still oxygenates, but I picturing a build up of CO2 and acidosis, resulting in a frightening situation for the patient. My gut says they were being reckless, but I can't back it up with fact.

[hypocaffeinemia, BSN, RN]

Let's just say there's a reason many states require licensed anesthesia personnel to administer propofol for procedural sedation, and you just found out.

In Texas, a non CRNA RN can't use propofol like this and it's against the standard of practice for an MD who should be focusing on the procedure to also be the person administering. That goes especially for MDs not competent in airway management.

As for the dosage, it's highly dependent on the patient. 200mg within 10 minutes isn't absurd for procedural sedation at all from my experience.

[atsay80]

Propofol is always administered by an anesthesiologist and not by rn's, unless you are in a critical care setting and the patient is vented. And don't believe an O2 sat of 100% in an apneic patient, bec. I've had a post code patient( dead) with a sat of 100%.

[tookdaddy]

Sounds like you were being a good RN and looking at your patient instead of fixating on the monitor. Also, your pulse ox monitor is reading only the saturation of that one finger that your probe is on. An MD can almost always talk you into feeling foolish or into believing his/her rationale if you let them (even when its not right). Stick to your guns.

[skipaway]

Propofol is always administered by an anesthesiologist and not by rn's, unless you are in a critical care setting and the patient is vented. And don't believe an O2 sat of 100% in an apneic patient, bec. I've had a post code patient( dead) with a sat of 100%.

or a CRNA

[skipaway]

I was assisting with a conscious sedation and wasn't giving the drugs fast enough so the doc took the syringe and injected about 200mg in less than 10 minutes, with 200 Fentanyl and 5 Versed. RT at the bedside. The patient stopped breathing...

What was the RT's purpose cough*sarcasm*cough? Why didn't they lift the jaw and open the airway? Were they just there to watch the procedure and not the patient?

Many states do not allow procedurest administered sedation (physicians giving the sedation at the same time they're doing their procedure) for good reason. No telling how long this apnea would have gone on.

BTW....titration makes alot of sense...have to give the drugs a chance to work or you'll get into trouble. Your physician needs to develop some patience.

[meandragonbrett]

Propofol is always administered by an anesthesiologist and not by rn's, unless you are in a critical care setting and the patient is vented.

Not always true!

[Larry77, RN]

We use Propofol frequently for sedation but always use capnography which would have been screaming at your doc and RT with prolonged apnea...sats are a pretty late sign of hypoxia. If he was using Propofol why was the Versed needed? Just means its going to take a lot longer for the patient to come around...ugh.

The laws regarding sedation meds are different state by state...RN's can administer it in my state.

[PMFB-RN, RN]

I would never allow a physician, or anyone else to inject drugs into MY patients. That's not his job, his job is to do the procedure. Sounds to me like what was needed was a more effective patient advocate.

[APNgonnabe]

Last I checked conscious sedation does not include a level deep enough to render the pt to the point of apnea. Were the fent & versed titrated or bolus dosed? If it seems that the MD pushing the medication was doing so in a manager that was not safe for the pt then I would follow you're chain of command and or fill out a adverse medication event. It seems sometimes nursing looks the other way because they are doctors. We need to make sure our pt are safe. I hope he came out of the procedure just fine.

[Rickbos]

RNs do not administer Propofol IVP at my facility, just via drip with vented patients. We do use capnography when we do conscious sedation and that would have have verified/documented your apnea situation instantly. As for your physician's lack of patience, I can't say what should be done to him/her in this venue.

[MikeyBSN]

It is against my hospital's policy to administer propofol on non-vented patients. We had the policy in place long before Michael Jackson understood why. I do administer diprivan to my vented patients regularly. I like the drug, so long as the person is vented and the BP is stable. I feel is works much better than versed, which never seems to adequately sedate anyone. Plus, propofol is relatively short-acting and this allows you to quickly find the dosage that your patient likes (sedated but stable).