astromorph injection ?

Specialties CRNA

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I work on a med/surg floor and have a few patients come up with epidurals and require astromorph injections every few hours for pain control. When injecting it, I've heard both that you take a syringe, pull back to see if you get any return (some say you should get nothing, others say you may get a very small amount, but never continue if you get a lot), then do you just unscrew the syringe after pulling back or push the small amount of fluid or nothing back in before injecting the astromorph (I've heard and seen both). After that step, we then inject the astromorph. I saw a person check for return and then push the small amount of fluid back in, but when injecting the astromorph, the patient had some pain, but subsided quickly. There was no air in the astromorph syringe which was drawn using a filtered needle. Want details on this and can't find it anywhere. Thanks.

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if it is epidural you should not get any return (although a very small amt may be from the infusion -if any - that was running)

i may be niave here - but i was always under the impression that epidural "pushes" must be done by anesthesia...it is an aweful big risk for those not trained in epidurals to be dosing them.

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I'm not thrilled with epidurals. You're right about who should be doing these pushes, but they are becoming more and more popular on our med/surg floor. I'm trying to learn the CORRECT way of doing the injections and can't seem to come up with a clear answer. If you have a syringe and there is no air in it and you screw it onto the epidural, then pull back just a bit to check for return, should you reinject that, or would you be injecting air?? I've seen it done both ways, but feel there must be a correct way or "more correct" way. If anyone knows, I'd really appreciate it. More and more floor nurses are doing IV pushes, but it doesn't mean it's right.

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the small amt of air/fluid you get on aspiration of an epidural cath can be reinjected - it is an air filled space you are injecting into...

but be careful - that fluid should only be the infusion that was running - csf will be hard to detect and if the cath has migrated you will be injecting into the subarachnoid space with could be detrimental to your patient....

again - i would check with your hospital protocols and anesthesia - epidural dosing should only be done by anesthesia as it is an anesthetic...and although your unit is doing it - that doesn't mean that when a case goes to court your unit will cover your behind...

good luck

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I agree with athomas 91. Make sure it's in your scope of practice. If you do not get answers from your hospital, check with your state board of nursing, either online or call them. They will know.

Jennie

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Specializes in ICU,ER.

sorry i can't give any insight into your question but if i may say.....i had astromorph after my c-section and it was the bomb. no pain...none at all for 24 hours after. but almost at the 24 hour mark.. i had mild pain. and i was an old fashioned "vertical cut".

oh, and the anes. guy gave it.

sorry, off subject!:)

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Specializes in CRNA, ICU,ER,Cathlab, PACU.
the small amt of air/fluid you get on aspiration of an epidural cath can be reinjected - it is an air filled space you are injecting into...

dont reinject air...the epidural space is a potential space, there should be no air in it (unless there is iatrogenic air in the space from insertion technique using loss of resistance to air).

my advice, if you get air, dont reinject the air, if you can freely aspirate fluid (say more than a couple of cc's), call an anesthesia provider...hopefully the one who put in, and do not reinject it.

If you reinject air you can cause unblocked segments, or worse, if a lot of air is reinjected (say greater than 20ml) clavicular subq emphasema, (greater than 30ml) severe enough to cause a temporary paraplegia or pneumocephalus, and cranial nerve palsies (Shnider and Levinson Anesthesia for Obstetrics 4th ed page 420)

think of the epidural space like the pleural space...should be negative, and more than 2-5 cc of air is bad news.

just my two cents

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Specializes in ORTHOPAEDICS-CERTIFIED SINCE 89.

Did you take a class on managing epidurals? Mine taught only an anesthesiologist can do a direct injection or begin an infusion. After it began, then the nurses were given parameters to follow in adjusting the pump.

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Specializes in Maternal - Child Health.
Did you take a class on managing epidurals? Mine taught only an anesthesiologist can do a direct injection or begin an infusion. After it began, then the nurses were given parameters to follow in adjusting the pump.

In many states, manipulating an epidural in ANY way is a category II procedure, requiring evidence of advanced training and competency for an RN.

Do not inject an epidural without first checking with your BON.

In NC, our LDRP unit went to PCA epidural anesthesia for C-sections, and we all had to attend a 2 day training course before we could handle the pumps in any way. The rates and boluses were set by anesthesia. We could only change the cassettes. We were not allowed to inject the catheters. Removal was done and signed for by 2 RNs.

I think you are treading on dangerous grounds by injecting epidural catheters. If patients need frequent injections, I would either insist that anesthesia come do them, or order a continuous infusion via a pump.

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As stated previously, do not even worry about injecting a small amount of air into the catheter. One technique used to identify the epidural space when placing a catheter actually involves injecting as much as 5-7 cc of air into the space....so don't sweat a small amount of air.

It does seem odd however to be responsible as a med-surg RN for injecting epidural catheters. There are quite a few things to watch for, none of which you were educated with in school, or should be responsible for knowing. It seems to me that the anesthesia department may be slacking a bit by having you do this. I would definitly check into it. In the interim, be very careful with the epidural catheters. I have heard some horror stories involving staff and catheters....TPN infusing into epidural; Marcaine for epidural infusion infusing into peripheral IV:eek:

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TPN in epidural? What the *&^*? You'd have to be on crack.

As stated previously, do not even worry about injecting a small amount of air into the catheter. One technique used to identify the epidural space when placing a catheter actually involves injecting as much as 5-7 cc of air into the space....so don't sweat a small amount of air.

It does seem odd however to be responsible as a med-surg RN for injecting epidural catheters. There are quite a few things to watch for, none of which you were educated with in school, or should be responsible for knowing. It seems to me that the anesthesia department may be slacking a bit by having you do this. I would definitly check into it. In the interim, be very careful with the epidural catheters. I have heard some horror stories involving staff and catheters....TPN infusing into epidural; Marcaine for epidural infusion infusing into peripheral IV:eek:

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First off, the drug is astramorph.

Second, although I used to push epidural narcotics back in my glory days as a med-surg nurse, knowing what I know now, I have to say it wasn't a very good idea. Just way too many potential complications.

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