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I cover EP studies in 15 hospitals across Louisiana and Mississippi. In all but one of these facilities, an RN is able to give sedation such as versed and fentanyl. However, one facility refuses to allow any EPs to be done without anesthesia support, even for versed and fentanyl. We are, of course, trying to change this. My question is for basic two to three catheter studies on adult patients. Does anyone require anesthesiology for versed and fentanyl as a standard protocol? Anonymous, New Orleans, Louisiana Conscious Sedation is the Norm I am a rep who works in multiple labs throughout the West. I have been present in close to 20 labs in the past year for EP cases. None of these facilities utilize anesthesia for anything except cases on extremely ill or agitated patients and pediatric cases. Conscious sedation is the practiced norm in the labs I have visited. I would recommend checking the NASPE website (www.naspe.org) and looking up their recommendations for sedation during EP procedures. This would provide a great deal of weight to any debate that may arise when setting policies and procedures. Anonymous Single Responsibility One nurse is responsible for the administration of all medications, including versed and fentanyl. Georgeanne Pettenati, Altoona Hospital, Altoona, Pennsylvania Certification Needed As RNs in New York, we are required to be certified to give and monitor for conscious sedation. However, we do monitor, if the attending is certified, to give propofol without anesthesiology being present. Buffalo General Hospital, Buffalo, New York We do not require anesthesiology for basic EPs. Our RNs are able to give versed, Demerol, and MS without further assistance. We have a policy in place for this. However, we do require anesthesia for kids and flutter RFA. The LA state board of nursing does allow this as long as the proper education, policy, etc. are met. Colleen, Lake Charles, Louisiana Anesthesiology Procedures I work for the Florida Hospital in Orlando. We currently have 4 fully designated EP labs. We employ four disciplines (RN, RT, RCIS and Respiratory Therapist). In the department of cardiology we are all of equal skills and practice in the same roles. We provide conscious sedation from basic EP to AFIB RFAs. It works well for us. There is one additional EP program in the city with 2 labs. They use RNs only, for conscious sedation and circulating. Tammy Collins, Florida Hospital, Orlando, Florida To Use or Not We do EP studies ablations and use versed and fentanyl, and never use diprivan hence we don't use any anesthesia staff and have had no problems. We have had to reverse an agent because of a sedation that was too deep (not apnea), which all worked well thus far. Some critical cares RNs have 3-4 years of experience, but some do not. I have a lot of experience with diprivan in the past from CVICU, and I believe in not using it in this type of setting without anesthesia. Support is political, and I know it can be used safely without anesthesia staff present, providing the correct person and procedure is used. Anonymous