Epidurals Lecture Notes Review

Epidurals and Midwifery Practice

• Student Involvement in Procedures

  • Midwives must recognize the limitations of student involvement in certain practices like epidurals.

  • Insertion of anything through the epidural catheter is strictly prohibited due to risks of complications.

• Training Requirements

  • Midwives need to complete additional training to be qualified to care for patients with epidurals.

  • It is acceptable for midwives to ask for support if they have not performed a procedure in some time or lack confidence.

• Clinical Knowledge

  • Understanding the pathophysiology of epidurals is crucial, as this may be a topic in national exams.

  • Students should familiarize themselves with the physiology surrounding epidurals to effectively respond to exam questions.

• Epidural Competency and Safety Protocols

  • Anesthesia should always be administered by a qualified anaesthetist; midwives play a supportive role.

  • It is essential to prepare all materials and maintain a sterile environment during the procedure.

  • Ensure that the patient's medical history, including previous surgeries and neurological conditions, is reviewed prior to administering an epidural.

• Monitoring During Epidural Administration

  • Blood pressure and pulse must be monitored every 5 minutes for 20 minutes once the epidural is administered.

  • If blood pressure drops by more than 20% from the baseline, intervention is necessary.

  • Keep track of block level to monitor the numbness and ensure it doesn’t affect breathing.

• Potential Complications

  • We should be aware that patients may experience 'breakthrough pain' despite being administered an epidural.

  • Respiratory distress can occur if the block level is too high.

  • If complications arise (e.g., significant hypotension or respiratory distress), the epidural infusion should be stopped, and medical personnel should be alerted.

• Post-Procedure Care

  • After epidural administration, continuous monitoring is essential until the patient regains sensation and can mobilize freely.

  • Administration of IV fluids is often necessary to counteract any hypotensive effects.

• Documentation

  • Accurate documentation of the procedure, patient responses, and any interventions is crucial for quality care and legal protection.

  • Record all timings relating to the administration of drugs, monitoring parameters, and patient assessments.

• Patient Education

  • Discuss the risks and benefits of epidural use with the patient before administration.

  • Address common misconceptions and ensure the patient's informed consent is secured.

• Understanding Clinical Guidelines

  • Be aware of the hospital protocol regarding removal of the epidural catheter, especially if there are concerns about clotting factors or need for surgery.

  • Ensuring that the patient is monitored closely while the catheter is in place is vital; this includes checking for any side effects like headaches or infections post-removal.

• Intraoperative and Post-operative Considerations

  • Patients may require additional support post-operatively, especially if they undergo complications from the epidural.

  • Assessing the patient's recovery, including the resolution of numbness and bladder function, is necessary before discharge.

Epidural Analgesia: Summary of Key Points and Midwifery

• Before We Start

  • Understanding epidural analgesia is crucial for midwives in providing effective pain management during labor.

• What is an Epidural and How Does It Work?

  • An epidural is a type of regional anesthesia that blocks pain from the lower body.

  • It involves the insertion of a catheter into the epidural space of the spinal cord, administering anesthetics that provide pain relief.

  • It works by interrupting pain signals transmitted to the brain.

• How Common is an Epidural in New Zealand?

  • Epidurals are one of the most popular forms of analgesia used during labor in New Zealand, with a high percentage of women opting for them to manage labor pain.

  • Awareness and educational initiatives have increased knowledge about options for pain relief.

• The Role of the Anaesthetist

  • The anaesthetist is responsible for the administration of the epidural and ensuring patient safety.

  • They may ask for laboratory tests such as blood counts and hydration status before placing a Luer catheter for fluids essential for epidural.

Overview: Epidural Insertion

• Epidural Insertion and Management: Te Whatu Ora C Manukau (CM)

  • Midwives must prepare by ensuring that all equipment is sterile and available.

  • Anaesthetic techniques should be followed precisely to minimize risks, including ensuring patient comfort during insertion.

• Ongoing Management: Te Whatu Ora CM Health Guidelines

  • Continuous monitoring of maternal and fetal vitals is essential following epidural placement to assess for hypotension and other complications.

  • Medical teams should be ready to respond to any potential drug reactions or complications.

• Management of Hypotension and CTG Abnormalities (CM guidelines)

  • If a patient experiences hypotension post-epidural, immediate intervention such as IV fluid administration is needed.

  • Close observation of cardiotocograph (CTG) patterns is vital to ensure fetal well-being.

• Management of High Block or Drug Toxicity (CMH Guidelines)

  • In cases of a high block (where numbing may affect breathing), emergency protocols must be in place.

  • Recognizing signs of drug toxicity early is crucial to take appropriate action.

Postnatal Care: Women with Epidural

• Continuous monitoring should remain in place until the patient has regained normal sensation and is able to mobilize safely.

• Education regarding the effects of epidurals and expected recovery will help manage patient expectations post-delivery.