La. Admin. Code tit. 46 § XLVII-3705

Current through Register Vol. 50, No. 6, June 20, 2024

Section XLVII-3705 - Administration of Anesthetic Agents

A. Registered nurses, who are not certified registered nurse anesthetists, may administer anesthetic agents to intubated patients in critical care settings, and may titrate and continue infusion of local anesthetic agents through the use of epidural catheters for pain management, excluding obstetric patients, provided that the following conditions are met.

1. There is an institutional policy and plan for registered nurses (non-CRNAs) to administer anesthetic agents to intubated patients in critical care settings, and to titrate and continue infusion of local anesthetic agents through the use of epidural catheters and perineural catheters for pain management for patients other than obstetric patients that includes:

a. a clear statement of the purpose and goal of the treatment;

b. written protocols, with documentation of acceptance of the protocols by the medical staff of the agency;

c. policies and procedures to include but not be limited to the following:

i. preparation of solution;

ii. initiation of infusion;

iii. responding to emergency situations;

iv. maximum dose per hour of an anesthetic agent which can be administered by a registered nurse, who is not a certified registered nurse anesthetist, as approved by the medical staff; and

v. criteria for documentation of the procedure.

2. No anesthetic agent may be administered by a registered nurse, who is not a certified registered nurse anesthetist pursuant to this part unless there is a medical order by an authorized prescriber. Any orders to change the rate of infusion must be a medical order or in lieu of a specific order to change the rate of infusion, there are clearly stated criteria, by the authorizing prescriber, for adjusting the rate of infusion. However, in an emergency situation, the registered nurse may decrease the rate of infusion before calling the authorized prescriber.

B. Further, registered nurses, who are not certified registered nurse anesthetists, may titrate and continue infusion of local anesthetic agents through the use of epidural catheters and perineural catheters for pain management, excluding obstetric patients, provided that the following conditions are met.

1. There is documentation that the registered nurse has successfully completed a course of instruction, which includes but is not limited to didactic instruction and supervised clinical practice on the following:

a. anatomy and physiology of the spinal cord and column and neurological system;

b. purpose of the epidural and perineural catheter for pain management;

c. catheter placement and signs and symptoms of misplacement;

d. effects of medication administered epidurally and perineurally;

e. untoward reaction to medication and management;

f. complications; and

g. nursing care responsibilities:

i. observation;

ii. procedures;

iii. catheter maintenance;

iv. proper calibration and operation of infusion pump; and

v. removal of the epidural or perineural catheter.

2. Competencies shall be measured initially during orientation and on an annual basis.

C. The administration of anesthetic agents to intubated patients in critical care settings, and the titration and continuance of infusion of local anesthetic agents through the use of epidural and perineural catheters for pain management for patients may not be delegated or assigned by a registered nurse to anyone other than a registered nurse who meets the criteria set forth in this standard.

La. Admin. Code tit. 46, § XLVII-3705

Promulgated by the Department of Health and Hospitals, Board of Nursing, LR 32:246 (February 2006), amended 37:898 (March 2011).

AUTHORITY NOTE: Promulgated in accordance with R.S. 37:935.