Melissa Kukulski RN, BSN
Disconnection of Catheter From Filter
Disconnection of the filter from the catheter happens often. The connection can become loose from a restless patient or from normal friction in bed. It is important for the nurse to assess the epidural connection site at least every two hours as well as after repositioning, ambulation, and tubing changes. If the catheter does become disconnected, the on-call anesthesiologist must be notified immediately. If the nurse witnesses the disconnection, the anesthesiologist will come to the bedside and sterilely reattach the catheter to the filter. If the nurse does not witness the disconnection or is unsure of when the disconnection occurred, the catheter must be removed. Break in sterility can lead to infection and removal of the catheter can result in inadequate pain control.
If your patient reports increased pain or has physiological signs of pain including, hypertension, tachycardia, or tachypnea, check the filter to ensure the connection is adequately secured.
If your patient reports increased pain or has physiological signs of pain including, hypertension, tachycardia, or tachypnea, check the filter to ensure the connection is adequately secured.
http://www.ace-medical.com/2014/en/product/product/view.asp?po_no=25
Epidural Catheter Migration/Hematoma
Epidurals can migrate during movement of a patient or can cause damage to a vessel due to friction. Damaged vessels can bleed causing compression on the spinal cord. It is important that the epidural site and catheter markings are assessed at least every four hours.
Signs/symptoms of hematoma include, restlessness, severe back pain, decreased sensation in lower extremities, paraplegia, urinary incontinence, and swelling/bleeding at insertion site.
Discovery of epidural hematoma's are vital to a patients success. Prolonged treatment can ultimately lead to paralysis or death.
Signs/symptoms of hematoma include, restlessness, severe back pain, decreased sensation in lower extremities, paraplegia, urinary incontinence, and swelling/bleeding at insertion site.
Discovery of epidural hematoma's are vital to a patients success. Prolonged treatment can ultimately lead to paralysis or death.
http://www.vertechcorp.com/pages/portfolio_epidural.html
Anesthetic Toxicity
Anesthetic toxicity can occur from a large bolus of medication with a rapid onset or intravenous absorption. The patient can experience central nervous system or cardiac complications. It is best to keep the anesthetic continuous dose at a low therapeutic level.
Early signs/symptoms: Tinnitus, blurred vision, circumoral numbness, metallic taste, and dizziness.
Late signs/symptoms: Slurred speech, seizures, loss of consciousness, hypotension, bradycardia, dysrhythmias, and cardiac arrest.
Early signs/symptoms: Tinnitus, blurred vision, circumoral numbness, metallic taste, and dizziness.
Late signs/symptoms: Slurred speech, seizures, loss of consciousness, hypotension, bradycardia, dysrhythmias, and cardiac arrest.
http://www.theholisticingredient.com/blogs/wholesome-living/10217821-the-great-toxicity-overhaul-one-room-at-a-time
References
Bang, J., Kim, J. U., Lee, Y. M., Joh, J., An, E.H., Lee…In,C. (2011). Spinal epidural hematoma related to an epidural catheter in a cardiac surgery patient – A case report. Korean Journal of Anesthesiology, 61(6), 524-527. Doi:10/4097.kjae.2011.61.6.524
Dewaele, S. & Santos, A. (2013). Toxicity of local anesthetics. Retrieved from http://www.nysora.com/mobile/regional-anesthesia/foundations-of-ra/3075-toxicity-of-local-anesthetics.html
Schreiber, M. (2015). Nursing care considerations: The epidural catheter. MedSurg Nursing 24(4), 273-276. Retrieved from http://www.medsurgnursing.net/cgi-bin/WebObjects/MSNJournal.woa