The nurse receives the client in the postanesthesia recovery unit and assesses the epidural analgesic infusion. Which is the nurse's priority?

Question

1. Filter needle attached to catheter tubing
2. Distal end of tubing attached to catheter
3. Infusion contains opioid and local anesthetic
4. Pump settings match the provider prescription

Answer 1

3
3. Combining an opioid with a local anesthetic agent increases the client's risk of complications from epidural analgesia because adding another agent exposes the client to the risks of both medications, risks from drug-drug interactions, and risks of epidural analgesia. The risks of local anesthetic agents not associated with opioids include seizures, allergy to Marcaine, edema, swelling, and febrile response. Local anesthetic also shares adverse effects with opioids, including respiratory depression, dizziness, sedation, tinnitus, and blurred vision.
1. The filter needle is used to remove microscopic debris as the medication is with-drawn from the medication vial and is removed before injecting the medication into the infusion fluid. A filter needle piggybacked into the epidural catheter is likely to increase the pressure necessary to pump the infusion through the catheter and to ac-tivate the high-pressure alarm on the infusion pump. The nurse should replace the filter needle with a standard needle or needleless adapter; however, many systems are set up with a special PCA pump with tubing that attaches directly to the catheter, thus eliminating the necessity of a needle to piggyback the infusion.
2. Attaching the distal end of the tubing to the epidural catheter is correct.
4. Matching the pump settings to the provider prescription is expected nursing beha-vior.