Pulling epidurals

allele, LPN · Sep 7, 2007

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?

PegRNBSN · Sep 7, 2007

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.

lmc512 · Sep 8, 2007

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!

vandermom · Sep 10, 2007

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

vandermom · Sep 10, 2007

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!!!

Elvish, BSN, DNP, RN, NP · Sep 11, 2007

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

Wow. In NC the BON says it's a category II thing, and we can do it after it's documented that we've received training.

cassioo, RN · Sep 16, 2007

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.

allnurses Guide · Sep 16, 2007

We pull them.

steph

eden · Sep 16, 2007

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.

RAIZIE · Dec 11, 2007

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

allele, LPN · Dec 12, 2007

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!

:)