epidurals in small hospitals

  1. We are a small hospital in upper Michigan. We do approximately 350-400 deliveries per year. I would like to know from similar size hospitals if you do epidurals and what your policies are regarding them (who's responsible, anesthesia's part in monitoring, etc). Thank you.
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  2. 32 Comments

  3. by   mark_LD_RN
    we do them here anesthesia places epidural doses it , rn monitors patient. and removes cath.
  4. by   canoehead
    We do not guaruntee(sp?) the availability of an epidural on demand but it is available and anesthesia has never said "no" to us although they have asked us to hold out until the OR schedule has finished. An anesthetist must be on site at all times while a labor epidural is running.
  5. by   anitame
    We do around 500/year. We have anesthesia "on call" 24 hours a day. They are only in house on days unless there's a surgical case in progress. They usually respond fairly quickly (unless involved in a long case). They insert the epidural, do the test dose, and monitor the patient for the first few minutes. RNs assess dermatomes, V/S, set up the continuous infusion, may rebolus prn (with approp orders) and remove the epi after delivered. Anesthesia must remain on call (they are anyway) but are not required to remain in house (unless pt is a VBAC).
    Anita
  6. by   NurseDianne
    Originally posted by mark_LD_RN
    we do them here anesthesia places epidural doses it , rn monitors patient. and removes cath.
    The difference w/ us it that the RN is present during insertion and we LPN's monitor the pt. The RN also removes the cath if anesthesia is not around. WE are a very small rural hospital but do have epi's on demand.
  7. by   bagladyrn
    Originally posted by anitame
    We do around 500/year. We have anesthesia "on call" 24 hours a day. They are only in house on days unless there's a surgical case in progress. They usually respond fairly quickly (unless involved in a long case). They insert the epidural, do the test dose, and monitor the patient for the first few minutes. RNs assess dermatomes, V/S, set up the continuous infusion, may rebolus prn (with approp orders) and remove the epi after delivered. Anesthesia must remain on call (they are anyway) but are not required to remain in house (unless pt is a VBAC).
    Anita
    Anita - I'd suggest you check with your BON asap! In many states it is NOT within the scope of an RN to rebolus an epidural, no matter what kind of orders you have. I've found nurses in various states where it was not allowed doing so, "because we were told to" or "we have an order". Recipe for disaster - if something goes wrong, orders won't make a difference if it's outside of your scope of practice.
  8. by   labornurse
    In our hospital, ansthesia is here on days and oc at any other time. Ansthesia places the epidural and the RN monitors and removes the epidural cath. We have standing orders from anesthisa for drops in b/p and frequency of monitoring.
  9. by   SmilingBluEyes
    WOAH anita, I am glad I am Washington. (just across the River,what a difference in nurse practices, I would say).... We are IN NO WAY COVERED to set rates, administer boluses or do ANYTHING w/epidural drips except to turn them off. We DO remove the catheters and assess dermatomes. Anesthesia remains inhouse once the epidural is in til delivery occurs. (I love that). But never ever do we touch the pump! I would not want the responsiblity YOU have. No thanks. (our del. rate approx 850year).
  10. by   mark_LD_RN
    here we are allowed to adjust rates and to reinject epidurals with none narcotics only
  11. by   jmcrn
    I work in a rural WI hospital that does approximately the same # of deliveries annually. We do not offer epidurals, but we do offer intrathecals - it's a one time injection of narcotics into the intrathecal space. We do a 500cc prebolus, 5 min VS x3, then q15" VS until delivery. The patients generally get very godd relief for 2-4 hours, and retain their motor abilities. The CRNA only administers the actual intrathecal injection, then the rn monitors etc for the duration.
  12. by   AlaskaKat
    We do about 280 - 300 births per year, and we do not do epidurals. We do an occasional intrathecal, but they are few and far between. We don't do them because 1. Our patients don't ask for them (or very rarely) and 2. we don't have anesthesia in house 24 hours and we don't think it is fair to offer them only to some people. Plus, Alaskan women are tough!
  13. by   emily_mom
    OMG, why would you go to hospital where you couldn't get one? Do they give you a complimentary stick to bite on?


    Kristy
  14. by   bagladyrn
    I've worked in hospitals where epidurals were not offered. The women there were not necessarily "tougher". I think the difference was that they had not been brainwashed into believing that childbirth was impossible without an epidural. Maybe it's because the t.v. out on the res. doesn't carry "A Baby Story".(Can you tell I HATE that show?) The emphasis on epidurals is a relatively recent development, and I think overused as a result.

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