Ephedrine

This is a practice issue

On post partum patients who have had an epidural are RNs able to give ephedrine IVP for hypotension? Please let me know the your practice

Pharmacy says we should but OB nurses do not want to do it. I just think they need education so they will feel more comfortable with the practice. Please also let me know the state you live in. Thanks

I do not think this is a drug that staff nurses should be administering. There are limits to its effectiveness and many situations in which there are superior alternatives. In some cases, it can do more harm than good. I would leave the administration of ephedrine to the CRNAs and anesthesiologists.

I dont see why it should be a problem, I think it sucks people abused this drug and gave it a bad name.

Have to watch fluid and potassium like any other diuretic.

It stimulates ephineprine and norephineprine that can help recovery, for your use I think this is a good choice.

I dont see why it should be a problem, I think it sucks people abused this drug and gave it a bad name.

Have to watch fluid and potassium like any other diuretic.

Diuretic??????????? That kind of weak dude. Exactly why we should leave this one to the anesthesia staff.

Diuretic??????????? That kind of weak dude. Exactly why we should leave this one to the anesthesia staff.

Kinda funny you didnt show my whole quote, do you even know what this OTC drug does?

Yes this OTC drug is 2 much for you so you should leave it alone.

good side effects-for this use increased heart rate and increades blood pressure (counter acts anesthesia)

bad effects-cramping (potassium) low fluid volume...

other than that whats the problem, remember it is still an Over The Counter Drug and if nurses cant give this should they give Tylenol?

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We have orders on our Epidural Order Sheet that call for giving Ephedrine and how much and when (what parameters)---- when and if it is needed. Often, we can't wait for MDA to make it up to the unit to administer it in the case it is needed. I have had to give it a handful of times and it worked well, but yes, I watched these patients like a hawk all throughout their course when it was needed. Oh and I am a staff nurse. Just giving my input here.

Have to agree with smilingblueeyes, ephedrine is part of our epidural orders for hypotension immediately following the block.

Our hospital allows us staff nurses to give it IM ONLY. The anesthesiologist has to be the one to give it IVP. The anesthesiologists would love it if the hospital would change the policy, they are always trying to get us to do IVP.

Our CRNA's are the only ones to give this drug. I actually think they wanted it this way (the CRNAs).

Okay, please enlighten this new nurse. I am new to L&D and we administer ephedrine IVP after epidurals for hypotension. I never questioned it because it is how I was taught and all the RN's administer it, with anesthesia's orders of course. So at the risk of sounding stupid, please tell me what the dilemma is. ???

Regarding the original post - you should not need ephedrine post epidural on postpartum. The initial time after epidural administration is when the hypotensive episode r/t epidural administration will occur - if it should occur.

There is no need for ephedrine use in postpartum r/t the epidural. You should be looking for other causes for the hypotensive episode.

Where I work, RN's can give ephedrine IVP. We have prewritten orders on the epidural order sheet for parameters to give it.

But honestly....a fluid bolus will usually do the trick as well (though it may take a little longer). If you've adequately hydrated your patient before the epidural, you usually will not see that severe of a hypotensive episode.

And to Drakan -- ephedrine IV is not the same as the OTC type.

The staff RNs at my hospital are allowed to give ephedrine IVP, but the CRNAs have to stick around for at least 30 min p epidural placement so they're usually still there to give it if needed. I have ended up giving it myself a few times with great results. In the case where pt's BP bottoms quickly and CRNA already left, I'm glad we don't have to wait for them to come back to give ephedrine, esp when BP is so low baby is decelling. I agree that IVF bolus usually does the trick, but I've had a few pts that are still severely hypotensive after 2 liter bolus (1 liter bolus a epidural and 500-1000ml bolus p epidural if hypotensive).