Using Propofol for conscious sedation

[wtbcrna, MSN, DNP, CRNA]

My SRNA research group is looking into the safety of RNs (non-CRNAs) using propofol for conscious/moderate/procedural sedation.

I would like to know, for the RNs that are allowed to use propofol/Diprivan for conscious sedation, if you have ever had any adverse reactions/outcomes that required advanced interventions (such bagging the patient, inserting oral/nasal airways, starting pressor or anything else you would like to share).

I will chime in a little later and tell you guys what the vast majority of the literature states.

Thanks for your responses in advance.....

[ukstudent]

I have never used propofol for conscious sedation, only for sedation on already vented pt's. I have had to start pressors on one pt after starting propofol, and that was at a low dose as well . I would not consider it a safe drug for a non-vented pt.

You should add a line for voting against the use of popofol with conscious sedation.

[wtbcrna, MSN, DNP, CRNA]

I have never used propofol for conscious sedation, only for sedation on already vented pt's. I have had to start pressors on one pt after starting propofol, and that was at a low dose as well . I would not consider it a safe drug for a non-vented pt.

You should add a line for voting against the use of popofol with conscious sedation.

I see that you are in MD. The state board of MD agrees with you. An RN in MD is not allowed to use propofol for conscious/moderate sedation on patients.

Out of curiosity have you looked at the research literature on nurse administered propofol sedation. It shocked the heck out of me when I saw all the literature on it, and its conclusions.

[pickledpepperRN]

As an RN not a CRNA I would not use it unless a competent person were right there to intubate the patient if necessary.

Not the ER doc doing the procedure.

Our committee prevented having our ER nurses do it by uniting for a policy that for non intubated patients an anesthesiologist or certified registered nurse anesthetist must be present when propofol (Diprovan) is administered.

ONLY patients already intubated or trached and using mechanical ventilation in a critical care unit may be given propofol without an anesthesia provider at the bedside.

We do use it for cardioversions sometimes but always with anesthesia administering the med and intubation equipment at the bedside too.

[traumaRUs, MSN, APRN]

When I was a staff RN in the ER, (Illinois) we did administer propofol with an MD in the room for a quick relocation of a shoulder or hip. Yes, have had to insert oral airway and bag for just a couple of minutes. Never had to intubate or use pressors.

In IL, this is legal provided it is under the direct supervision of an MD who is skilled in advanced airway techniques.

[AirforceRN, RN]

Ive seen it used in BC frequently in the emerg for closed reductions, cardioversions, nail-gun "oops" removals etc. Once in a while you get a patient that will need to be bagged for a minute or two (so I picked yes) but I don't really consider that a horribly adverse reaction. It wears off so quick that you only need to bag for a short period of time. We were not allowed to use it however unless there was a RT there with us.

[RN1980]

99.9% of the time the drug is only used in our hospital for sedation for vent support. of course this excluses the or setting. a few rare cases they'll use it in the er for sedation prior to intubatuion. don't know of any bad episodes with it's use except the standard hypotn thing.

[dcarriv]

in our er we use it all of the time. it is only done with the er md and rt in the room. there is also one rn there to record everything and watch the monitors. if rt is not available, then the procedure is not done until they are available. the worst thing i have seen with propofol is the rr slows down, and they may need to be bagged for a few minutes, though usually its just blow by with the mask on the ambu.

[fisher chick]

Responding to UKStudent: Check out Dr NAPS.com (Nurse Administered Propofol Sedation) Dr. Walker advocates this and has a lot of useful information. I work with him in a hospital setting. You should check with other nurses that have this experience and rethink your position on this subject.

[MAISY, RN-ER, BSN, RN]

Use it for dislocation and tubing/keeping patients sedated-NJ. Do not require anesthesiologist-but physician must have certification.

Physician must push first dose-afterwards nurse may administer during remaining conscious sedation procedures.

For intubation, nurse may administer first and subsequent doses with physician and respiratory at bedside-patient being tubed anyway-not worried about losing airway.

Maisy

PS voted yes, meant no. Never had a problem.

[trrinatl]

I have used propofol a couple of times for CS but generally for vented patients. The information about half life is confusing, the same source says that it's 30 to 60 minutes, then another place in the same source says it's 6 hours. So even if the patient is sensative too it, I"m much more worried about hypotension than long term airway management. Usually bagging them for a couple of minutes is all you have to do. I know we have had some patients in our ICU that went "nuts" usually either DT's or a mix of some bad street drugs; propofol works great as a short acting agent to get them under control until you can get pharmacy to put your ordered drugs in the Pyxis.

The best use I've ever see was a 19 year old male prostitute that was standing, naked, in the middle of his ICU bed. He was swinging his IV bag by the tubing and had already DC'd his Foley (bet THAT hurt the next time he had a trick!). He had his pulse ox cable and was threatening to hang himself from the ceiling, all because his hospitalization for a CHI from a assault made him miss is regular weekly well paying "john". He forgot he had a second IV and the charge nurse managed to get behind him and slide about 4 cc of propofol in his line. In about 30 seconds he just kinda wilted into a naked pile on the bed at which point in time he aquired a new hospital gown, 4 point restraints and a dose of geodon.

[alkaleidi]

In the EDs I have worked at, all of our conscious/moderate sedations (for intubation, closed reductions, etc) require an MD, RN, and RRT present during the entire procedure, and until the patient comes around and is responsive, require the RRT and RN present the entire time... and until the patient is actually sitting up talking, I am in and out of the room almost constantly (never leaving the patient for more than 5 minutes). I have administered Propofol under those conditions several times, and have never had to bag a patient.

Can you please paste links to literature re: RNs administering Propofol for sedation? Thanks!