Vasoactive drugs

yoga crna · Sep 9, 2005

I think this sounds a little harsh. Everyone can make a mistake. I run into this attitude a lot at work. The tone of your comment makes it sound like you are indignantly chastising this poster instead of trying to impart information.
People learn best in an environment where questions are not belittled or comments pounced upon.

You are correct, I was harsh and for that I apologize. However, before you are too hard on me, you may be interested in understanding my frustration. I just got a lawsuit to review that is based on propofol administration by an RN in an endoscopy unit. The patient aspirated. became hypoxic and now has brain damage. The RN, in her deposition admitted to not knowing anything about the pharmacology of propofol and "was just following the doctor's orders". I am not at liberty to talk more about the case, but I am told that there are other similar lawsuits out there.

I find that as a CRNA I am constantly reading professional journals and keeping current in my profession. Right now I am learing how to do basic pain blocks. I know for a fact, that the RNs I work with do NOT read anything about current nursing practices, medications or surgical procedures. They are intelligent and good nurses, but they seem to lack the professionalism or make the time that is required for lifelong learning. I make it a point to bring in a guest lecturer once a year (at my expense) for updates. I am afraid that they wouldn't do it on their own.

The last thing I have to say is, since we are all computer literate enough to be on this forum we should all know how easy it is to do a Medline search or even Google to obtain medical/nursing information.

Yoga CRNA

chadash · Sep 9, 2005

abridged quote:
I know for a fact, that the RNs I work with do NOT read anything about current nursing practices, medications or surgical procedures. They are intelligent and good nurses, but they seem to lack the professionalism or make the time that is required for lifelong learning. I make it a point to bring in a guest lecturer once a year (at my expense) for updates. I am afraid that they wouldn't do it on their own.
Yoga CRNA

That's just darn scary!

WakingLife · Sep 9, 2005

The last thing I have to say is, since we are all computer literate enough to be on this forum we should all know how easy it is to do a Medline search or even Google to obtain medical/nursing information.
Yoga CRNA

You are absolutely right. I'll look it up online. Sorry for this post, the topic has taken an interesting turn. But I did learn a little more about Diprivan :)

athomas91 · Sep 9, 2005

I think this sounds a little harsh. Everyone can make a mistake. I run into this attitude a lot at work. The tone of your comment makes it sound like you are indignantly chastising this poster instead of trying to impart information.

the poster posted on a CRNA thread - and stated - as if it were fact - that propofol is a benzo - yoga's comments were not harsh - but right on the money.

true - everyone makes mistakes - and in time we all learn to be sure about what we are stating prior to posting it to an international web page. just my thoughts.

gaspassah · Sep 10, 2005

yeah alive a well thank god. i had family and friends in new orleans that lost everything but still have life. up here in miss we just have a bunch of trees down that i now have to cut up and move off.

dave

ICUDOUCME? · Sep 12, 2005

Yoga, Thanks for the reply. It is scary how much I don't know as a professional. I looked up Diprivan in detial because of this thread and I learned that it can cause hypotension, vagal stimulation etc. I didn't know that. I give Diprivan on a regular basis as an ongoing drip for vent patients.

I try to look things up as I go along when I run into something unfamiliar. We have computer terminals with internet access right outside our patient's rooms. It's great. But during a busy shift, I can't even see straight, let alone look it up. I need to keep a few notes and look it up at home.

fungirl · Sep 13, 2005

You are correct, I was harsh and for that I apologize. However, before you are too hard on me, you may be interested in understanding my frustration. I just got a lawsuit to review that is based on propofol administration by an RN in an endoscopy unit. The patient aspirated. became hypoxic and now has brain damage. The RN, in her deposition admitted to not knowing anything about the pharmacology of propofol and "was just following the doctor's orders". I am not at liberty to talk more about the case, but I am told that there are other similar lawsuits out there.
I find that as a CRNA I am constantly reading professional journals and keeping current in my profession. Right now I am learing how to do basic pain blocks. I know for a fact, that the RNs I work with do NOT read anything about current nursing practices, medications or surgical procedures. They are intelligent and good nurses, but they seem to lack the professionalism or make the time that is required for lifelong learning. I make it a point to bring in a guest lecturer once a year (at my expense) for updates. I am afraid that they wouldn't do it on their own.
The last thing I have to say is, since we are all computer literate enough to be on this forum we should all know how easy it is to do a Medline search or even Google to obtain medical/nursing information.
Yoga CRNA

