Maintenance of the catheter andor infusion device and related equipment. Epidural narcotics are finding increasing favor in management of postcesarean birth pain. Classen boulevard, suite 524 oklahoma city, ok 73106 405 9621800 registered nurse monitoring obstetrical patients receiving analgesia anesthesia by catheter techniques epidural, pcea and intrathecal catheters guidelines i. A woman who requests epidural analgesia during labor should not be deprived of this service based on the status of her health insurance. It can provide excellent pain relief, minimal sideeffects, and high patient satisfaction when compared with other methods of analgesia. Registered nurses and midwives knowledge of epidural analgesia. It is a hightech mode of analgesia that may be safely managed by ward nursing staff following appropriate support and training cox, 2001. Shortterm epidural analgesia is administered through a temporary catheter and external infusion. Read and sign epidural analgesia guidelines for rhw 2016 3. Seventyfive percent of critical care nurses and anesthesia providers were not aware that epidural. Effective pain relief coupled with minimal side effects often make this technique the method of choice. The level of insertion of the epidural catheter, the catheter position at skin and the. Instruct patient on pcea or continuous epidural infusion. Successfully complete epidural analgesia education program on the theory of epidural analgesia powh 2012 2.
Clinical indications for epidural anesthesia and analgesia have expanded significantly over the past several decades. Examine the common medications used for epidural analgesia and their effects. For delivery suite please refer to epidural analgesia programmed intermittent epidural bolus pieb plus patient controlled epidural analgesia pcea delivery suite local operating procedure 2019. Identify potential complicationsside effects of region nerve block analgesia and appropriate nursing interventions. In our hospital laboring women received epidural analgesia with an initial bolus 1820 ml of sufentanil 10. Although the availability of different methods of labor analgesia will vary from hospital to hospital, the methods available within an institution should not be based on a patients ability to pay.
Nurse anesthetists are qualified to provide epidural analgesia. Jun 05, 2018 the epidural analgesia workshop using sps proved to be feasible and satisfactory to a pilot group of senior nursing students, and suggested anticipated learning outcomes were achieved. Nov 29, 2014 stratifying infants by model of assistance and differentiating between the two groups no analgesia vs epidural analgesia we note that in case of partial roomingin the rate of exclusive or prevailing breastfeeding is significant more frequent in newborns born to mothers who didnt receive analgesia p nursing care problems were identified, continuous epidural analgesia can be used for pain relief in critical care patients, if the analgesia is administered by accurate reliable infusion systems and carefully monitored by nursing staff who are knowledgeable about the pharmacologic considerations of epidural analgesic agents and. Role of the registered nurse in the care of the pregnant. Determine the narcotic and catheterrelated side effectscomplications of epidural analgesia and appropriate nursing interventions. In my unit, the anesthesiologists want the nursing staff to increase and decrease epidural pump rates. How to assess epidural blockade authors angela sugden, rn, is sister, pain management.
A guide to epidural management british journal of hospital. Registered nurses who are not licensed anesthesia care providers should monitor, not manage, the care. To administer spinal neuraxial anesthesia andor analgesia, a needle is inserted through the ligaments between the vertebrae and a onetime injection of medication approximately 1 to 2 ml of local anesthesia with or without an. Anesthesia produced by injection of a local anesthetic into.
This article provides an overview of epidural analgesia including patient assessment. To provide guidance on the dosing, administration and monitoring of epidural analgesia infusions, including patient controlled epidural analgesia pcea. Current protocols, policies and guidelines that may relate include. The synergistic combination of a local anaesthetic such as. Epidural abscess protocol special analgesia nursing observations policy. Administering topups of epidural analgesia nursing times. Epidural analgesia is a safe and effective way to manage pain in many kinds of patients. An overview of neuraxial anesthesia american nurse. A nursing process approach to epidural analgesia journal of. When used appropriately epidurals can decrease a patients opiate consumption, as well as reducing the risk of adverse cardiorespiratory outcomes. Registered nurse monitoring obstetrical patients receiving. Identify nursing considerations for patients receiving epidural analgesia. To expand the program to other surgical units at hamad medical corporation hmc. Analgesia anesthesia by catheter techniques guidelines oklahoma board of nursing 2915 n.
