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CMC EPIDURAL MANAGEMENT
Epidural Catheter Physiology: Catheter threaded into epidural space Catheter is in close proximity to spinal cord Injury to spinal cord can paralyze patient Epidural Line/Site/Dressing Care: Dressing to remain clean, dry, intact Occlusive dressing mandatory Place Anticoagulation sticker on dressing if patient is on anticoagulation therapy and cover w/ tegaderm Lock Box/Tubing: Epidural bag in locked box w/ separate IV pole Yellow striped tubing w/ no injection ports Epidural stickers on tubing, pump & lock box Patient on Anticoagulation Therapy: Anticoagulation stickers on tubing & dressing Anticoagulation sign at bedside Epidural LDA Documentation: Locate Avatar Navigation Tab Add epidural/PNB catheter thoracic line MAR Documentation: MAR dual sign off required upon: Hanging new bag Rate change Verifying rate at shift change Document Assessments in LDAs: Safety Check Catheter Status Site Assessment Dressing: Type/Status/Intervention Sensory/Motor Testing Side Effects Document Dose/Intake In I&O Sheet: Rate and volume in I&O sheet Q8H Monitoring Documentation: HR, RR, O2 Sat, RASS, Pain level Q1H for 24H then Q4H (VS min Q4H) Epidural Initiation & w/ Boluses (MD Only): HR, RR, O2 Sat, RASS and BP Q5min x 4, then Q15min x 4, then Q4H Sensation/Motor Strength Lower Extremities: SDU/PCU: Q4H Med/Surg: Q8H
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