Hey yoga, I am a travelling RN, and once received report on a pt. whom was going through dt's.....Propofol gtt ordered as main drug to treat dt's....Note that the pt. was not intubated.......After report I immediatly turned the propofol off and used prn drugs to sedate and calm the pt.....Now, my thoughts were that it wasn't within my scope to administer propofol gtt without mechanical ventilation.......I spoke with several doctors who were passing by that night about their opinion on the order, they didn't see anything wrong with it....I then asked an anesthesiologist in the morning, and he of course doesn't even agree with rn's titrating propofol gtts...... I asked other rn's and charge nurse, they all agreed with propofol gtt in this manner......Anyways, just wondering your opinion on this and is this normal or routine, I have never come across the use of propofol in this manner since this time.....

rn29306 · Sep 13, 2005

Hey yoga, I am a travelling RN, and once received report on a pt. whom was going through dt's.....Propofol gtt ordered as main drug to treat dt's....Note that the pt. was not intubated.......After report I immediatly turned the propofol off and used prn drugs to sedate and calm the pt.....Now, my thoughts were that it wasn't within my scope to administer propofol gtt without mechanical ventilation.......I spoke with several doctors who were passing by that night about their opinion on the order, they didn't see anything wrong with it....I then asked an anesthesiologist in the morning, and he of course doesn't even agree with rn's titrating propofol gtts...... I asked other rn's and charge nurse, they all agreed with propofol gtt in this manner......Anyways, just wondering your opinion on this and is this normal or routine, I have never come across the use of propofol in this manner since this time.....

While certainly not encouraging this practice, I have seen it used in the downtown Altanta hospitals just as you described - for DTs. The hospital had strict policies about infusion rates and had a max rate.

I DO NOT AGREE WITH THIS MEDICATION USAGE, but I have seen it. I have typed until blue in the face about issues such as this on the GI thread in the past and very recently on the Emergency Nursing thread, but yes (unfotunately) it is a practice that exists.

yoga crna · Sep 13, 2005

[.....Anyways, just wondering your opinion on this and is this normal or routine, I have never come across the use of propofol in this manner since this time.....

Putting on my legal hat, remember that one way the standard of care is determined is by use of the package insert for medications. I would recommend that any non-anesthetists read the package insert for propofol and then see if you meet the qualifications to administer it. If you are in an intensive care setting with the patient intubated and on a ventilator, the circumstances are different than in an ER or GI lab. I don't like to fall back on legal issues, because I think nurses can get really hung up on the wrong ones as a means of overcoming lack of power. But I do feel strongly about the propofol issue because it is a drug I administer every day and have a great deal of respect for its cardiovascular and respiratory effects. It is not a panacea for everything and can be dangerous.

Yoga CRNA JD

UCDSICURN · Sep 13, 2005

Yoga CRNA JD

I suddenly feel like a total underachieving slacker......

yoga crna · Sep 14, 2005

I suddenly feel like a total underachieving slacker......

Hopefully, you are joking. I have a great deal of respect for all of you who are working in critical care areas, getting high grades in the hard sciences and who get into anesthesia school. I would have to study for a long time to pass certain sections of the board exams at this point in my career. But I can still do great anesthesia because I have a ton of experience and have the luxury of working in a surgery center that I own with excellent self-confident surgeons who show a mutual respect for me.

The law degree was something I did--night school while working full time in anesthesia--to obtain the knowledge that was lacking in my education. It has added a wonderful dimension to my career, but law could never replace anesthesia. I do a lot of reading relative to legal aspects of anesthesia and nursing, review anesthesia malpractice cases and do contract preparation and negotiations for CRNAs. I even teach Law and Business in an anesthesia program--love the students.

I also enjoy trying to clear up some of the legal myths in our practice. My favorite is "If it wasn't charted, it wasn't done". That is legally incorrect--there is such a thing as "common practice" that does not have to be charted to have been done. For example, did you use a tourniquet to start an IV? Did you chart it? It would be unusual if you charted it. You can think of many more. Just give excellent anesthesia and don't worry about legal myths.

Off of my soapbox and on to my yoga class.

Yoga

UCDSICURN · Sep 14, 2005

Yeah, I was joking. I'm proud of what I've accomplished so far and look forward to even more professional milestones in the future. My hat's off to ya for what you've accomplished, it's quite inspiring to say the least.

D.C.