PATIENT CARE,EPIDURAL ANALGESIA

200th INTERNATIONAL NURSES DAY

CARING FOR A PATIENT RECEVING EPIDURAL ANALGESIA

Epidural analgesia is being used more commonly to provide pain relief during the immediate postoperative phase (particularly after thoracic, abdomi-

nal, orthopedic, and vascular surgery), procedural pain, trauma pain, and 

for chronic pain situations. 

Epidural pain management is also being used with infants and children.

The anesthesiologist or radiologist usually inserts the catheter in the mid-lumbar 

region into the epidural space that exists between the walls of the vertebral 

canal and the dura mater or outermost connective tissue membrane surrounding the spinal cord.

For temporary therapy, the catheter exits directly over the spine, and the tubing is positioned over the patient’s shoulder with the end of the catheter taped to the chest. For long-term therapy, the catheter is usually tunneled subcutaneously and exits on the side of the body or on the abdomen.

The epidural analgesia can be administered as a bolus dose (either one 

time or intermittently), via a continuous infusion pump, or by a patient-

controlled epidural analgesia (PCEA) pump.

Epidural catheters used for the management of acute pain are typically 

removed 36 to 72 hours after surgery, when oral medication can be substituted for pain relief.

EQUIPMENT

• Volume infusion device

• Epidural infusion tubing

• Prescribed epidural analgesic solutions

• Computerized medication 

administration record (CMAR) 

or medication administration record (MAR)

• Pain assessment tool and measurement scale

• Transparent dressing or gauze pads

• Labels for epidural infusion line

• Tape

• Emergency drugs and equipment, such as naloxone, oxygen, endotracheal intubation set, handheld resuscitation bag

• Gloves

NURSING DIAGNOSIS

• Acute Pain

• Chronic Pain

• Risk for Infection

• Deficient Knowledge

PLANNING

• Patient reports increased comfort and decreased pain, without adverse effects, oversedation, and respiratory depression.

• Patient displays decreased anxiety.

• Patient displays improved coping skills.

• Patient remains free from infection.

• Patient verbalizes an understanding of the therapy and the reason for 

its use.

IMPLEMENTATION

1. Gather equipment. Check the medication order against the original order in the medical record, according 

to facility policy. Clarify any inconsistencies. Check the patient’s medical record for allergies.

2. Know the actions, special nursing considerations, safe dose ranges, purpose 

of administration, and adverse effects of the medications to be administered. 

Consider the appropriateness of the medication for this patient

3. Prepare the medication syringe or other container for administration

4. Perform hand hygiene.

5. Identify the patient.

6. Provide Privacy to the patient.

7. Complete necessary assessments before administering the medication. Check 

allergy or ask the patient about allergies. Assess the patient’s pain, using an appropriate assessment tool and measurement scale.

8. Have an ampule of 0.4 mg naloxone and a syringe at the bedside.

9. After the catheter has been inserted and the infusion initiated by the anesthesiologist or radiologist.

10. check the label on the medication 

container and rate of infusion with the medication record and patient identification.

11. Tape all connection sites. Label the bag, tubing, and pump apparatus “For Epidural Infusion Only.”

12. Do not administer any other narcotics or adjuvant drugs without the approval of the clinician responsible for the epidural injection.

13. Assess the catheter exit site and apply a transparent dressing over the catheter insertion site.

 

14. Remove gloves and Perform hand hygiene.

15. Monitor the infusion rate according to Hospital policy. 

Assess and record sedation level and respiratory status, including the patient’s oxygen saturation, continuously for the first 20 minutes after initiation, then at least every hour for the first 12 hours, 

every 2 hours up to 24 hours, then at 4-hour intervals.

16. Notify physician if the sedation rating is 3 or 4, the respiratory depth decreases, or the respiratory rate falls below 10 breaths per minute. Also monitor end-tidal carbon dioxide level (capnography) 

for patients at high risk of respiratory depression.

17. Keep the head of bed elevated 30 degrees unless contraindicated.

18. Assess the patient’s level of pain and the effectiveness of pain relief.

19. Monitor the patient’s blood pressure and pulse.

↓

 Hypotension can result from the use of epidural analgesia.

                               

20. Monitor for adverse effects (pruritus, nausea, and vomiting).

↓

Opioids may spread into the trigeminal nerve, causing itching, or resulting in nausea and vomiting owing to slowed gastrointestinal function or stimulation of a chemoreceptor trigger zone in the brain. Medications are available to treat these adverse effects.

20. Monitor urinary output and assess for bladder distention.

21. Assess for signs of infection at the insertion site.

22. Change the infusion tubing every 48 hours.

EVALUATION

• Patient verbalizes pain relief.

• Patient exhibits a dry, intact dressing, and the catheter exit site is free of signs and symptoms of complications, injury, or infection.

• Patient reports a decrease in anxiety and increased ability to cope with pain.

• Patient verbalizes information related to the functioning of the epidural catheter and the reasons for its use.

DOCUMENTATION

• Document catheter patency; the condition of the insertion site and 

dressing; sedation score, oxygen saturation, vital signs, and assess-

ment information; any change in infusion rate, solution, or tubing; analgesics administered; and the patient’s response.