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Epidurals

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Question	Answer
What are some indications of Epidurals?	Control of post op pain, chronic pain, or labor pain.
Epidurals are effective in controlling acute pain to chest, abdomen, pelvis and lower limbs. (T/F)?	TRUE
What are the contraindications?	* Hypovolemia * Skin infection near insertion site * Clotting abnormalities or therapeutic anticoagulation * Abruptio Placentae * Certain heart conditions * Patient refusal or unable to give informed consent.
What are some steps prior to the procedure?	* Witness consent, perform "timeout" * Ensure IV infusing, bolus as indicated * Supplemental oxygen available * May be asked to give Midazolam I.V. (non-pregnant only) * VS and prepare to monitor BP and O2 sat. * Prepare for continuous cardiac monit
What does the Nurse care after the procedure include?	* Position pt. * Monitor Vitals * Supplemental Oxy PRN * Safety sign above bed "epidural protocol client" * Assess dressing, catheter insertion site, and tubing * Assess pain, muscle weakness, sedation * Document
What is monitored in the ongoing assessments?	Monitor: Ability to void, Pressure and positioning, Analgesic/ anesthetic effects, compliance with mobility limitations if appropriate.
What are some Epidural narcotic medications used?	Hydromorphone hydrochloride (dilaudid), Fentanyl (Sublimaze), Morphine sulfate (Duramorph).
What are some common Anesthetics used?	Bupivicaine hydrochloride (Marcaine), Ropivicaine hydrochloride (Naropin)
What determines the dose?	Patients response.
What are some complications of an Epidural?	* Hypotension * High Spinal anesthesia (affects breathing) * Migration of catheter into epidural vein * "Wet Tap" headache * Infection at insertion site * Spinal compression dure to formation of epidural hematoma (hard mass + tingling)
How do you terminate epidural anesthesia?	* Check labs: if INR >1.5 bleeding risk is increased * Check tip to verify complete removal * Monitor VS 15 minutes post-removal. * Instruct patient to report pain or bleeding at site, urinary retention or headache.