Potential Problem [PDF]

if numbness not resolving. DO NOT ambulate patient if Bromage Scale ≥ 2. Pain. Dosage (rate or concentration) too low.

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Idea Transcript


EPIDURAL ANALGESIA Troubleshooting Potential Problems Potential Problem Modified Ramsey Sedation Scale “Sedation 4-5” and/or RR10.**Page APS STAT

Numbness

Dosage (rate or concentration) too higher than necessary for analgesia. Catheter displacement. Hematoma

Notify APS. ↓ in rate will usually resolve numbness in ≈ 2 – 3 hours. Call APS if numbness not resolving. DO NOT ambulate patient if Bromage Scale ≥ 2.

Pain

Dosage (rate or concentration) too low. Catheter Displacement. Pump malfunction. Tubing occlusion Hematoma. Catheter displaced. Opioid side effect. Cutaneous reaction.

↑ rate and/or medicate for breakthrough pain as ordered. Check pump and tubing. Teach and encourage use of PCEA dose, if ordered. * Notify APS is unresolved and patient at maximum ordered dose.

↓ rate if pain controlled, as ordered. Give Droperidol (Inapsine) 0.625 – 1.25mg IVP q 4-6 hr PRN. Elevate HOB to prevent aspiration.

Anaphylaxis

Opioid side effect. Suppression of vomiting center inhibitory fibers. Opioid and/or local anesthetic effect on spinal nerves Dural puncture R/T catheter insertion or migration. Opioid side effect. Disorientation R/T dose, hypoxia, hypercapnia Intravascular migration of catheter Catheter to neural tissue contact. Spinal cord compression Medication related

Infection

Contaminated line

Disconnected Catheter

Inadequately tightened adapter. Not securely taped @ connection port. Catheter displacement (too shallow) Rate to high

Severe Back Pain Pruritis

Nausea/Vomiting Urinary Retention Headache Confusion Sudden onset N/V; ↓ SBP < 90 mm/hg Parasthesia (abnormal sensation), Paralysis

Leaking Catheter

Give 0.9% NS 500 ml IV over 30 minutes. Give Ephedrine 5-10mg IVP; repeat x 3 q 2 minutes PRN. (Dilute 50mg in 9ml of NS and give ½ to 1 ml) Avoid Trendelenburg position. * Notify APS

STOP infusion. * Notify APS immediately. ↓ rate if pain controlled, as ordered. Give Benadryl 10-25 mg IVP q 4-6hr PRN. If itching persists, Narcan 0.05 -0.1mg IVP q 6hr PRN(dilute 0.4mg in 9ml NS)

Assess for distention. Straight cath q 6-8hr. PRN. Notify APS if straight cath done x 2. Give Narcan 0.05 -1 mg IVP q 6h PRN (dilute0.4mg in 9 ml NS). Bed rest with HOB ↓ if not contraindicated. * Notify APS √ Baseline; was pt confused prior to epidural infusion? If not, STOP infusion. * Notify APS STOP infusion, initiate rapid response measures PRN. Bedrest. * Notify APS STOP infusion. * Notify APS STAT STOP infusion. Initiate emergency procedure. * Notify APS Assess insertion site per protocol (q 8hr) for redness, swelling and drainage. * Notify APS. Cover with a sterile 4 x 4. * Notify APS If the patient is comfortable reinforce the dressing and monitor the amount of leakage. High pressure alarm may occur. If the patient is in pain, Notify APS.

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