Epidural infusions for acute pain may ONLY be managed in the following areas:
2. Surgical High Dependency
3. Recovery, Main Theatres
The responsibility for ensuring safe and effective epidural analgesia after surgery rests with the Anaesthetist the instituted the epidural and with the Department of Anaesthesia. Changes to the epidural prescriptions may only be authorised by an
Anaesthetist or the Acute Pain Nurse.
Epidural infusions are delivered by a dedicated Epidural pump only.
Insertion of epidural catheter is an aseptic technique, performed in theatre. The catheter can remain in-situ for a maximum of 48 hours. If epidural analgesia is required for longer, the decision must be agreed by the anaesthetist who inserted the epidural or the On Call/Duty consultant anaesthetist.
All routine surgical problems can be dealt by the Surgical Medical Staff. For example: Hypotension; Nausea and Vomiting; Urine Collection; Itching
Setting up an epidural infusion
- Any of the following who have received training in the use of the epidural pump: Anaesthetists; Anaesthetists assistants; Acute Pain Nurses
- Obtain 200ml bag of 0.125% levobupivacaine.
- Attach the infusion bag to the epidural giving set.
- Programme the Epidural pump and purge the line according to the manufacturer’s instruction and as per training.
- On arrival in recovery, two recovery nurses must check the pump programme against the prescription sheet to ensure that it is correct.
- Prior to discharge from recovery the pump and the prescription must be checked with the ward nurse
Dressings and infection control
- Epidural catheters must be inserted using full aseptic technique and should preferably be sited in theatres or ITU.
- The Acute Pain Service can advise on the epidural fixation device to be used.
- The epidural filter should be secured to the upper arm or chest wall with a padded dressing, preventing the catheter from being pulled out of the Portex connector. If the line does become disconnected at this point (i.e. between the filter and the patient) the epidural catheter is inevitably contaminated and must be removed.
- Epidural infusion bags should not be changed until they are empty. The infusion tubing should not be disconnected for any purpose other than air in the giving set.
- The skin exit site should be inspected every nursing shift. If there are any signs of infection (tenderness, inflammation or exudation), the Acute Pain Nurse or Anaesthetist should be informed. If the epidural is removed, the tip should be sent to bacteriology for culturing.
- The epidural catheter may remain in situ for 48 hours post-operatively. If the epidural needs to remain for any longer, this must be discussed with the anaesthetist who initially sited the epidural, or (in their absence) with a Consultant Anaesthetist.
This helps us identify which nerves have been blocked by the local anaesthetic. We assess thermo receptors at a dermatomal level using a cold stimulus (such as ice) only. It is useful to have a supply of ice cubes in the freezer compartment of your fridge. The ice cube can be placed in either a disposable glove and in a gauze for single patient use.