spinal anesthesia discharge criteria

[spazrn]

I am looking for input as to your discharge criteria from phase 1 with regards to spinal anesthesia. Does your center require regression below T10 only or do they require movement as well....and if so, to what degree. I am looking mostly at total joints and inpatients.

[HeySis, BSN, RN]

We do not have criteria for spinals that id different from normal discharge criteria. We will check the dermatome level of the spinal for a base line, but they do not have to be at a specific level.

On our aldrete's the patient must be at least a 9 out of 12 and no one category can be a 0. Quite a few of our total knees cannot move anything from the waist down when they leave PACU. But in order to score a 1 instead of a 0 on movement they'd have to be able to move both arms, be able to have the reflexes to maintain the airway.... but since that's the same criteria for all patients, we don't differentiate.

Any patient that has a spinal with duramorph gets transferred to step down, instead of the surgical floor, so they can be more closely monitored for the first 20 hours.

[gizmopacurn]

Our PT's have be at T-10 or below to transfer out of PACU, if they come into PACU at T-10 level then we have to show that the spinal is moving down so have to wait to discharge until it goes to T-9. Movement is not a requirement.

We have gone to no foley's for all total joints in our hospital and spinals no longer contain Fentanyl and they are given less Bupivicaine so the spinals are not lasting as long any more. Almost all our patients are coming out at L-1 or lower and moving legs and feet, so waiting for the spinal to be at T-10 is a mute point anymore.

[Mavrick, BSN, RN]

Wish I had found this thread sooner because we are reevaluating our D/C criteria.

Currently we use ice to test for dermatome. I would rather use return of movement because that's what really matters not whether they can feel ice or not.