Epidural bag change

[Greenbayslacker]

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Is a simple bag change outside of a labor floor nurse's scope of practice? I've been told that's just how the culture is at my hospital, but I'm not sure if there is any official regulation (New York State). This would keep us from being called in at 2 AM to change someone's epidural bag.

 

[OneTyme]

Same at my shop, in Cali.

 

[OneTyme]

Their own society says it’s ok though....

DEFINE_ME

 

[GassYous]

Nurses can change epidural bags in New York State. Even in the same hospital, l&d nurses will refuse to do it when every other unit will do it. Can you imagine them calling the surgeon to come in and change the bag for them? What a joke.

 

[sbmed100]

How about changing the rate with a physician's order? Anybody won that battle?

 

[sevoflurane]

OMG... can’t believe this is even a topic.

Change bag: YES
Change rate: YES

Never have I been woken up to change out an epidural infusion. This is 100% a nursing task.

 

[FiO2@21]

In L&D we have to change it, for thoracic epidurals the nurse can change it...

The only possible explanation I could come up with is that the bags are individually sent up for the thoracic epidurals while the L&D ones are all there in the Pyxis...

So the nurse would have access to all those bags vs just the one that’s sent up. Idk seems like a culture thing at this point.

 

[sevoflurane]

In L&D we have to change it, for thoracic epidurals the nurse can change it...

The only possible explanation I could come up with is that the bags are individually sent up for the thoracic epidurals while the L&D ones are all there in the Pyxis...

So the nurse would have access to all those bags vs just the one that’s sent up. Idk seems like a culture thing at this point.

Change the culture.
You are not a nurse.

 

[deleted697535]

lol

 

[DocVapor]

Are you serious? You get called just to change a bag?

A few years ago before I started at my shop the nurses would even set up the pumps and flush tubing at standard infusions, then the doc would double check and/or make adjustments after placing if desired, then would start the pump. It was a huge to-do when the nurse manager decided it was outside their scope of practice to program the pump.

I find it hard to reconcile nurses being "highly trained and intelligent individuals" with "we can't push these buttons to make these numbers match what you ordered, so you have to do it."

Anyway, the Anesthesiologist having to change a bag without any changes being made to the settings is outrageous.

 

[GassYous]

Lol they call for pump battery changes, kinked lines, pump malfunctions, etc. The worst is when they would call for an epidural but no pump in the room, no consent ready, moms not positioned, nurse is not in the room, no supplies, etc. Even a nurse that I knew in the icu that moved went from being a pretty ok nurse to total crap. They think their job is to just stand around and yell push! push! I don't know what they do but it doesn't seem like much.

Those idiots will also call for ivs on non npo patients with garden hoses running down their arms, to do consents at 3 in the morning because god forbid a patient and their doctor have a good nights sleep. It is ****in amateur hour up there and if patients weren't otherwise young and healthy they would probably be dropping like flies from the general uselessness of their nurses.

One time I was running around like a chicken with its head chopped off from all the floor work and pending sections and some nurse on the antepartum floor tried to give me the business because I refused to place an iv on a patient that we had nothing to do with. Not your iv service!

 

[nimbus]

Usually there is a story behind stuff like this. There must have been a precipitating event in 1986.

 

[Hork Bajir]

I could be mistaken, but I was always told that the reason we had to change bags on l&d as a resident was something to do with billing. Apparently for Medicare you are required to go into the room and physically assess the patient every so many hours, and by ensuring that the resident went into the room to change the bags, that requirement was conveniently always met (at least this is what I was told).

I never actually did it, but we were supposed to click the “patient assessed” button in Epic every time we went into a room to change a bag. I suppose the floor patients with thoracic epidural‘s were being rounded on by the pain team, which would have taken care of that requirement. I always assumed that there was no motivation for this set up to change because residents are cheap/free labor

 

[deleted162650]

Apparently for Medicare you are required to go into the room and physically assess the patient every so many hours

Fake news.

Plus, not many parturients on Medicare 😉

 

[sevoflurane]

Sevo’s recipe on labor and delivery:

Place a good working epidural with a spring wound catheter -> orders ->DONE

I mean do you do when your are placing 15+ epidurals in a shift?

 

[Velefunt]

WA state checking in.

My current gig, they'll change the bag in L&D. They'll page me to troubleshoot if there are issues: battery dies (though wasteful, I always put a fresh battery every time - who wants to trudge over in the dark, rain and cold to change a battery and reprogram the pump), occlusion, alarms.

Whenever's there's issues/surprises, it's usually a newly hired RN from somewhere else who doesn't change bags or titrates the pump w/o orders. We don't have standing L&D titration of pumps - only on the floor for pain service.

There was a time, maybe in my last job, when the RN's policy-wise began to balk at removing labor epidurals post-delivery. It's always some inciting event which results in some non-evidenced based policy, which some administrator believes will preclude the problem.

Thank god we're not a high-volume service.

 

[camkiss]

Our place tried that. We negotiated to this: anything from the patient to the end of the catheter is our job (placement, redose, cap came loose, etc). Anything from the catheter to the pump belongs to nursing. We use PCEA so redoses are rare and with new kits, we rarely see the connectors come off any more.

 

[deleted126335]

Usually there is a story behind stuff like this. There must have been a precipitating event in 1986.

It goes back to AMWOHN trying to help AANA. Their belief that abdicating all responsibility for Epidural related issues was beneficial for increasing roles for CRNAs. Support for increased roles for CRNAs was actually part of an earlier version of this position statement about 25 years ago.

 

[Gaslamp]

I've worked at various hospitals and have seen both sides. At the hospitals where they make the anesthesiologist change the bag, I always ask them to show me the policy that they are incapable of doing it themselves. I've yet to see this policy.

 

[Velefunt]

I've worked at various hospitals and have seen both sides. At the hospitals where they make the anesthesiologist change the bag, I always ask them to show me the policy that they are incapable of doing it themselves. I've yet to see this policy.

But they still make you do it, right? 😒