office based sedation regulations - TX

[AKMD_1984]

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qn for you guys, may seem very elementary and basic.

for instance, for regional anesthesia in an ASC, I will routinely do sedation and do the block myself. We also do US guided regional anesthesia under general anesthesia. so that means its typically one person doing both.

With that said, in order for an office to do conscious sedation only (versed/fentanyl only), no Propofol, is a sedation RN necessary, or can an anesthesia trained pain doc perform both iv sedation plus the pain procedure?

I read the texas health code, but i cannot find this exact information.

is this dependent on facility bylaws and rules and regs?

 

[AKMD_1984]

https://tsa.org/professional/anes_rules.pdf

That is what I was reading for level 2 sedation. Versed/fentanyl only on selected patients.

 

[Ducttape]

its right in the guidelines.

ii - another individual has to attend the patient. if you are doing the procedure, you are not attending the patient.

and i would highly doubt an MA would be considered a licensed health care provider.

 

[AKMD_1984]

Language is washy man

“Another person” what do they mean by that? My plumber with ACLS?

I can tell why it’s written this way

It’s loose and can be tighten up with bylaws language

I’ll need to find out more

 

[Ducttape]

Don't skimp. I know you want to save money.

But a bad outcome will screw you over. And think - would you want to have a plumber do your sedation?

Found this:

Site Has Moved

Only mentions an RN administering sedation at direction of the physician. Not the plumber.

 

[AKMD_1984]

Don't skimp. I know you want to save money.

But a bad outcome will screw you over. And think - would you want to have a plumber do your sedation?

Found this:

Site Has Moved

Only mentions an RN administering sedation at direction of the physician. Not the plumber.

This isn’t my practice
I’m contracting with this practice on a day rate so I could care less but I’m being asked to “delegate” staff

 

[AlvinKamara]

Interested in the answer to this question for California. Know a guy doing sedation, only MAs, no nurses.

 

[Agast]

With that said, in order for an office to do conscious sedation only (versed/fentanyl only), no Propofol, is a sedation RN necessary, or can an anesthesia trained pain doc perform both iv sedation plus the pain procedure?

I read the texas health code, but i cannot find this exact information.

is this dependent on facility bylaws and rules and regs?

This happens, it’s not illegal, and unsurprisingly leads to codes and 911 calls

The issue is the MA you assign to watch the vitals while you’re staring at the fluoro images is not trained to tell when they should alert you and will probably be zoned out thinking about her next nail appointment

 

[IAmTheOne1]

An anesthesia trained pain doc who has worked a few years of anesthesia INSTANTLY knows when vitals change even a tiny amount (if you have a pulse ox on that reduces tone as O2 sat goes down). Also, if doing conscious sedation the easiest way to confirm preserved consciousness is to just have a convo with the patient the whole time. If you cannot do the procedure while holding a convo, you should not be doing conscious sedation (whether you have an RN, LVN, MA, janitor or donkey monitoring vitals).

Also, if you’re not prepared to truly manage the airway if the patient does become apneic, it doesn’t matter who is helping you to “monitor vitals.”

 

[AKMD_1984]

An anesthesia trained pain doc who has worked a few years of anesthesia INSTANTLY knows when vitals change even a tiny amount (if you have a pulse ox on that reduces tone as O2 sat goes down). Also, if doing conscious sedation the easiest way to confirm preserved consciousness is to just have a convo with the patient the whole time. If you cannot do the procedure while holding a convo, you should not be doing conscious sedation (whether you have an RN, LVN, MA, janitor or donkey monitoring vitals).

Also, if you’re not prepared to truly manage the airway if the patient does become apneic, it doesn’t matter who is helping you to “monitor vitals.”

So are you saying that this is your practice?

 

[Ducttape]

i might go further and say that any anesthesia trained doc even without a few years of anesthesia should recognize when something is starting to go wrong.

unless they are distracted by something else, like a fluoro image.



in the scenario of an MA being the second person, from a purely practical standpoint, id like to know how additional medication could be administered. does the pain doc break sterility, move to the patients' iv to push additional fentanyl or versed or naloxone?

 

[IAmTheOne1]

So are you saying that this is your practice?

No, the point I'm trying to make is you can't depend on anyone other than another anesthesiologist when it comes to taking care of a patient's anesthetic. Even an RN or CRNA might be thinking about their nail appointment. Ultimately unless there's another anesthesiologist present, the liability will fall on the pain doc for anything that goes wrong with the anesthetic whether it's GA, MAC, or conscious sedation.