This document discusses epidural and intrathecal administration of medications. It defines epidural administration as injecting medication into the epidural space just outside the subarachnoid space, allowing diffusion into the cerebrospinal fluid. Intrathecal administration injects directly into the subarachnoid space. The document then outlines the proper procedures, equipment, monitoring, and potential complications for epidural administration.

1. Ms. ULFAT AMIN
P.G PEDIATRIC NURSING
DIPLOMA IN NURSING
ADMINISTRATION

2. Epidural: Administering
medication, into the
epidural space, which lies
just outside the
subarachnoid space
where cerebrospinal fluid
(CSF) flows. The drug
diffuses slowly into the
subarachnoid space of
the spinal canal and then
into the CSF.

3. • Intrathecal:
Injection of medication into
the subarachnoid space of the
spinal canal. Certain drugs,
such as antiinfectives or
antineoplastics used to treat
meningeal leukemia, are
administered by this route
because they can’t readily
penetrate the blood-brain
barrier through the
bloodstream.

4. • Analgesia is usually given via this route.
• Epidural analgesia helps manage acute or
chronic pain, including moderate to severe
postoperative pain.
• It’s especially useful in patients with cancer or
degenerative joint disease.
• This procedure works well because opioid
receptors are located along the entire spinal

5. • Cesarean section
• Genitourinary procedures
• Lower extremity procedures
• Procedures of uterus or perineum
• Best choice for those who dint tolerate general
anesthesia

6. • Gloves
• Infusion pump and compatible tubing
• 20-gauge needleless adapter
• Filter needle (per agency policy)
• Syringe
• Antiseptic swab
• Sterile gauze pad
• Tape
• Label (for injection port)
• Equipment for vital signs and pulse oximetry

7. • Verify the doctor’s order.
• Perform hand hygiene.
• Confirm the patient’s identity.
• Perform a comprehensive pain assessment using
techniques that are appropriate for the patient’s
age, condition, and ability to understand.
• Explain the procedure and its possible
complications to the patient.
• Take written consent.

8. • Put on gloves
• Position the patient in the knee-chest position,
or have him sit on the edge of the bed and lean
over a bedside table while the catheter is being
inserted.
• After the anesthesiologist aspirates the device to
make sure cerebrospinal fluid or blood isn’t
present, help him connect the infusion tubing to
the epidural catheter.

9. • Bridge-tape all connection sites, and apply
an EPIDURAL INFUSION label to the
catheter, infusion tubing and infusion pump
and start the infusion.
• Remove and discard your gloves, perform
hand hygiene.
• Measure the external catheter length with
a tape measure to serve as a baseline for
comparison to assess for catheter
migration.

10. • Clean the insertion site with povidone-iodine
solution, and then allow it to dry completely.
• Place a chlorhexidine-impregnated sponge
dressing around the insertion site to reduce the
risk for central nervous system infection.
• Secure the catheter to the skin with sterile tape,
as needed.
• Place a transparent semipermeable dressing over
the chlorhexidine- impregnated sponge dressing.

11. • Label the dressing with the date, the time,
and your initials.
• Discard all used supplies in the appropriate
receptacle.
• Tell the patient to report any pain
immediately.

12. • If ordered, place the patient on a pulse
oximeter or cardiac monitor for the first 24
hours after beginning the infusion.
• Perform hand hygiene.
• Document the procedure.

13. • Assess the patient’s vital signs, oxygen
saturation level, sedation level (if an opioid is
being administered), and pain status hourly for
the first 24 hours, and then every 4 hours
thereafter.
• Monitor the patient closely for signs of infection,
such as back pain, tenderness, erythema,
swelling, drainage, fever, malaise, neck stiffness,
progressive numbness, or motor block

14. • Routinely assess for catheter migration by measuring
external
catheter length; catheter migration may cause inadequate
pain control or an increase in adverse effects.
• Routine dressing changes on short-term catheters aren’t
recommended because of the risk of dislodgement and
infection.
• Semipermeable transparent dressings are commonly
used for epidural catheters and should be changed every
7 days.

15. • Change administration tubing every 48 hours and the
epidural solution every 24 hours.
• Keep in mind that drugs given epidurally diffuse slowly
and may cause adverse effects, including excessive
sedation, up to 12 hours after epidural infusion has been
discontinued.
• The patient should always have a peripheral IV catheter
(either continuous infusion or saline lock) open to allow
immediate administration of emergency drugs

16. • Infection
• Epidural hematoma, and
• Catheter migration.
• Infection is treated with antibiotics.
• Insertion site hematomas should be observed and any
increase in size reported to the doctor.
• Catheter migration occurs when the epidural catheter
migrates out of the epidural space toward the skin.

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