Care of the Patient with Peripheral Nerve Infusion
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Transcript of Care of the Patient with Peripheral Nerve Infusion
Care of the Patient with Peripheral Nerve Infusion
Policy PCS P-2.14
Nursing Responsibility
• to change the tubing,
• to change medication solution,
• to program the pump according to the prescription, and
• to deliver via the pump any intermittent bolus doses ordered by the Anesthesiologist
Types of Peripheral Nerve Catheters
• Femoral
• Sciatic
• Brachial Plexus
Femoral Catheter
• cover the femoral nerve, which runs along dermatome levels L2-L4.
• This will cover the front of the knee, but not the posterior or lateral aspect of leg.
• If a patient complains of pain outside of the Femoral Nerve Distribution (FND) additional pain medications will be required.
Femoral Nerve Distribution
Sciatic Nerve Catheters
Sciatic Catheters cover the sciatic nerve, which runs along dermatome levels of S1-S3.
These are often used in conjunction with Femoral Nerve Catheter to cover anterior and posterior knee for postoperative pain.
The sciatic catheter will cover the back of the knee, and medial/lateral aspect of leg.
If a patient complains of pain outside of the Sciatic Nerve Distribution (SND) additional pain medication may be required.
Sciatic Nerve Distribution
Brachial Plexus Catheter
Brachial Plexus Catheters cover the entire upper extremity in the C5-T1 distribution.
Peripheral blockade of the brachial plexus is used for analgesia of the entire extremity from shoulder down to fingers.
Brachial Plexus Distribution
Special Considerations
• When contacting “Anesthesia” you may contact the NPs Monday- Friday 8a-4p via beeper first. All other times, including Holidays contact the Anesthesiologist on call.
• Be sure that patient is aware of which “button” does what e.g. the PCA button versus the peripheral nerve infusion button, if these are not already marked- do so for the patient.
Peripheral Catheter Troubleshooting using Algorithm
Peripheral Nerve Catheter Troubleshooting Algorithm
Uncontrolled Pain Leakage Disconnection Knee Buckling
Bupivacaine
Toxicity
Review patient education &
understanding
Pain beyond Specific Peripheral Nerve
Distribution (SPND) give pain med
Check for connection
problems- tubing etc.
Check for pump problems intervene
prn or get new pump
ContactAnesthesia (NPs or
MDs)
Check connections
Cover with ABD dressing
Assess pain over Specific Nerve Distribution.
Cover with sterile dressing
Turn off pump
Give alternate pain medication prn
Contact Anesthesia(NPs or MDs)immediately
Instruct patient to stop bolus use
MonitorIf resolves ok to
resume
If unresolved Contact Anesthesia
for dose adjustment
Observe for signs: Metallic taste Perioral tingling Ringing in Ears Atypical Headache
Stop infusion & Contact Anesthesia
Immediately.
Poor pain control over SPND or ABD saturatedContact Anesthesia