Anaesthetists Handbook - MEDICAL EDUCATION at University ...
Anaesthetists Handbook - MEDICAL EDUCATION at University ...
Anaesthetists Handbook - MEDICAL EDUCATION at University ...
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Epidural anaesthesia and analgesiaPrinciples of good practiceFive professional organis<strong>at</strong>ions led by the Royal College of<strong>Anaesthetists</strong> published good practice guidelines in November 2004– Good practice in the management of continuous epidural analgesiain the hospital setting [http://www.rcoa.ac.uk/docs/Epid-Analg.pdf].While these are relevant to continuous epidural analgesia, theprinciples are sound and are endorsed by the trust. All localguidelines in clinical areas should be consistent with the principles inthis document.As a principle of good practice, clinicians who administer drugs by theepidural route should confirm the drug, the dose, and the correctidentific<strong>at</strong>ion of the epidural line connector with a second personbefore administering the dose. This includes bolus injections andcommencement or continu<strong>at</strong>ion of infusions. Particular care must betaken when using epidural administr<strong>at</strong>ion in a p<strong>at</strong>ient who has acentral venous c<strong>at</strong>heter as these lines may easily be confused.Epidural infusions may only be administered using an infusion pumpwhich is clearly identified as being used for the epidural route.Gemstar epidural pumps should be used on ward and critical careareas. Syringe infusion pumps may be used in labour ward andoper<strong>at</strong>ing the<strong>at</strong>res but must be identified by the fix<strong>at</strong>ion of anadhesive label identifying them as being for epidural use only. Thislabel must be applied to the infusion device directly in order to reducethe risk of inserting a syringe intended for epidural use into aninfusion device connected to a vein.Labels identifying machines, infusions and lines as being solely forepidural use are available from the Pharmacy department and mustbe used.It is possible th<strong>at</strong> n<strong>at</strong>ional developments in medical devices will leadto line connectors and other devices th<strong>at</strong> will only connect for epiduraladministr<strong>at</strong>ion. If and when available, these should be used forepidural administr<strong>at</strong>ions. This policy will be revised <strong>at</strong> th<strong>at</strong> time.<strong>Anaesthetists</strong> <strong>Handbook</strong> January 2010 123
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