Epidurals for anesthesia

[Mississippi_RN]

Recently at my facility, they have implemented a new policy that a RN that has been given "training" can do almost anything dealing with an epidural placed for anesthesia in surgery. That means, flushing, bolusing, changing rates, hanging meds and removing epidural catheters. Now...I feel a little strange about this, but it's ok if within my scope of practice. I looked at the MS BON guidelines and it is within scope IF the RN is properly trained. At this facility, this generally means going to an hour long inservice and getting a booklet to read. I just think there is more to it than this. Although, the anesthesiologist claims that we can do more harm with an IV!!!

What do y'all think???

[porterwoman]

Most absolutely definitely without a hint of a doubt ask for help with it if you don't feel 100% comfortable. Even if you feel 99% comfortable, get help. We recently had some errors happen on our floor by nurses caring for orthopedic pts with epidurals for post op analgesia: Lovenox given to pt with epidural (no no no never do that), wrong concentration med hung, pump came loose (?) and pump out of pt left running (? don't know all the details on that one)--anyway, anesthsiology staff was very very unhappy with all this and, needless to say, now only charge nurses can change settings and give boluses, and we had big staff education stuff on the dangers of hematoma at the epidural site. Epidurals probably shouldn't make me nervous, and if you're doing all the correct assessments when you should then you catch stuff early, but still, eeeeee, they give me the willies.

More harm with an IV? Maybe. But our NM told us that if a hematoma forms at the epidural site, permanent neuro damage can be done in 2-3 hrs. Lovenox greatly increases the chances of that happening. I guess bad stuff can happen with IVs, too...

Good luck!!