Nurses play a central role in preventing, planning for, and managing major complications of epidural analgesia/anesthesia. Close collaboration with obstetric and anesthesia providers is essential to ensure that important information about the woman's history and the maternal and fetal status is shared. The nurse must acquire expertise in performing focused assessments, and preparing for the possibility of potential emergencies before the epidural is administered. The nurse is fully familiar with the range of major epidural complications and is skilled in detected the first signs of developing problems. The nurse enhances the safety and quality of care for the woman receiving an epidural by using evidence-based clinical guidelines whenever they are available to direct practice. She relies upon standards and guidelines promulgated by professional organizations whenever possible.
Nurse managers and educators support the development of competence and expertise in the nursing care of women experiencing epidural emergencies. They provide opportunities for ongoing education and skill development. Planning for mock emergencies is a particularly effective way to promote continuous quality improvement relative to managing significant epidural complications. Nurse leaders and educators also contribute to patient safety and improved outcomes when there are epidural complications, by developing appropriate policies or protocols, monitoring performance, and evaluating the team response to epidural emergencies. (American Nurses Association, 2001)
The nurse ensures intravenous access with a large bore intravenous catheter for the administration of emergency drugs and fluid resuscitation should an emergency arise. A non-glucose-containing isotonic crystalloid solution such as Ringer's lactate is recommended for fluid resuscitation. The rapid infusion of glucose-containing solutions may contribute to the development of metabolic acidosis. They may cause neonatal hypoglycemia in the postbirth period.
There is insufficient evidence to determine the benefit of giving a clear antacid, such as bicitra, before placement of a labor epidural. Although nausea and vomiting occur....
