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Epidural Catheter: Assisting

  1. Ensure that the child and family understand the procedure and that questions are answered.
  2. Confirm that consent for the procedure has been obtained.
  3. Apply a local anesthetic cream to the anticipated insertion site as prescribed and in accordance with to the manufacturer's recommendations.
  4. Gather the needed equipment and supplies, including local anesthetic for subcutaneous infiltration.
  5. Identify the child with the use of the appropriate patient- and procedure-verification process (e.g., "Time out").
  6. Perform hand hygiene.
  7. Ensure that the child has cardiopulmonary monitoring, with alarms appropriately set, and patent IV access.
  8. Compare all medications for bolus or infusion purposes with the prescribing practitioner's orders to ensure consistency. Medications, their concentrations, and initial pump settings should be independently verified by another licensed staff member. Ensure that all medications and solutions are preservative free.
  9. Consult with the individual inserting the catheter about the benefits of sedating the child during the procedure, if the child is not under general anesthesia at the time of placement, to minimize movement during insertion.
  10. Prime the infusion tubing from the reservoir to the distal end of the infusion tubing. Ensure placement of an contisiphon valve or mechanism to prevent free flow within the infusion system.
  11. Assist the anesthesia practitioner inserting the catheter in positioning, prepping, and draping the child. Support the child during the remainder of the insertion.
  12. Observe the child while the anesthesia practitioner confirms catheter placement by injecting a test dose to rule out intravascular placement of the catheter tip. If the heart rate (HR) does not increase, the needle is considered to be in the epidural space rather than a vascular space. The catheter is then threaded through the needle.
  13. Assess BP, HR, oxygen saturation (Spo2), respiratory rate (RR), and signs of sensory or motor blockade every 3 to 5 minutes for the first 30 minutes. If boluses are given at any other time during the infusion, these parameters must be reassessed as described above. If any signs suggest that the catheter tip is in the intrathecal space, discontinue the infusion and notify the prescribing practitioner to reposition the catheter immediately.
  14. Connect and start the infusion as prescribed. Boldly label the pump and tubing "Epidural." The use of indwelling filters depends on institution-specific protocol.
  15. Do not insert any stopcocks within the tubing system. Avoid tubing with injection ports; if such tubing is used, tape over every injection port and boldly label the tubing "Epidural," indicating that the infusion is going into the epidural space.
  16. Secure the catheter with a transparent dressing at the insertion site and apply tape along the length of catheter, from the insertion site to the shoulder. Tape the adapter securely to the shoulder to prevent tension and accidental disconnection of the catheter from the infusion system. Protect the dressing from contamination by urine or stool.
  17. Discard used supplies and equipment, including sharps, in the appropriate receptacles.
  18. Remove gloves; perform hand hygiene.
  19. Document the procedure in the child's record.
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