IUPC Insertion - Epidural Settings

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Specializes in L&D/MB/LDRP.

I don't know if this question has been addressed but I'm just curious to know how many of you have policies in place that allow RNs to place IUPCs? I'm sure it's less common @ teaching hospitals since we all know the residents are the ones that do much of this.

Also are any of you allowed to prime, set and connect the epidural pumps to the pt? I've never been to a facility that allows the nurse to do this until now. I have been to one place that the anesthesia department hires their own nurses to do this. However, it's only when the unit is so busy the anesthesiaologist can just place the catheter and move on.

What do you all think about this?

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Regarding IUPC placement: RN's are trained, checked off and do place our IUPC where I work. And you are right, in some teaching hospitals the residents do this mostly. But in smaller, community hospitals, they rely upon us to place our own IUPC and FSE after documented competency.

Regarding Epidural pump adjustment, NO--- we RNs may NOT adjust them in ANY way except turn OFF w/MD order. AWHONN http://www.awhonn.org has a position statement that basically prohibits RN's from establishing or changing epidural rates for pregnant patients (we can adjust rates for GYN patients who have post-op epidural). But on laboring women, in NO way are we to administer boluses, or set or adjust the rates, up or down; the CRNA Or MD must do this.

It is true: State BON/laws differ on this subject. You should always err on the more restrictive side, to be prudent. I would make sure I am following the more restrictive AWHONN policy myself. Today, would urge you or your manager to visit AWHONN policies regarding epidural rates adjustment by RN's, to be on the safe side.

We just had a big argument w/one of our MDAs regarding this, (he felt we should adjust rates w/his order)---and the State regs did not prohibit it specifically----- but---- once the AWHONN position statement was printed and shown the Perinatal Committee and this MD, there was no further argument. They (the MDAs) MUST come in and adjust rates and administer boluses on epidurals on laboring women. RN's MAY NOT DO THIS EVER at our institution.

Hope this helps.

Good luck.

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Specializes in L&D.

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We have an ongoing problem with our MDA's not wanting to come up and adjust rates on our epidural pumps. They keep insisting that our "managers" on L&D can adjust rates - and that is definitely not so. Our policy goes by the AWHONN guidelines - that only a trained Anesthesiologist or CRNA may adjust the rate of all epidurals, give boluses, or restart the epidural pump if it has been shut off. We may only change the bag inside, or shut the pump off in cases of toxicity or after delivery.

Just yesterday, one of the MDA's insisted that the policy has changed recently, and that the RN's on L&D can adjust the rates (they try this about once a month!). Meanwhile, we have to fight back and forth between our managers and their managers to get an MDA or CRNA to come up and increase/decrease the rate!! The poor patient is usually 1- in agony, and needs bolused or increased, or 2- totally numb and needs the rate decreased to push.

I have brought our OB dept head (MD) into this issue once before, when it was the head of Anesthesia that was insisting we could change the rate!

It never ends ........

Jen

L&D RN

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

It's hard. That is why such issues can and should be worked in Perinatal committees. I also am a BIG fan of PCEA use (the patient can self-bolus a limited amount as needed). This has definately decreased the wait time for the patient to get herself comfortable again, as well as reduced the hourly rate needed to keep her comfy-----and the MDA loves not having to come, obviously, to administer boluses. MDA-adminstered boluses are rarely needed when they set up the PCEA for the patient. Gotta love it.

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We don't place IUPC's or adjust epidural rates. We turn off epidurals after delevery but call the residant/CRNA to place and IUPC or change the epidural rate.

Rn's do place IUPC's at some facilies and can adjust epidurals on surgical patients. Both of these things are within the capability for an RN just not allowed. The question as to why AWHONN has a policy agisnt changing epidural rates and why my facility has a policy of haveing an MD place an IUPC is one that I prefer not to ask. I'm just glad that there are 2 things that I dont have to do. I mean everythign else is on me and allowing someone to have part of the responsibilty (even if its just a littel) is a welcome thing.

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We don't place IUPC's at my facility either, but I know RN's at another facility do, after being checked off.

We do prime the tubing for our continuous epidurals, but we do not set or adjust rates. The only time we do anything with the epidural pump is to turn it off after delivery.

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At my institution, priming, touching, whatever the epidural pump is a NO-NO. Anesthesiologist only.

Likewise, IUPC insertion may only be done by an MD. FSE, on the other hand, you can do with (I think) 2 years experience and you have to be checked off on it.

Interesting to me the differences between states and institutions.

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