3.3 Practice

3.3.1 On placement of the epidural cannula, the anaesthetist is responsible for the first injection through the catheter and should remain in the vicinity until the block is complete and the patient's condition is stable

3.3.2 All patients with an epidural cannula in-situ, who are to be left in the care of the nursing staff, should have an intravenous infusion in place.

3.3.3 The first dose must be recorded and its effect documented, preferably by reference to degree of analgesia obtained.

3.3.4 The subsequent dose must be prescribed in writing giving :-

(a) The drug (The policy of the unit is Marcain (bupivacaine), with or without pre-mixed fentanyl, is to be used if non-anaesthetic staff perform the top-up)

(b) Concentration (The policy of the unit is that nursing staff may only use bupivacaine 0.125% with pre-mixed fentanyl 5 mcg/ml, for top-ups. 0.25% bupivacaine may also be used if it has been prescribed by the anaesthetist.

(c) The volume (This should never be greater than the initial volume injected by the anaesthetist).

3.3.5 In these orders, the posture of the patient should be stated :-

(a) During the injection

(b) Subsequently (refer to standing orders)

3.3.6 Standing Orders in the Nursing Manual set out :-

(a) The frequency and the nature of observations to be made following the administration of top-up dose.

(b) The procedure to be adopted in the event of these observations departing from what is normally anticipated.

(c) Emergency procedure to be followed in the event of collapse or serious complications pending the arrival of the anaesthetist.

(d) Procedure to be adopted for the removal of cannula.