As Labor Nuses we know the AWHONN standards for taking care and managing Epidurals in Laboring patients. In my hospital we a having an on going battle with Anesthesia about our role. At this pint we intiate the continou,set up pumps to Doctors orders, we will decrese the rate and turn the continous off. They want us to increase the rate on the pumps if ordered with out the MD seeing the patient.
Well I have never done this and I will not do it..I am not a trained advanced practice nurse in anesthesia.........
Need to find out what other hospitals in PA and in other states do........
The more reserch we do the better...Thanks
Aug 14, '06
We never change or decrease the rates. Only Anesthesia touches the rates, we only change out the bag when it is empty. If the Pt is uncomfortable, or the MD/CNM wants the rate turned down to puash, we call anesthesia to come do it. I think this is the safest thing to do for the pt's.
Aug 14, '06
Have you checked with the PA BON?
Please, don't let Anesthesia cow you into going outside your scope. Hopefully, your manager is involved and very vocal about this and will advocate for you all on this very critical issue. As a CRNA here put it so well once, "Anesthesia is a specialty of its own for a very good reason". Your role is NOT to manage the epidural, but to care for the patient herself while it's being infused, period.
GOOD LUCK to you.
Last edit by SmilingBluEyes on Aug 14, '06
Aug 15, '06
Wow, that's scary to me! The only thing we can do is turn off the pump and d/c the epidural catheter itself. I wouldn't want the responsibility that you describe - I'm not an anesthesiologist or CRNA!
Aug 15, '06
Our Nurse Manager is of no help really all she has done is change the hospital policy..........no in our favor.... PA BON is very vague it acknowledges AWHONN Standards but not in so many words says that as Registered Nurses we could do all of what I stated with education........... NO help... we are getting more help from the OB Docs then anyone in management...........
Aug 15, '06
I live in PA. We have a specific policy as to what RN's on L&D can do with epidurals.
1. Get pt prepped for epidural (LR bolus, EFM, pull meds, pull pump, get epidural cart, sit pt up at side of bed, call Anesthesia)
2. Monitor pt during administration, including our specific BP and documentation protocols. (rate of infusion, PCEA settings and lock out dose, EFM protocols)
3. D/C epidural infusion (shut off the pump) if pt presents with s/s of toxicity.
4. D/C epidural pump after delivery, and remove epidural catheter.
5. Change epidural medication bags with a 2nd RN verifying.
6. Troubleshoot pump alarms, unless it interferes with the infusion rate.
7. Change pump batteries (the pumps will not lose the info that was set into them)
8. Waste the remaining fluids in Pyxis with another RN as a witness.
9. Document total amt infused.
We may NOT do the following, unless we are specifically trained or a graduate of a Nurse-Anesthesia program.
1. Start an epidural
2. Program the epidural pump (except when we add a new bag)
3. Change the rate (increase or decrease) even with a MD order
4. Give bolus doses or test doses
5. Troubleshooting that the RN is not able to fix.
6. Restart an epidural pump after it has been off.
Aug 16, '06
We are able to do pretty much everything with an epidural.
We can help set up the patient, program and start the pump, change the epidural bag, increase or decrease the rate of infusion and discontinue the epidural. We may also give top ups once we have been observed and signed off by an anestesiologist.
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