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Discussion

Ambulating a pt. with an epidural cath

Had a pt. s/p surgery with a PCEA in the thoractic region. Anesthesia gave orders for ambulation. Some nurses were for it, some were against.

Right now there is no policy at my job.

What would you have done?

The doc said due to the cath being in the thoractic region versus the lumbar it would be much more safe for the pt. to ambulate.

I've researched online and haven't had much success getting a clear answer on whether it is the best thing for the pt. or not?

I spoke to the NM and anesthesia to write a policy on this.

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    Not all epidurals are the same. Epidurals in laboring patients can cause leg weakness since they target pelvic innervation, although at my hospital these patients aren't absolutely prohibited to ambulate, it's depends on the patient. There are some studies that show it's safe to ambulate laboring patients with epidurals and may even have some benefits.

    In patients with thoracic coverage typically for a thoracotomy, the epidural shouldn't prohibit ambulation and long as the coverage is appropriate (T3-T6 dermatomes for instance). I think many Nurses just think "epidural=bedrest" without really thinking it through. Thoracotomies often have epidurals since it is an extremely painful post-op course, yet these same patients are often at high risk for many of the complications that can result from not ambulating, so the Nurse's you work with really need to get over the misconceptions they have about epidurals and ambulating.

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    We always ambulate our post-op patients who have epidurals, unless there is some reason not to (such as other post-op complications)

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    You both rock! Exactly what I was looking for...

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