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31.02 Epidural

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Overview

An epidural is a nerve block to block pain signals

Nursing Points

General

  1. Uses
    1. Block 
      1. Labor
      2. Aggressive manipulation in physical therapy
      3. The patient controls analgesia similar to a PCA pump
    2. Injection
      1. Localized to the painful area
      2. contains local anesthetic and or steroids
      3. Pain relief 
        1. Chronic back pain
    3. Long term pain control
      1. Indwelling epidural catheter
      2. Cancer patients
      3. Chronic pain management
  2.  Administration
    1. Someone trained and with great knowledge of the spine
    2. Injected into the epidural space 
    3. Supplies
      1. Kit with the epidural catheter, long needle, syringes, sterile gloves, mask, and gown and a lot of tape!
      2. Lidocaine
      3. Analagesia
  3. Patient Positioning
    1. Most common
      1. Sit on edge of bed
      2. Dangle legs
      3. Chin to chest and curl to arch back
      4. Hold very still
    2. Prone positioning is used for catheter insertion for chronic pain nerve block
    3. Lateral decubitus position can also be used
  4.  Contraindications
    1. Hypovolemia
    2. Increased intracranial pressure
    3. Platelets <100,000
    4. Spinal deformities
    5. Sepsis
    6. Combative/uncooperative patient
  5. Removal
    1. Remove tape
    2. Pull–> if any resistance is felt STOP
    3. Inspect that the catheter tip is intact

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Video Transcript

Today we’re going to be talking about epidurals. 


In this lesson, we will talk about what they are used for, how they are placed, removed, and contraindications


Epidurals are used for blocks. This would be in labor, which is probably the first thought for most people. But they also have other uses. They can be used for aggressive manipulation in physical therapy too. They can also be used for injection purposes. This would be for localized pain relief to a painful area. These injections contain local anesthetic and or steroids. This helps with pain relief for things like chronic back pain. Long term pain control is done with an indwelling epidural catheter. This would help give pain relief to people with cancer and other chronic pain management

The administration will occur by someone speciality trained and with great knowledge of the spine. This will be an anesthesiologist or a trained physician. A nurse would only do this if they become a CNA. But you will help with positioning for administration. The epidural is Injected into the epidural space. Easy to remember, right? You can see in this image the epidural space, here. Supplies will include a kit with the epidural catheter, long needle, syringes, sterile gloves, mask, and gown and a lot of tape! Lidocaine is usually injected to help numb the space before they do the full procedure and then of course the analgesia that is used in the epidural so this is like Duramorf.


Ok guys you can see in this picture they have the catheter in place and all the iodine around it. Patient Positioning is so important. We have to make sure they are still and in a good position for insertion. The most common position is going to be having them sit on edge of bed and have them dangle legs. Have them put their chin to chest and curl to really arch the back. We say like an angry cat arching it’s back. This will allow for the spine to be pushed towards anesthesia and just in good positioning. They MUST hold very still. Positionng could also be in lateral so on their side or prone. Prone would be used more so for those that are getting a more permanent block. So those chronic back pain patients.


Contraindications will be hypovolemia, Increased intracranial pressure, low platelets <100,000, spinal deformities,  and combative/uncooperative patient. So low volume because the medicine injected can cause low bp so if our volume is already low that will be a problem. These patients are typically given a fluid bolus prophylactically before the epidural. If platelets are low this can cause bleeding into that space so we need over 100,000 platelets, now this is not a hard rule but anesthesia will want to know a current platelet level. Spinal deformities because well the spinal anatomy will be off and damage could occur. And an uncooperative patient just isn’t going to hold still and remember that’s important!

 

For removable you will remove tape. There is a lot of tape. Next, pull so if any resistance is felt STOP. Then you will inspect that the catheter tip is intact. This is important. You want to ensure the whole thing came out. You will document that it is removed and the catheter tip is intact. This is also helpful to show the patient.


So to summarize. Epidurals treat pain. The patient needs to arch their back and remember to have them hold still. Anesthesia or medically trained doctor will perform this sterile procedure. And ALWAYS make sure the cath tip is intact on removal. 


We love you guys! Go out and be your best self today! And as always, Happy Nursing!

 
Module 0 – Pharmacology Course Introduction
Module 3 – Disease Specific Medications

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