Although some nursing care problems were identified, continuous epidural analgesia can be used for pain relief in critical care patients, if the analgesia is administered by accurate reliable infusion systems and carefully monitored by nursing staff who are knowledgeable about the pharmacologic considerations of epidural analgesic agents and. Apr 16, 2012 rns are expected to achieve and maintain the requisite competence necessary for nursing assessment, monitoring, selected intervention techniques related to and evaluation of the effectiveness of regional analgesia and anesthesia, and measures designed to minimize untoward effects awhonn, 2008. The epidural infusion is prescribed according to the guidelines on the regional anaesthetic infusion presription. Increasing or decreasing epidural pump rates is considered management of the epidural. Analgesiaanesthesia by catheter techniques guidelines oklahoma board of nursing 2915 n. A nursing perspective article pdf available in gastrointestinal nursing 57 september 2007 with 68 reads how we measure reads. If any change in setting or medication or increased frequency of monitoring is required, the plan of care is no longer considered established. Nursing care of epidural analgesia training program atef mansour al tawafsheh1, dr. Development and evaluation of an epidural analgesia workshop. Nick scott2, catherine gillespie3 1advance clinical nurse specialist pain management,2vice chairman of anesthesia,3aedon cancer transformation team hamad medical corporation, p. Epidural analgesia is a safe and effective way to manage pain in many. Identify indications and contraindications for regional nerve block analgesia.
Epidural analgesia is often used to supplement general anesthesia ga for surgical procedures in patients of all ages with moderatetosevere comorbid disease. Position statement, definitions, and clinical practice advisories regarding the role of the rn and lpn. Neuraxial anesthesia can be administered via spinal, epidural, or cse routes. What nurses need to know find, read and cite all the. Is there evidence to indicate that this is a safe practice for the registered nurse. Development and evaluation of an epidural analgesia. The number of parturients given intrapartum epidural analgesia is reported to be over 50 percent at many. Epidural analgesia is extensively used to manage acute and chronic pain in a variety of clinical settings.
This involves a single injection of local anaesthetic andor opioid into the subarachnoid space spinal and the insertion of an epidural catheter with the use of the epidural as per usual once the effects of the spinal analgesia wear off. Felicia cox, msc, rn, is senior nurse, pain management. Epidural analgesia during labour can also be provided in the form of a combined spinalepidural cse. To increase the number of competent nurses in the nursing care of patients receiving epidural analgesia to 100% by june 2014. The epidural analgesia workshop using sps proved to be feasible and satisfactory to a pilot group of senior nursing students, and suggested anticipated learning outcomes were achieved. In order to accomplish these goals, the assessment phase must include an ongoing evaluation of the patients pain level, vital signs, neurologic. Nursing assessment for the home patient on an epidural pain regimen includes observation for complications from the administration route which are uncommon and for side effects from the drugs used which are more often seen.
Epidural analgesia, neonatal care and breastfeeding. Epidural analgesia selfstudy baptist health south florida. Epidural analgesia is a key component in the management of inpatient pain relief, particularly in surgical and trauma patients, and those with comorbidities. Epidural analgesia is a commonly employed technique of providing pain relief during labor. To provide comprehensive and safe nursing care for the mother using epidural narcotics, nurses must be knowledgeable about the technique, drugs, and associated patient responses. An audit was carried out to measure the knowledge, skills and adherence to protocols of nurses deemed competent to care for patients receiving ea. Millerchip s 2015 administering topups of epidural analgesia. Epidural analgesia ea can provide total relief from pain and is. Changes of forced expiratory volume in 1 second fev, were measured after upper abdominal or thoracic surgery in 41 patients, and comparisons were made with results in an additional 17 upper abdominal surgery patients who received general anesthesia and muscle relaxants followed. Competency in managing care in epidural analgesia nursing times. We found that following the appropriate training and assessment, nurseadministered diamorphine topups are a safe and effective way to improve the efficacy of epidural analgesia and can be integrated into acute pain team practice. Chumbley g, thomas s 2010 care of the patient receiving epidural analgesia.
