Hooking up epidural line

Specialties Ob/Gyn

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Hello,

I am a travel nurse working in FL and at the hospital I work at the anesthesiologist wants you to hook up the epidural line to the patient after he places the epidural. I am uncomfortable doing this since they have no epidural policy and it is against Awhonn guidelines to initiate the epidural continuous infusion. Also, I called the board and they have no specific guidelines in the nurse practice act. A couple of them downright refuse to hook it up. What would you do?

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Specializes in anesthesiology.

Why can't the anesthesiologist hook it up?

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Specializes in L&D, OBED, NICU, Lactation.

I do not see in the AWHONN guidelines where it says nurses are not to CONNECT the line. This is different from the initiation of the infusion which is specified in the guideline. We connect the tubing all the time while the anesthesiologist programs and starts the pump.

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Murseman- Some of the anesthesiologists are extremely stubborn and just flat out refuse to do it and will say its not there job and we can do it. I talked to my director about it and she said that I can refuse doing it and notify my charge RN and director but I am hesistant to do that because I dont know if I want to cause a big scene. Other travel RN's have told me to just document it as a verbal order from the anesthesiologist to cover my butt if they refuse. I literally am handing them the line and they refuse. Alot of time they even have a tech with them that sets up everything for them so all they have to do is put the epidural in..

On 10/24/2019 at 3:52 PM, murseman24 said:

Why can't the anesthesiologist hook it up?

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On 10/24/2019 at 7:19 PM, labordude said:

I do not see in the AWHONN guidelines where it says nurses are not to CONNECT the line. This is different from the initiation of the infusion which is specified in the guideline. We connect the tubing all the time while the anesthesiologist programs and starts the pump.

If you are initiating an infusion in my eyes you are the the one that is allowing the med to get to the patient. Initiating a med is giving a med and I am the one giving the med if I am hooking it up. The med would not reach the patient if I didnt hook it up to the patient so I am initiating it. No?

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Specializes in L&D, OBED, NICU, Lactation.
9 hours ago, LaborRN said:

If you are initiating an infusion in my eyes you are the the one that is allowing the med to get to the patient. Initiating a med is giving a med and I am the one giving the med if I am hooking it up. The med would not reach the patient if I didnt hook it up to the patient so I am initiating it. No?

We do not agree here. If you connect a med line to IV tubing, but don't start the medication did you administer it? I'd say no but by your previous logic you would have initiated the infusion even though the patient never received any medication.

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Specializes in anesthesiology.
12 hours ago, LaborRN said:

Murseman- Some of the anesthesiologists are extremely stubborn and just flat out refuse to do it and will say its not there job and we can do it. I talked to my director about it and she said that I can refuse doing it and notify my charge RN and director but I am hesistant to do that because I dont know if I want to cause a big scene. Other travel RN's have told me to just document it as a verbal order from the anesthesiologist to cover my butt if they refuse. I literally am handing them the line and they refuse. Alot of time they even have a tech with them that sets up everything for them so all they have to do is put the epidural in..

Sounds like you could just tell them the same, "it's not my job". That's ridiculous. Where is this? Do you have CRNAs putting in epidurals there too? If the tech opens the kit how do they know it's sterile? Doctors get away with poor behavior way too often. This is childish.

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Specializes in anesthesiology.

What if it comes unhooked somehow? You can't just hook it back up, and you would be to blame. The CRNAs where I'm at do the assessment, prep the pt, setup the kit, get the meds/prime bag/hook up to pt, and hang out for some time to ensure the pt is OK before leaving the room. You should also be aspirating from the catheter before hooking it up to ensure it's not in an epidural vein. If the line is not primed and enough air goes in the epidural space pnuemocephalus can result (seizure). I don't know what your knowledge base is regarding neuraxial anesthesia, but when I was bedside nursing I never worked in L&D but I had zero knowledge regarding the subject.

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13 hours ago, labordude said:

We do not agree here. If you connect a med line to IV tubing, but don't start the medication did you administer it? I'd say no but by your previous logic you would have initiated the infusion even though the patient never received any medication.

I guess I should clarify one thing. When anesthesia brings the pump and med into the room the pump is already running/medication started. So if I am the one hooking it up to the patient then i am administering the med is my thought on things. Thank you for responding ?

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10 hours ago, murseman24 said:

Sounds like you could just tell them the same, "it's not my job". That's ridiculous. Where is this? Do you have CRNAs putting in epidurals there too? If the tech opens the kit how do they know it's sterile? Doctors get away with poor behavior way too often. This is childish.

This is Florida. I havent seen any CRNAs but they have AAs that do spinals in the OR. I would be okay with doing it IF they had a policy or if I was backed up by the BON but when I called the BON they told me that they don't have guidelines on epidurals specifically. They told me to follow hospital policy. I told them there isn't one... I don't think I should be expecter to do something that there is no policy on if the BON has no support to provide for me either.

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10 hours ago, murseman24 said:

What if it comes unhooked somehow? You can't just hook it back up, and you would be to blame. The CRNAs where I'm at do the assessment, prep the pt, setup the kit, get the meds/prime bag/hook up to pt, and hang out for some time to ensure the pt is OK before leaving the room. You should also be aspirating from the catheter before hooking it up to ensure it's not in an epidural vein. If the line is not primed and enough air goes in the epidural space pnuemocephalus can result (seizure). I don't know what your knowledge base is regarding neuraxial anesthesia, but when I was bedside nursing I never worked in L&D but I had zero knowledge regarding the subject.

It's all fun and games until something goes wrong and then the nurse is to blame. If I hook up to the patient I am the one administering when i wasnt involved in anything except pulling the med. Also, anesthesia refuses to review pump settings with me because they are preset?‍♀️☹ i have to have a nurse come in to the room but they "aren't allowed" to verify settings only verify correct med.

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I'm so glad I'm not working inpatient when I read these!!!! Doing what's best for the patient is not a priority anywhere!

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