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Epidural Catheter maintaining

  1. Using, maintenance and care
  2. Assisting with Insertion and Initiating Continuous Infusion
  3. Wash hands and don nonsterile gloves, gowns, and masks with eye shields.
  4. Obtain the prepared epidural fluid with medication from the pharmacy as prescribed.
  5. Connect the epidural tubing to the prepared epidural fluid with medication and prime the tubing.
  6. Ensure the patient is in position for catheter placement.
  7. Assist as needed with the antiseptic preparation of the intended insertion site.
  8. Assist with holding the patient in position or consider sedation, if necessary.
  9. Assist the physician or advanced practice nurse as needed with the epidural catheter placement.
  10. After the epidural catheter is inserted, assist as needed with application of an occlusive dressing.
  11. Secure the epidural filter to the patient's shoulder with gauze padding.
  12. The physician or advanced practice nurse will administer a bolus dose of medication.
  13. Connect the prescribed medication infusion system.
  14. Initiate therapy:
  15. Place the system in the epidural pump or the PCEA pump and set the rate and volume to be infused.
  16. Attach an epidural only label to the epidural tubing and tape over the ports or preferably use a portless system.
  17. Do not use a burette.
  18. Lock the key pad on the epidural or PCEA pump.
  19. Assess the effectiveness of the analgesia.
  20. Determine the pain score (0-10 scale).
  21. Test the level of the epidural block with ice or an alcohol swab.
  22. Discard used supplies and wash hands.
  23. Nurses with competency may give an epidural bolus dose of opiods via epidural catheter for analgesia if ordered.
  24. Wash hands and don nonsterile gloves, gowns, and mask with face shield.
  25. Boldly label the epidural catheter used for intermittent bolus dosing (suggest color coding).
  26. Identify the correct patient and medication by utilizing the five rights of medication administration.
  27. Inform the patient of the procedure.
  28. Prepare the bolus dose as prescribed.
Bolus Dose Administration, Without a Continuous Infusion
  1. Prepare and cleanse the epidural filter with an antiseptic agent.
  2. Utilize a sterile technique to administer the epidural bolus:
  3. Connect the syringe with the bolus medication to the catheter port.
  4. Aspirate the epidural catheter. NOTE:  If more than 0.5 ml of blood is aspirated, do not inject. Notify the physician or the advanced practice nurse.
  5. Administer the medication slowly.
NOTE:  If excessive pressure occurs, assess for kinks in the catheter and/or reposition the patient.Assess the effectiveness of the medication.
Monitor vital signs.
Discard used supplies and wash hands.