Epidurals are increasingly popular and have become more versatile, with applications in adult surgery, trauma, obstetrics and paediatric practice. This book of best practice guidelines aims to help develop and improve patient care, stimulate learning and highlight ideas for nursing research. It can be used as a quick reference guide for clinical practice or as a framework for developing individual local epidural services and practice guidelines. It: outlines the specific responsibilities of the multidisciplinary healthcare team in relation to epidural practice; reviews the issues of risk benefit analysis and informed consent; provides an overview of the physiology of acute pain, epidural catheter insertion procedure and the pharmacodynamics and pharmacokinetics of the commonest classes of drugs; and, describes the equipment required to ensure safe and effective delivery of epidural solution to patients. It is an overview of the nature and frequency of the observations required for close monitoring of patients and a practical guide to the removal of the catheter are also provided.
Clinical governance and competency based training are also addressed, and a framework provided to fit the training into the Agenda for Change Knowledge and Skills framework.
Carolyn Middleton, Clinical Nurse Specialist, Nevill Hall Hospital, UK.
List of Figures. List of Tables. Contributors. Foreword. Preface. Acknowledgements. 1 Responsibilities of the Multidisciplinary Acute Pain Team (Carolyn Middleton). 2 Patient Selection (Lynda Jenkins). 3 Insertion and Epidural Catheter Management (Carolyn Middleton). 4 Physiology of Pain, Pharmacodynamics and Pharmacokinetics of Local Anaesthetic and Opioid Drugs (Carolyn Middleton). 5 Epidural Delivery Systems (Carolyn Middleton and Lynda Jenkins). 6 Epidurals in Obstetrics (Carolyn Middleton). 7 Epidurals in Paediatric Practice (Carolyn Middleton). 8 Patient Observations (Carolyn Middleton). 9 Discontinuation and Removal of the Epidural Catheter (Carolyn Middleton). 10 Troubleshooting (Dee Comerford). 11 Education and Training (Carolyn Middleton). 12 Clinical Governance and Clinical Audit (Rachel Swinglehurst). Glossary. Index.