18.3 Continuous Epidural Anaesthesia Flashcards
a) What are the complications of continuous epidural analgesia (CEA) in the ward setting? (40%)
Opioid related:
» Pruritis.
> > Respiratory depression or arrest.
Local anaesthetic related:
» High block with cardiovascular collapse
or respiratory arrest.
> > Hypotension.
> > Urinary retention.
> > Motor block.
> > Pressure sores.
> > Local anaesthetic toxicity.
Catheter related:
» Unexpected development of high block
(e.g. catheter migration,
intrathecal injection).
> > Postdural puncture headache
and subdural haematoma.
> > Superficial infection around insertion site.
> > Epidural haematoma or abscess.
> > Meningitis.
> > Spinal cord ischaemia.
> > Permanent harm,
e.g. paraplegia, nerve injury.
Human factors and organisational issues:
» Drug administration errors (especially wrong route).
> > Inadequate analgesia.
b) How should patients be monitored throughout the period of CEA? (25%)
> > Trained nursing staff
(able to deal with complications),
acute pain team,
24-hour anaesthetic service,
handover of ongoing CEAs,
ongoing duty of care by the anaesthetist
who sited the epidural
(or the consultant under
whose supervision they were working).
> > Ward must be adequately staffed,
patient close to nurses’ station.
> > Protocols with action plan in
event of abnormal observations.
> > More frequent physiological
observations in first 12 hours and after
top-ups/changes in infusion rate/periods of cardiovascular or respiratory instability.
> > Heart rate.
> > Blood pressure.
> > Respiratory rate.
> > Sedation score.
> > Temperature.
> > Pain score.
> > Motor and sensory block.
> > Pressure areas.
> > Venous cannula patency.
> > Epidural site.
> > Pump: prescription and volume given.
c) Outline the safety features that relate to equipment used for CEA. (35%)
Pumps:
> > Configured for epidural analgesia only in millilitres.
Labelled as such.
> > Preset limits for maximum infusion rate and bolus size.
Lock-out time.
> > Alarms
(air, end of infusion, high pressure).
> > Locked box
(but able to see fluid without unlocking).
> > Lock/code required for
programming/bolus administration.
> > Documented maintenance programme.
Epidural infusion system:
» Closed, no injection ports.
> > Antibacterial filter.
> > Labelled as epidural with yellow label.
> > Yellow stripe to infusion system.
> > Anti-siphon valve
Epidural kit:
» Needle:
standardised, markings,
Huber tip with blunt leading edge,
stylet, wings.
> > Syringe: low resistance.
> > Connector: securely fastening to
minimise risk of breaches in circuit.
> > Catheter: blue tip, multiple fenestrations,
blunt tip, standardised markings.
