Nurses managing epidurals on L&D

[kathiecnm]

I know that this battle has been going on for years without a clear resolution. I am familiar with the AWHONN position statement on this topic that was last reviewed & reaffirmed in 2007. I believe that AWHONN made this statement because there is no literature that says it is SAFE for an RN to be managing an epidural in L&D. The physiology of the fetus in response to hypotension or a high block & anesthesiologists giving up part of their practice to the RN are two other topics of concern when discussing an optimal environment for mothers & babies. Also, how can we quote AWHONN as our professional organization & then only follow the guidelines we like or that fit into our current hospital culture? Finally, our BON says that "an RN MAY NOT ADMINISTER EPIDURAL ANESTHETICS". Our anesthesiologists are trying to get around this ruling by responding that they only given epidural ANALGESIA in L&D & the RNs can safely start the pump, adjust the medication rates (per verbal or S.O.) & remove the catheter, but the anesthesiologist is still doing all the "managment" of that patient. Our patients do get pain relief (analgesia), but they also have little or no feeling in their legs & can't get up & go anywhere while vaccums, forceps & episiotomies are done under that same "analgesia". I'd call that anesthesia! A:cry:ny comments, ideas or suggestions to help decide what is safest for our mothers, babies & nurses???

[ILuvNewBabies!]

Your clinical practice should reflect the nurse practice act in your state. In my state, nurses are not allowed to do anything other than spike a new bag or discontinue epidural infusions; not the catheters. In my state, the anesthesiologists must manage everything else. I hope this helps.

[CEG]

Our anesthesia essentially places the catheter and we do the rest- we program the pump, spike the bag, spike a new bag, d/c the epidural, d/c the catheter. The only thing we cannot do is restart an epidural that has been stopped. My main concern is that anesthesia does their test and loading dose and leaves. Most often when we have an adverse reaction they are long gone and I am trying to manage mom and baby which I am sure should be their job.

[nursejohio, ASN, RN]

Same here. We usually set up the pump while anesthesia is taping the catheter, I've got my bag spiked & primed before they ever hit my room. After the loading dose I have them check the settings with me, and they connect the catheter to the pump. We can change the bags, turn off the pump & pull the catheter after delivery too. When I was travelling in NYC, it was nice to have anesthesia manage setting up the pump and such, but it was *hideous* when my bag was empty, the pump was screaming and anesthesia was in a section. By the time they'd get out to come change the bag, mom was all over the bed with each ctx and the family was nuts from the alarms

[mommy2boysaz]

kathiecnm~ Our anesthesiologists tried the same "word-game" with us. It's not anesthesia, it's analgesia. Then why do we need to pay an "ANESTHESIologist" to come administer it?

It's ridiculous to say it's not anesthesia. We went round and round with our docs, too. It's no fun.

As it ended up, we spike the bag and prime the pump with a premixed bag from pharmacy. We do NOT connect the epidural to the bag or program or start the pump. Although we can replace the bag if it gets low. Kind of semantics, I guess. I still think we do more than we should and if the right lawyer ever got hold of it in case... ugh.

Good Luck with your issues!

[BirthCenterRN]

I work at two different birth centers. The first one the RN does everything except place the catheter. However, we have additional training on orientation on how to manage the epidural and the pump as well as mom and baby. The anesthesiologist stays in the room for the first 10-15 minutes and on the unit until the mom is completely satisfied with her pain relief and both mom and baby are stable. They then leave with the expectation that they will return for any complications and administer the appropriate meds ie ephedrine etc. We only do IV bolus and in rare circumstances ephedrine if it is an extreme case and they are tied up in trauma and the back up is in route. They don't get mad about you calling and one night I called 5+ times about a patient's BP and he returned each and every time to assess her and give meds.

The second place I have just started and haven't gotten all of the logistics but I did have epidural pump orientation today so I am assuming that prime/program is the RN job.

Both of these places require 2 RN's to be at the bedside during programming, connection, and initiation of the infusion. The med must then be signed in the EMAR by both RN's.

I am comfortable with this and couldn't imagine waiting on the anes. provider for everything and having patients in pain while waiting.

Our nurse practice act covers these actions because you have additional training in the programming and maintenance. Kind of along the lines of a nurse specially trained in iv sedation or other specialties.

my 2 cents

[babynurse357]

I agree with a previous poster. You need to check with your state BON and determine what is in your scope of practice. If you are practicing out of your scope and something bad happens, you will be held accountable not the anesthetist. At the first facility I worked at we didn't do anything but turn the pump off. No bag changes or d/c'ing catheters at all. Anesthesia did everything. I was suprised to learn that in my state RN's can change the bag and the rate with an order to do so.