The nurse cares for patients who receive propofol extended [Diprivan]. What are important nursing considerations for these patients? (Select all that apply.)
a. Ensuring that respiratory support equip-ment is readily available
b. Maintaining the rate of intravenous infu-sion at 6 mg/kg/hr
c. Refrigerating open vials of the drug up to 24 hours
d. Stopping the infusion if a patient's CPK is greater than 5000 units/L
e. Using a local anesthetic at the IV site prior to infusing the drug
A, D, E
Propofol can cause profound respiratory depression. It has a relatively narrow therapeutic range and can cause death from respiratory arrest. Facilities for respiratory support should be imme-diately available. Propofol infusion syndrome may occur in patients receiving prolonged, high-dose infusion, and CPK levels should be monitored and the drug should be stopped if they are >5000 u/L. Propofol can cause transient pain at the IV site, which can be minimized by in-jecting IV lidocaine at the site just before injecting. The infusion rate should never be greater than 4 mg/kg/hr. There is a high risk of bacterial infection, so opened vials need to be discarded within 6 hours.
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