Anesthesiologists order epidural infusions which are prepared by pharmacy and administered by nurses trained in epidural infusion pumps. Nurses maintain and modify infusion rates as ordered, can administer bolus doses up to 10ml, and must change tubing every 72 hours and solutions every 24 hours. Blood thinners are not used or given when a patient has an epidural in place due to risk of bleeding. Nurses should address any side effects by following protocols before contacting anesthesia.

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