Labor nurses - what's your policy/procedure on post-epidural vitals?

[klone, MSN, RN]

And at what point during the epidural procedure do you start doing them, specifically BPs? As soon as the procedure has officially started, or not until after it's completed, or at some specific point in between?

[labordude, BSN, RN]

Copied from the policy at my facility:

Epidural

During the administration of anesthesia, assess blood pressure, pulse and fetal heart tones every 5 minutes times 4, then every 30 minutes. Repeat routine after each injection. Assess temperature prior to administration and then every two hours.

Another hospital in my system:

After the epidural is performed and after each re-injection, assess and document

blood pressure, pulse and fetal heart rate:

• Every 5 minutes x 5

• Every 15 minutes x 3

• Every 30 minutes for the duration of the epidural

• PRN for patient complaint of lightheadedness, nausea, dizziness, the

development of non-reassuring fetal heart rate tracing, and/or any other

untoward reaction.

I follow the second one as I was trained at that hospital and the anesthesiologists at my current facility have been known for bottoming out moms, I'd rather get a couple extra rounds of vitals.

I start cycling the vitals after timeout, but don't start counting toward the q5min x5 until the anesthesia bolus has started, that way I'm guaranteed to see any impact on the vitals.

[ashleyisawesome, BSN, RN]

We throw a pulse ox on them and assess the pulse continuously through the test dose and until they lay down. I cycle B/Ps q3m starting when the test dose is given and switch it to q15 when I think they are stable (usually about 20-30 mins after they lay down). They stay on q15 min b/p and pulse checks throughout the rest of labor and fetal heart tones are charted q15 as well (can be q30 without epidural if low risk).

If they receive any top off/boluses later I put them on q3m b/ps for a little bit after (usually 20 mins).

[AZBlueBell]

Pulse ox and FHT continuously during and after, but continue to chart at Q30min intervals or Q15 min depending on labor stage.

BP assessed prior to start, then as follows:

Q2 min x 5

Q5 min x 4

then Q15min til delivery

I start the Q2min right after test dose and we lay them down.