Wide range of epidural rates for use with PCEA

[RNLaborNurse4U]

I've noticed that depending on the anesthesiologist, our patients will have this wide range of different epidural rates for use with a PCEA.

For instance, the continuous hourly rate I have seen anywhere from 8-15 cc/hr.

Bolus rates of 4-10cc, with lockout ranges from 10-60 minutes.

Usually though, the total hourly lockout will be no more than 25-26cc/hr.

It was my understanding, when we started with PCEA epidurals, that the basal rate would be low - in the 6-8cc/hr range, and the bolus would be small but frequent (2-4cc every 10-15 minutes).

Just the other day, I had a PCEA with the following dosages: 15cc basal, 5cc bolus Q 30 minutes, total hourly maximum was 25 cc/hr. Me thinks the doc didn't want called back for redoses for breakthrough pain! That was by far the highest basal rate I had ever seen.

Thoughts?

[RNLaborNurse4U]

I forgot to mention, our epidural bags are all a mixture of 2 mcg fentanyl per cc in 0.125% bupivicaine. Total bag volume is 100 cc.

[eden]

That doesn't seem too outrageous. Our basal rates are 10-15cc with a 5cc blous dose and a 20 minute lockout for a total of up to 30cc hourly. If that still does not keep them comfortable they are allowed to get top ups.

[nurseynightnight]

We use 14-16 ml/hr as a basal rate. Our PCEA doses are 4-5 ml boluses every 20-30 minutes depending on the doc.

So 8 ml/hr seems pretty low to me!!! How do the patients do with that???

I have never had to call a doc back with the dosages we use.