Labor Nurses regulating epidurals

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I wanted to ask if any labor nurses out there are responsible for regulating, bolusing labor patients epidural infusions.

Thanks!

Teri

Specializes in Maternal - Child Health.
The conversation got me curious, so I went and had a look.

From NC BON Website:

"Administration of subsequent doses of epidural anesthesia/analgesia and the removal of epidural/caudal catheters is within the scope of nursing practice for the REGISTERED NURSE. (Jan. 1986)"

Wow! That far exceeds what we were allowed to do, even after taking a state-approved course on epidurals designed to enable us to perform Category II procedures.

I was working on an LDRP unit in Charlotte in 1991 when our anesthesiologists decided to switch from Dura-morph for C-sections to PCEA. The nursing staff took a 2 day course and then had to demonstrate continuing competence in order to "manage" the PCEA post-operatively, as some of these duties involved Category II procedures. The infusion started in the OR contained Fentanyl and a "-caine" drug. (Sorry, I can't remember which one.) That ran for approximately 8 hours until the casette ran out and had to be changed. The subsequent casette(s) contained only the "-caine" drug. They were changed by the RNs, but any rate changes or non-patient-controlled boluses had to be done by anesthesia. The epidural catheters were removed by the nursing staff, requiring 2 RN signatures that the catheter was intact.

This involved post-op C-section patients only. The nursing staff did not regulate labor epidurals in any way.

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The conversation got me curious, so I went and had a look.

From NC BON Website:

"Administration of subsequent doses of epidural anesthesia/analgesia and the removal of epidural/caudal catheters is within the scope of nursing practice for the REGISTERED NURSE. (Jan. 1986)"

Now the MDA who hands me a syringe and tells me how much more fentanyl to add to the catheter directly if the pt needs it (and this has happened) is dreaming, I just smile and nod, then waste the med, and call if I have trouble.

Unfortunately this is TRUE. :nono:

Over the years I've done more with epidural catheters, meds, tubing, etc. than I care to admit and remember. Basically the ONLY thing we had to notify anesthesia for was if the pt needed a bolus (note this was if WE thought they needed a bolus) or if we were going to reduce the rate below what was written (as a courtesy).

And before the 'ologists decided they would do all our epidurals, our OB RESIDENTS did all the epidurals and my oh my what a mess that was!!!

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If you had a court case w/ the likes of someone like a Michelle Murray who often serves as an expert witness, you could be fried. I think anesthesia needs to manage their own domain. We don't do anything but turn the epidural off. As the unit educator for OB, I am sticking to it. We do enough stuff w/o worrying about this too. AWHONN says no and that is fine w/ me.

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Specializes in postpartum, nursery, high risk L&D.
If you had a court case w/ the likes of someone like a Michelle Murray who often serves as an expert witness, you could be fried. I think anesthesia needs to manage their own domain. We don't do anything but turn the epidural off. As the unit educator for OB, I am sticking to it. We do enough stuff w/o worrying about this too. AWHONN says no and that is fine w/ me.

OK this conversation has got me nervous. can anyone direct me to AWHONN's statement/position on epidurals? the BON in my state doesn't seem to have anything to say about epidurals specifically (that I can find anyway)

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try this link http://www.awhonn.org/awhonn/?pg=873-6230-6990-4730-4760

I am not sure if it will work because I am a member and it may not work if you're not.

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Specializes in postpartum, nursery, high risk L&D.
try this link http://www.awhonn.org/awhonn/?pg=873-6230-6990-4730-4760

I am not sure if it will work because I am a member and it may not work if you're not.

Thanks!!

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Specializes in many.

Thanks for the link to the AWHONN statement, hopefully I can use it as backing for why we should not be managing anaesthesia as regularly as we do.

At this time we have 23 beds in our birthing unit and one anaesthesiologist to cover us plus 4 OR's at a time. The ologist will bring a CRNA to every c/s and the ologist is gone as soon as the baby is delivered and the CRNA finishes the case.

The CRNA students that go through are taught how to do epidurals and spinals, but then are not allowed to use their skills if they stay with us.

We have trouble if a section is called and we have pt's waiting for epidurals, it is always - "I have 3 OR cases that I need to check on, she will have to wait"

Wonder what it would take to get a CRNA in the unit 24/7....probably the daughter of the CEO being told she'll have to wait for her epidural, as if!!

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Funny you brought this up...I had an anesthesiologist rant for a good 15 - 20 minutes about changing the rate on the epidural pump. I told him that it was against policy to do so, questioned what would happen if I "snowed" the pt from an error with the pump, etc. but he continued on about how he should be able to place the epidural and walk out, that we should hook up th einfusion and start it after, how he loves his job and gets paid well-no kidding, I wish I could get paid that well for managing 1 epidural while the pt was sleeping...long story short and tears later, he was handed the policy with that section highlited by my manager, her secretary, and a charge nurse after they had caught wind of the confrontation...cant wait to see the intereaction when we see each other again...anyways-I refuse to touch the pumps, that is anesthesia's job-they don't touch my pit and i am glad for it.

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On my unit, in Illinois, we cannot increase an epidural or give a bolus. We can stop the infusion, but we cannot discontinue the epidural catheter. ]I know some hospitals let the nurse take out the catheter.

We just started using locked epidural pumps -- I think we were behind on that one. We used to just infusion epidurals on a regular pump used for IV's. The medication was hanging freely and not locked up.

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

Where I work we practice within AWHONN standards, meaning RNs may NOT adjust rates upward, bolus or change mixtures of medication...we may hang a new bag of the SAME drip/medication mixture, from pharmacy. Other than that:

We MAY

slow the rate at MD or MDA's order

Or

Turn off the pump at MD/MDA order.

That is it.

We went through this w/a couple of MDA's also wanting us to change rates and manage things only THEY should be doing. But we Had AWHONN backing us up, as well as some wise OBs who agreed. It's THEIR job to do this; they are trained/educated for it and paid to do it. LET THEM. Just refuse to practice out of your scope, period.

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Specializes in OB, lactation.

This was part of my orientation this last week & it reminded me of this thread... in my paperwork our policy states that RN's who have the training can administer boluses via pump, increase/decrease, d/c, and remove the catheters. In another section it states RN responsibilities "monitors, maintains, adjusts, and d/c's epidural infusions per anesthesiologist's orders".

I just looked around on the FL BON website but I couldn't find anything on it. Are there any other FL folks here who may know our BON's view, if any?

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