Opinions re: epidural vital signs

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Specializes in PERI OPERATIVE.

Ok, I know there are lots of threads out there about vitals signs and epidurals. I'm asking what you guys think about this:

Our head anesthesiologist is writing up 'new' epidural orders. He is known for being VERY picky (and also a bit of an arrogant you-know-what).

He is asking for the following vital signs (which I think is overkill and just makes busy work for the OB nurses, and sometimes not possible due to the labor situation):

Once the epidural has been placed, vitals signs (including HR, BP, 02 Sat, LOC, pain level, sensory level, and motor block q 5mins for 90 mins. Then all of that q 15 mins until one hour after delivery.

So we're supposed to be doing this every 5 mins for an hour an a half?!? Of course I continuously monitor my patient. I know if their LOC is going down, or if their sensory level is changing. So now I have to chart this every 5 mins? Crazy. And not to mention me asking the patient every 5 mins what sensory level and pain level is.

Please let me know what you all think!!

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Specializes in Trauma ICU,ER,ACLS/BLS instructor.

I am not an OB nurse,but we get rpidurals in the units. I would find out what the standard of care is per the AMA and present that to him.

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Specializes in ICU, currently in Anesthesia School.

If he is using bupivacaine, he may want continuous VS for the period that is most problematic during the usual duration of action. Check A$A guidelines for epidural monitoring, and the AWOHNN standards for epidurals and then take these to him. You may find that he is trying to not have to do the monitoring himself but ensuring it is done, a requirement for billing purposes. (Not saying that is the case, but a definite possibility.)

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Specializes in labor & delivery.

Sounds like overkill to me.... we chart q 5 min x 20 min after our epidurals... q 5 min x 90 min seems like way too much to me

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It seems to be overkill. We use bupivicaine and we do vitals q 2 min for 15 min then q 15 min for another hour.

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Specializes in L&D, Antepartum.

I agree that it sounds like overkill. We do q2m x4, then q5m x4, then q30m til delivery. We also use bupivicaine.

I agree with the poster that said to look up the guidelines, especially AWHONNs.

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