Its awhonns position that labor nurses should monitornot managethe care of women receiving epidural analgesiaanesthesia. Epidural analgesia is contraindicated in the presence of actual or anticipated serious maternal hemorrhage, refractory maternal hypotension, coagulopathy or anticoagulant medication e. Patient controlled analgesia pca lpn additional competency. Describe required nursing assessment, monitoring, and documentation as related to epidural analgesia. There is a clinical distinction between the administration of epidural analgesia and epidural anesthesia. Accurately describe the anatomy of upper and lower extremity regional nerve block analgesia. Classen boulevard, suite 524 oklahoma city, ok 73106 405 9621800 registered nurse monitoring obstetrical patients receiving analgesiaanesthesia by catheter techniques epidural, pcea and intrathecal catheters guidelines i. Notify anesthesia service to change the dressing nurses are not to change or remove the dressing over the epidural catheter. Epidural narcotic analgesia was assessed in 66 patients after surgery under epidural and light general anesthesia. Refer to local hospital policy for standardised epidural drug solutions. The goals of nursing management for a patient receiving epidural analgesia for pain control focus on optimizing comfort and minimizing side effects related to the narcotics andor catheter placement. The basics 31st oct 2017 page 2 of 5 consent and risks for labour epidurals2 1 in 10 need further attention to help function e. Registered nurse management and monitoring of analgesia by.
A nursing process approach to epidural analgesia journal. As nurses dont receive formal education in their basic nursing programs about how to manage epidural analgesia for. Advantages the only consistently effective method of pain relief during labor asrm, 2002 rapidly achieve surgical analgesia limited motor block reduction in maternal catecholamines hyperventilation the least depressant. Read and sign relevant epidural lops ward or delivery suite 4.
Anesthesia services should be available to provide labor analgesia and surgical anesthesia in all hospitals that offer maternal care levels iiv 1. Best practice in the management of epidural analgesia in. Continuous epidural analgesia for postoperative pain. The american society for pain management nursing has published the position statement titled registered nurse management and monitoring of analgesia by catheter techniques, which addresses the rns roles and responsibilities in the management of nonlaboring patients of all ages receiving analgesia by catheter techniques across all. Continuous epidural analgesia for postoperative pain management. Maintenance of the catheter andor infusion device and. Pdf on jun 29, 2012, mona sawhney and others published epidural analgesia. Only cpms and anaesthesia staff may prescribe epidural infusions. Epidural infusion is a specialised analgesia technique and is managed by cpms. The nurse outlines a nursing care plan specific to management of the epidural catheter table 1. Examine the dressing over epidural site every shift for intactness or dampness. However, it can cause series, potentially lifethreatening complications.
It is the expectation of the new hampshire board of nursing that administration of medications. Nowell a doctoral project submitted to the graduate school, the college of nursing and health professions and the school of leadership and advanced nursing practice at the university of southern mississippi in partial fulfillment of the requirements. Shortterm epidural analgesia is administered through a temporary catheter and external. Nursing care for patients receiving epidural analgesia focuses on safely administering analgesia, achieving optimal pain control, and identifying and managing adverse reactions or complications. Care of patients receiving analgesia by catheter techniques. Epidural analgesia during labor american family physician. Best practice in the management of epidural analgesia in the. Inservice on the use of the epidural pain management pump sapphire or cadd solis 5. The updated statement was published in jognn, 44 1, 151154. Rn monitoring obstetrical patients receiving analgesia by. Epidural analgesia definition of epidural analgesia by.
Thirdparty payers that provide reimbursement for obstetric services should not deny reimbursement for labor analgesia because of an absence of other medical indications. Potential adverse reactions of analgesia techniques used, medications being administered and appropriate nursing interventions c. Nowadays epidural analgesia is implemented in refracted bolus or in continuous infusion combining local anesthetics bupivacaine or ropivacaine with opioids fentanyl or sufentanil. Epidural analgesia ea is effective in providing postoperative pain relief, but has potential complications. Nursing assessment for the home patient on an epidural pain. Determine the narcotic and catheterrelated side effectscomplications. Epidural analgesia is highly effective for controlling acute pain after surgery, or trauma to the chest, abdomen, pelvis or lower limbs. What a timely question, as awhonn has recently released a new position statement titled role of the registered nurse rn in the care of the pregnant woman.