Nurses Managing Epidural Pumps?

klone, MSN, RN · Mar 13, 2013

AZ and CO, and we can shut them off, that's IT.

Fyreflie · Mar 13, 2013

Up here in Canada I've worked in three facilities with completely different rules. In the first, we had a medical directive not only to manipulate the rate within a set range, but also to give top ups as ordered and to troubleshoot.

In the second, we could change empty bags and prime the initial bag while waiting for the anesthetist but that was it.

In my current facility, we can turn up the rate by 2 or the bolus dose by one and occasionally we have to program the pump to start (as well as changing bags). Anesthetists get called for everything else, including troubleshooting.

IrishIzCPNP, MSN, RN, APRN, NP · Mar 13, 2013

I'm in PA. We prime the pump, hook up to catheter, set up rates in pump, give bolus via pump, change rate if ordered, start and stop pump.

RNinLDRP620 · Mar 14, 2013

OH, we decrease the pump at the discretion of a physician at the bedside if pt is too numb to push and shut the pump off. That is it.

melmarie23, MSN, RN · Mar 14, 2013

we can turn them off here in NH. If a pt has a persistent window or she is too numb to push, we call anesthesia.

Alikatz · Mar 20, 2013

I'm in CT and where I work we turn it off. Anesthesia takes care of anything else.

dah doh, BSN, RN · Mar 20, 2013

I'm in CA, not sure about the OB area, but in ICU, the epidural order set has a range that the nurse uses to titrate to effect. If we have issues or problems, we call the pain management or anesthesiologist. They prefer we crank up the epidurals for pain relief prior to sending the patients to med-surg floors because those nurses are nervous about messing with the rate unless they call the doctor even though the order set is the same. We can initiate and discontinue the epidural drip. The doctor manages the catheter and dressing changes.

SaoirseRN · Mar 20, 2013

I'm in Canada. We are allowed to adjust the settings on the pumps, including increasing the rate, but only with an order. We have a protocol to follow for monitoring with any rate change.

Often epidural orders often come with a range which we can titrate (up or down) the rate and/or the delay according to the patient's needs. If we reach the maximum upward adjustment then we would have to call the anesthesiologist, but having room to adjust is nice and ends up with fewer delays in achieving good pain control for most patients. Because the orders are first set by the anesthesiologist, we aren't doing this independently, even if we are making adjustments to the pumps directly.

eden · Mar 24, 2013

I am also in Canada. At my facility we can prime, program, start and adjust the rates. It is a 2 nurse check to adjust and start the pumps. We can also do top ups but if we have given 2 and they are still uncomfortable then we call back anesthesia. Before we can do top up we have to be signed off by an anesthesiologist.

itsnowornever, BSN, RN · Apr 6, 2013

I'm in PA. We prime the pump hook up to catheter, set up rates in pump, give bolus via pump, change rate if ordered, start and stop pump.[/quote']
CA here. Same as above
Posting from my phone, ease forgive my fat thumbs! :)

knitter523 · Apr 21, 2013

AWHONN clearly states that manipulating epidural pumps in any way is not the role of the OB RN. So, please just tell me briefly what state you work in and if nurses are permitted to adjust pumps, especially increasing the rate, where you are.
Thanks!!

AWHONN is only a professional organization. They are not a licensing body and therefore cannot dictate what is within the scope of practice.

Your state Nurse Practice Act can provide information regarding management of patients receiving epidural analgesia.

My state (WA) has an excellent document describing what the scope of practice is regarding epidural management.

http://www.doh.wa.gov/Portals/1/Documents/6000/Epidural.pdf