1. 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