Pulling epidurals

Nope, that never happened to me! *also knocking on wood* Only thing that ever happened to me was I actually got fluid when I aspirated before bolusing astromorph. I called anasthesia and he had me do it again, first with a 3 mL syringe to see if I could fill it, then had me do it with a 10 mL syringe to see if I could fill that. I did, so he just had me d/c the line. lol Simple enough. lol Good question though, I'm curious if that's ever happened, and how the patient made out?

While it has never happened to me (if I meet any significant resistance I call anesthesia who is in house. That's why they get paid the big bucks) it happened to a patient of mine when the MD pulled it. They did an X-ray and then an MRI to see if it needed to be surgically removed. It didn't and she has to have follow ups yearly.

it has happened at my hospital. they had just switched to a new k ind of cath and they are really stretchy, so when the nurse pulled it (not me) it broke off then since it had stretched out the part in the pt. slipped back inside. the decision was made to leave it in the pt. i guess that gives new importance to sterile field during epidural placement!

MD's pull the epidural caths (all intact so far TG).

Nope, that never happened to me! *also knocking on wood* Only thing that ever happened to me was I actually got fluid when I aspirated before bolusing astromorph. I called anasthesia and he had me do it again, first with a 3 mL syringe to see if I could fill it, then had me do it with a 10 mL syringe to see if I could fill that. I did, so he just had me d/c the line. lol Simple enough. lol Good question though, I'm curious if that's ever happened, and how the patient made out?

You bolus the epidurals??? NY will not even allow us to adjust the pump rate on a continuous! So we program the pumps etc with the MD looking over our shoulder cuz they can't do it themselves!!!

At my main hospital we don't pull them but they do sometimes "fall out" and anesthesia will say "I bet that one falls out when your done" some nurses they never fall out on though at the other where I was perdiem the nurse or tech in the delivery pulled it. As the CRNA I work with say if you meet resistance stop pulling or have them lean forward and try just a little to pull again one said he'd seen one wrapped around a nerve fiber once and that got pulled on.

We pull them. I have always had them intact but if I get one that is difficult to pull I will have someone else come in rather then risk it breaking off. Usually a change in position/nurse is all that is needed to come out.

FYI: AWHONN's Position Statement is that no one other than a licensed anesthesia provider should be bolusing epidurals or adjusting infusion rates.

You bolus the epidurals??? NY will not even allow us to adjust the pump rate on a continuous! So we program the pumps etc with the MD looking over our shoulder cuz they can't do it themselves!!!

Sorry I didn't answer sooner, I just got this. Yes, we can bolus astromorph in the state of NH. It was actually just reviewed by the BON because some nurses were doing it at certain hospitals while others weren't. Came down the pike that we weren't supposed to and were to stop immediately until everything was reviewed. It was eventually decided that it was within our scope if proper education was provided. We do have a policy and a competency. You can't even change the rate?? We get a range that we can use in the initial orders, and we have a policy involving neuros and respiratory status EVERY time we adjust the rate upwards. It's more of a pain. I'd LOVE it if the anasthesia docs had to do all that! It'd be a lot off my plate!

:)

Not great for the patient because anesthesia is not in house 24/7. Many times they must wait an hour to get a bolus. The new thing for us will soon be PCEA we can't give a dose but the patient can give it to herself. Hmmmm give her a button with instructions to call us before pushing it. Like that will work 100%.

We have one doc who loves to do spinal epidurals. Great for the slow moving primip with no tolerance but multips at 5 or more. Now we have a mom with no use of legs at all... guess who gets to hold them up to push? Yep that would be us.

Ok I've whined enough for one post!!! Merry Christmas all:Santa1: