1. Epidural
 Epidural infusions are ordered by the anesthesiologist
 Epidural solutions are mixed by pharmacy/anesthesia
 RN’s who have demonstrated competency with epidural
analgesia therapy infusion pumps, initiate ordered infusion and
verify with another licensed associate that the program is
correct
 RN’s maintain and/or modify infusion rates as ordered by
anesthesiology
 RN’s administer a bolus up to 10ml per anesthesia

2. Epidural (continued)
 Bolus doses are to be given at a maximum of 3 ml every 15
minutes
 Epidural tubing is changed every 72 hours
 Epidural solutions are changed every 24 hours and
monitored to ensure medication is infusing
 Neurolytics such as alcohol or betadine are not used
around any part of the epidural
 Any time Heparin, Coumadin, or Lovenox is ordered on a
patient with an epidural, anesthesia on call is to be notified
immediately (blood thinner is not given)
 A patient cannot be on a blood thinner and have an
epidural

3. Epidural (continued)
Before calling anesthesia with any side effects from epidurals
(itching, breakthrough pain, nausea, etc) please be sure to do the
following:
 Give ordered medications for side effects
 If pain is the problem - open the epidural box and make sure
that the bag is emptying
 Have this information for MD
• Current vital signs
• Current pulse ox
• Current settings of epidural, medication
• What medications have been given, times, effects
• Any other side effects/symptoms