epidural pumps

Your concern over mix-ups between regular IV infusions and epidural infusions is a valid one. Although there is no universally sanctioned standard, sound judgement as to what you have alluded should dicatate that epidural infusions be administered in a device that clearly distinguishes them from other infusions. I have practiced in both scenarios, where the epidurals are infused via a standard IV pump, and in others where they are given via either a Bard (Smartplate) infusion or locked device such as the GemStar pump made specifically for epidurals. Sadly only a few weeks ago, a newspaper in the midwest reported just such a mix-up, where the patient died. This unfortunate incidient occurred at a major metropolitan hospital where the patients wear bar-coded bracelets to help prevent medication errors of any kind. Once again we can use this example to remdind us that the direct patient care provider is the best and the last barrier to untoward events in the health care setting.

I have worked in both scenarios and when I am at a place that uses a regular infusion pump for the IV there are some safety precautions that I utilize. I make sure the pump for the epidural is on the opposite of the bed from my other pump. I label the epidural pump with tape stating "EPIDURAL" and place the tape across the pad so that if anyone walks in and tries to change the settings they will see the tape. If the tubing is not epidural tubing (which unfortunately does happen), I asked the anesthesiest or CRNA to tape the injection ports or I will do it myself to ensure that nobody inadvertantly tries to inject something into them. I do the same thing when I'm doing an amnioinfusion. Just some thoughts on how to keep the patient safe...hope they help!

I work in a small rural L&D and here we use regular IV pumps for our epidurals. We have a policy in place that include doing the following:

1. The epidural infusion is place inside a locked plastic box then hung on the IV pole.

2. The IV pump is then programed and checked by another RN before it is started.

3. Three inch silk tape is then wrapped completely around the pump, covering the key pad.

4. The key pad is then locked, which requires simply pushing a button on the back of the pump...the screen then displays "loc" and until you push that button again you can't reprogram the pump. Since we only "loc" epidural it reminds us that this isn't a regular IV.

5. A large florescent green sticker stating "EPIDURAL INFUSION" is then placed over the silk tape.

Epidural/port free tubing is supposed to be used routinely and usually is, but if it isn't we tape each port with strips of another green "epidural infusion" sticker. We also are not to be hanging any other fluids from that pole.

When this is done it would be difficult for a nurse to mistake the pump controlling the epidural for one controlling an IV, but many times I've taken over a pt or received one from PACU who had one pole with two pumps. The epidural bag is not secured in a lock box, there is no tape or sticker and the epidural is running through regular IV tubing with untaped ports. So even with a very good policy, if you don't follow it you could end up in trouble....

The trouble you have to go to to take all of the above measures are why I am glad we use a completely different pump/set-up for our epidurals. There is no mistaking them this way.......

pump and tubing are COMPLETELY different. I think this is how it should be.