Guidelines for management of epidurals and local anaesthetic infusions in ward
areas. Dr. R Walker/D. Jonas/A. Adams Sept 2008 (Review Sept 2009).
TITLE
DOCUMENT CONTROL PAGE Title: Guidelines for management of epidurals and local anaesthetic infusions in ward areas. Version: 2
REVIEW
CIRCULATION
APPLICATION
APROVAL
ORIGINATOR
SUPERSEDES
Reference Number: Supersedes: all previous additions Description of Amendment(s): Inclusion of local anaesthetic infusions
Originated By: Dr. R Walker, D. Jonas, A. Adams Designation: Lead clinician pain management, Lecturer/practitioner, Principal pharmacist
Approved by: Medicines Management Committee & Children’s Pain Team Sub Committee Approval Date: [if required]
All Patients
Adults Only
Children Only
All Staff
Staff Group (Nursing & Medical)
X Other (please insert)
Issue Date: September 2008 Circulated by: Children’s Pain Team Issued to: Circulation List
Review Date: September 2009 Responsibility of: Children’s Pain Team
Guidelines for management of epidurals and local anaesthetic infusions in ward areas. Dr. R Walker/D. Jonas/A. Adams Sept 2008 (Review Sept 2009) Page 1 of 3
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Guidelines for management of epidurals and local anaesthetic infusions in ward areas. Dr. R Walker/D. Jonas/A. Adams Sept 2008 (Review Sept 2009) Page 2 of 3
Childrens Division Guidelines for management of Epidural and Local Anaesthetic Infusions in ward areas. Children may be nursed with epidural/local anaesthetic infusion for management of pain following surgery in the following areas only. RMCH: Liebert Ward, Victoria Ward, Wrigley Ward, PICU, HDU BHCH: Ward 6, Ward 10, HDU. Prior to the insertion of the epidural/local anaesthetic catheter the anaesthetist must discuss his/her intentions with; 1. Child and parent to secure consent. 2. Child’s nurse and nurse in charge of the ward to check that appropriate staffing is available. Nurse in charge of ward should inform clinical co-ordinator. 3. Theatre recovery staff to ensure availability of epidural pump and correct dispensing of epidural/local anaesthetic fluid. 4. If patient requires HDU bed this must be arranged before insertion of epidural/local anaesthetic catheter. Infants under 1 month of age must be nursed in HDU/ICU area with an epidural/local anaesthetic infusion. Infants under 6 months of age must be nursed in HDU/ICU area if Fentanyl or Clonidine has been added to the epidural infusion. 5. The child’s temperature, pulse, respirations and blood pressure should be recorded before the child gores to theatre to provide a baseline by which to compare future observations. The child should be examined to check for any abnormal limb weakness or loss of sensation to prevent present problems from being associated with the use of the epidural. Recovery The recovery nurse/ODA must document a least one set of epidural/local anaesthetic observations before the child leaves theatre. The nurse/ODA must ensure that the child’s pain is controlled before they leave theatre. If further analgesia is required in the form of bolus dose of local anaesthetic or bolus dose of opiate then the child must remain in recovery for at least a further 20 minutes. The ultimate responsibility for the epidural/local anaesthetic infusion remains with the individual anaesthetist who inserts the epidural/local anaesthetic catheter. This anaesthetist must fully assess the child in recovery prior to discharge to the ward. Ward All nursing staff caring for a child having an epidural/local anaesthetic infusion must have attended a training session provided by the children’s pain team. Recovery staff, members of the pain team and anaesthetists are responsible for adding Clonidine to epidural infusion bags. This must not be undertaken by ward staff. Ward staff assessed as competent may change epidural/local anaesthetic infusion bags but may only change a rate on the epidural/local anaesthetic infusion if they have discussed the change first with a member of the pain team or the on-call anaesthetist. Any problems with the epidural/local anaesthetic infusion should be always directed to a member of the pain team, a consultant anaesthetist or the on-call anaesthetist. The child will be assessed daily by a member of the pain team or the on-call anaesthetist. References Middleton, C. (2006) Epidural Analgesia in Acute pain Management. Whurr Publishers Ltd, Chichester.
Royal College of Anaesthetists (2004) Guidance for the provision of paediatric anaesthetic services. Standard 1.5 Chapter 7. Royal College of Anaesthetists, London. Guidelines for management of epidurals and local anaesthetic infusions in ward areas. Dr. R Walker/D. Jonas/A. Adams Sept 2008 (Review Sept 2009) Page 3 of 3
