Nursing Sedation for colonoscopy

[Neogenesis]

What is everyones take on the use of GI directed sedations nurses (not talking about CRNAs) for colonoscopies?

---

Members don't see this ad.

 

[criticalelement]

its ok if they are using midaz fent demerol.... if they are using propofol this practice is inappropriate

 

[ZzzPlz]

It's ok if the patients feel like sleeping for 12 hours and feeling like they just got off a week long bender.

 

[Chloroform4Life]

Its also okay if patient don't mind higher likelihood of awareness during procedure vs being overly sedated that the occasional rapid response has to be called.

 

[pgg]

What is everyones take on the use of GI directed sedations nurses (not talking about CRNAs) for colonoscopies?

It's safe if they are restricted to short acting drugs that have reversal agents, i.e. midazolam and fentanyl.

At my last hospital, the RN sedation program fell under the anesthesiology dept, and we mandated the use of capnography. I don't think that's a rule here, but it should be.

No propofol.

 

[Promethean]

I've seen a lot of midazolam and fentanyl sedation by non-CRNA sedation RNs. No freaking way would I be okay with that for myself or anyone I cared about. Heck, I'd rather just have it done awake rather than semi-conscious, with depressed respirations and sub-adequate monitoring. I'm sure that it could be made safer with proper monitoring, and that might change my mind, but what I've seen didn't inspire much confidence.

 

[pjl]

I've seen a lot of midazolam and fentanyl sedation by non-CRNA sedation RNs. No freaking way would I be okay with that for myself or anyone I cared about. Heck, I'd rather just have it done awake rather than semi-conscious, with depressed respirations and sub-adequate monitoring. I'm sure that it could be made safer with proper monitoring, and that might change my mind, but what I've seen didn't inspire much confidence.

It is a realistic and safe method, that is clearly inferior to us and propofol. (They should use Midazolam and Fentanyl, in my mind) It should be used for any patient that is relatively healthy and not willing to pay additional money to avoid the inherent disadvantages.

That said, patients need to understand the sedation they are getting and nurses need to understand the level of sedation they are targeting.

Monitoring in my mind should be identical to our monitoring.


Sent from my iPad using SDN mobile app

 

[fakin' the funk]

It is a realistic and safe method, that is clearly inferior to us and propofol. (They should use Midazolam and Fentanyl, in my mind) It should be used for any patient that is relatively healthy and not willing to pay additional money to avoid the inherent disadvantages.

That said, patients need to understand the sedation they are getting and nurses need to understand the level of sedation they are targeting.

Monitoring in my mind should be identical to our monitoring.

I agree with you that a propofol-based sedation for colonoscopy/EGD is far, far superior for quality of the exam for the GI, the patient's experience, etc.

I also agree with most here that it should only given by anesthesiologists or in ACT model.

I would think that us being involved necessarily drives medical costs higher, and driving costs higher on the scale of colo/EGD for a marginal quality benefit, THAT I do not want to be a part of.

 

[WholeLottaGame7]

One of the CRNAs at my training institution said that before anesthesia was officially involved, they would frequently be called to rescue patients. He said the most he saw was 32mg of midazolam. Thirty-two.

I'm OK with RN sedation with fent/midaz, as long as there's a hard-stop. Say, like 5 of midaz and 250 of fentanyl or something and then they have to call anesthesia. Otherwise, they'll just keep pushing until they get a nice GA going.

That said, propofol is such a cleaner anesthetic. I would definitely pay whatever extra it costs to not get slammed with midaz and fent.

 

[Promethean]

It is a realistic and safe method, that is clearly inferior to us and propofol. (They should use Midazolam and Fentanyl, in my mind) It should be used for any patient that is relatively healthy and not willing to pay additional money to avoid the inherent disadvantages.

That said, patients need to understand the sedation they are getting and nurses need to understand the level of sedation they are targeting.

Monitoring in my mind should be identical to our monitoring.

I hear you. Just what I've actually seen happen is the sedation team playing cowboy, and then having anesthesia have to come help them sort it out. It may be a safer practice in facilities that I haven't worked in.

 

[GravelRider]

One of the CRNAs at my training institution said that before anesthesia was officially involved, they would frequently be called to rescue patients. He said the most he saw was 32mg of midazolam. Thirty-two.

I'm OK with RN sedation with fent/midaz, as long as there's a hard-stop. Say, like 5 of midaz and 250 of fentanyl or something and then they have to call anesthesia. Otherwise, they'll just keep pushing until they get a nice GA going.

That said, propofol is such a cleaner anesthetic. I would definitely pay whatever extra it costs to not get slammed with midaz and fent.

Even that seems like a lot. I can think of quite a number of patients who would be completely apneic and unresponsive with that level of sedation. The problem with hard numbers like that is these nurses don't really know when to stop and the GI docs are paying attention to their task at hand. Many of the newer GI docs are primadonnas who pretty much expect a general anesthetic for a routine colonoscopy. I can easily envision a scenario where the GI is complaining that the patient is moving and orders the nurse to give another 100 of fentanyl.

In order to have "conscious sedation" administered by an RN, you need a GI doc who is completely understanding of the limitations, a nurse who understands her limitations, and a patient who is ok with being mostly awake.

 

[WholeLottaGame7]

Even that seems like a lot. I can think of quite a number of patients who would be completely apneic and unresponsive with that level of sedation. The problem with hard numbers like that is these nurses don't really know when to stop and the GI docs are paying attention to their task at hand. Many of the newer GI docs are primadonnas who pretty much expect a general anesthetic for a routine colonoscopy. I can easily envision a scenario where the GI is complaining that the patient is moving and orders the nurse to give another 100 of fentanyl.

In order to have "conscious sedation" administered by an RN, you need a GI doc who is completely understanding of the limitations, a nurse who understands her limitations, and a patient who is ok with being mostly awake.

You're exactly right. And it's never going to happen, because what the majority of GI docs and patients actually want is a GA. I chose 5 and 250 just because if you don't choose arbitrary numbers, they'll just keep going to infinity and beyond. You could mandate that they go up by 1 and 50 q3min or something. It's not perfect, but it's better than nothing.

 

[IkeBoy18]

I worked with a GI doc in medical school who not only would go up past 10mg of versed, and more than 200 of fent, but also would push propofol. He said he took some classes and was cleared on using propofol, I have no clue which. He also seemed to have a chip on his shoulder saying "idk why anesthesiologists make it so hard for everyone else to propofol, its a a piece of cake."

 

[ranvier]

Unfortunately he will find out at the same time as his patient.

 

[pgg]

Unfortunately he will find out at the same time as his patient.

Probably 2-4 minutes after the patient, actually.