Epidural Analgesia Policy

Introduction

Epidural analgesia is the administration of medication via a catheter inserted into the epidural space at thoracic or lumbar level (Macintyre and Schug 2015) used within the Trust for post-operative pain management and used within specific parameters such as fractured ribs and pancreatitis. Epidurals are administered by a continuous infusion with a Patient controlled epidural analgesia (PCEA) Bolus Function, PCEA can provide greater analgesia efficacy in combination with low-dose background infusion (Jules-Elysee et al, 2015). In some instances where Levobupivicane is used without the addition of Fentanyl and Adrenaline the PCEA Bolus function is not permitted. The PCEA bolus function is set within predefined safety parameters. Patients receiving epidural analgesia are to be solely nursed on the St Peter’s Hospital site within the following areas: - Recovery, Intensive Care Unit (ICU), and the Surgical Wards (Falcon and Kingfisher) - list of designated areas is also available on the trust intranet. It is compulsory that the Nursing staff working in these areas receive training, are competent to care for patients with epidurals and have completed the Trust competency framework

An epidural service is provided within the Maternity unit. Maternity use the same designated CADD-Solis® ambulatory infusion pumps as those used by the Inpatient pain service for the treatment and management of acute pain. However, the protocols on the pumps in Maternity are significantly different from those used for acute pain management and are therefore not interchangeable between these two areas. Please refer to the Maternity Epidural policy for their designated protocols.

Epidurals are not permitted for use on the Ashford site,as there is no resident 24 hour anaesthetic cover (as per Royal colleague of anaesthetic guidelines).

Epidural analgesia is only to be administered using a yellow Smiths Medical CADD-Solis pump and a dedicated CADD-SOLIS ® Yellow Striped High Volume Administration Set. This equipment is for sole use for epidurals and is not permitted for any other infusions.

Purpose

The purpose of this policy is to set out the standard and the recommendations for practice at Ashford and St Peters NHS Foundation Trust which aims to ensure that health professionals are able to comply with local and national guidance of the care of the patients receiving epidural analgesia.

Policy Details

See also:

• Administration of Injectable Medicines via Intravenous Route Policy and Procedures
• Trust Medicine Management Policy
• Epidural Competency
• Trust Epidural Analgesia Observation Chart
• Patient Information Leaflet: Epidural Haematoma Letter
• Trust Oxygen Policy