Epidurals in pediatric patients

[shellasee]

Hello,

Wondering what other hospitals are doing in relation to pediatric patients who come back from surgery with epidurals in place, requiring either continuous gtts or boluses of medication. Do the nurses administer the medications or just monitor the meds? Do the anesthesiologists administer? Who removes the epidural? We are a general med surg unit with ADC in mid 40's with RN/LPN care pairs.

[Gompers, BSN, RN]

Once in a while our NICU babies come back from OR with epidurals. We basically don't touch anything! We make sure the dressing stays occlusive and secure - usually not a problem as they use a lot of tape and tegaderm - and document the hourly infusion totals on our flowsheets with our IV totals. If anything needs to be done - whether it's retaping the epidural, pulling it, or even changing the medication syringe out - we call anesthesia to do it.

[FutureNurse2B]

I work in Baltimore md and here we do the same. Monitor the epidural site, infusion recordings. At our facility, our pain service team comes around and does the rest. Pretty simple but I always get nervous with those epidural sites accidentally getting dislodged, which has happened. Pain service takes care of it.

[ittybabyRN, RN]

Once in a while our NICU babies come back from OR with epidurals. We basically don't touch anything! We make sure the dressing stays occlusive and secure - usually not a problem as they use a lot of tape and tegaderm - and document the hourly infusion totals on our flowsheets with our IV totals. If anything needs to be done - whether it's retaping the epidural, pulling it, or even changing the medication syringe out - we call anesthesia to do it.

I wish our babies could come back with epidural...or ANYTHING for that matter, just the other day I had a little one come back from open belly surgery with nothing more than PRN's of morphine 0.01mg/kg! :hdvwl: The fellows we've got want us to pursue more "alternative" forms of pain management, ie swaddling, i'd like to swaddle them up one day after cutting their belly open and see how they like it! geesh

[littleneoRN]

0.01 mg/kg? That's not going to touch a hangnail... Just our stable vented kids can have 0.1 mg/kg for comfort, and they aren't even post-op!

[ittybabyRN, RN]

omg we would have to beg for that, had a full tern oscillating kid today on 0.05mg/kg, 0.1mg/kg was the bolus we gave him when he had chest tubes placed...twice!... I'm a new grad, never having been to another unit I don't know what other protocols are but according to the older nurses in my nicu this has been a recent change with recent changes in fellows, etc to use less drugs & drips, if our kids are stable vents, they MIGHT have PRN's but no drips & the docs wonder why we can't keep them intubated??? because they're jumping off their beds in pain!

[pedspro]

Follow your Hospitals'policy. In my experience I have given Fentanyl Boluses for breakthrough pain to Peds patients (on the general Peds Floor)via epidurals. The line is D/C'd by Pain team .No biggie to give a Bolus,as long as you are educated on the subject and follow protocols.