The Anaesthetic Department and the Acute. Pain Management Service is committed to. ensuring the safety of all internal patients.
|
|
- Nickolas Snow
- 5 years ago
- Views:
Transcription
1 Guideline Title: Clinical guideline for Continuous Local Anaesthetic Infusion for post operative pain relief for Peripheral Nerve, Muscle Sheath and wound Infusion Document Number: WN_GL2015_XXX Summary: The Anaesthetic Department and the Acute Pain Management Service is committed to ensuring the safety of all internal patients. The OLHS ensure that the delivery of Regional Anaesthesia pain management techniques will be delivered in a safe effective manner by accredited Anaesthetic Department Acute Pain Service and nursing staff. The standardisation delivery of Regional Analgesia for acute pain management is in line with best evidence based practice. Key Words: Anaesthetics, Local Anaesthetics, Health Care, Nursing Guidelines, Drugs, Acute Pain Service, Infusions, Nerve Blocks, Catheters. Directorate: Functional Sub Group: Clinical Corporate New Replaces: Endorsement Date: Publication Date:
2 Next Review Due: (5 years following publication) Applies To: Clinical Network: National Standards that this Guideline Applies To: Approved By: Chief Executive Version Control and change history: Version Date from Date to Amendment 1.0 Original Version CONTENTS PAGE 1. Purpose 2. Key Principles 3. Use of the Guideline 4. Document Retention 5. References and Links 6. Attachments
3 1: Purpose This guideline provides governance and guidance to all Registered Nurses and Enrolled Nurses with Medication Endorsement within the Orange LH Services for a standard approach to the management of patients who have been prescribed Regional Analgesia via continuous infusion, peripheral nerve catheter/s, muscle sheath or wound infusions for trauma or post operative surgery for acute pain management. This document outlines the potential and actual use of Local Anaesthetic analgesia used by the Anaesthetic, ICU, Emergency Departments and Acute Pain Service outlining the precautions and care required. Regional Analgesia using catheter/s or nerve blocks are usually delivered by an Anesthetist Anaesthetic Registrar, ICU, Emergency Department and Pain Team who are deemed competent in the clinical technique of regional nerve blockade either as a single injection or catheter/s placement for continuous infusion or single top up injection. Regional analgesia catheter/s and nerve blocks are a technique which can reduce harmful effects of pain, aid recovery and healing, shorten length of stay, improve quality of pain management treatment and minimise suffering to the client, prevent escalation of opioids in acute and chronic pain management patients. Definition: Must Should Clinician Infusion Rate Local Anaesthetic Nerve Block Top Up Dose Regional Anaesthesia Indicates a mandatory practice required by law or considered by the NSW Health to be necessary in the interest of patient safety Indicates a practice strongly recommended by the Local Health District (LHD). A decision not to conform to a recommended practice must be able to be substantiated and the rationale is to be clearly documented in the patient s clinical notes. A health practitioner or health service provider (whether or not the person is Registered with the Australian Register of Health Professionals), e.g. nurses, midwives, medical practitioners, allied health practitioners, social workers, psychologists, aborig health worker etc. Infusion rates will depend on the area being blocked and the expected rate of absorption from that area (depending on vascularity). Works by pharmacologically blocking the nerve supply to a certain part of the body. This is achieved by reversibly interrupting the conduction of the impulses along the fibres. A nerve block is a single injection of numbing medication (local anaesthetic) near specific nerves to decrease the sensory of pain in a certain part of the body during and after surgery. The reinforcement of anaesthesia by a never catheter "top-up additional dose local anaesthetic needed to restore pain relief. Is loss of sensation in a region of the body produced by application of an anaesthetic agent to all the nerves supplying that region, hence providing pain relief?
4 continuous peripheral nerve A continuous peripheral nerve blockade is achieved by placing a fine catheter close to a nerve or nerve receptors and infusing a solution of local anaesthetic either at an hourly rate or as prescribed bolus doses. The presence of the catheter allows the block to continue for a number of days post-surgery, thereby improving patient analgesia, and lessening the need for more invasive blocks or strong opiates. 2: Key Principles Effective analgesia is crucial to patient outcome after major surgery to ensure comfort, mobilisation and decreased risk of potential post-operative complications such as DVT and chest infection. Ensure that there is a common understanding when using a local anaesthetic, to ensure safe delivery of clinical practice and patient care by all health professionals involved. Ensure that the necessary knowledge and competencies are practised throughout the provision and delivery of patient care, knowledge of the drug/s, potential side effects and use of specific pump/delivery device. All clinicians MUST have education and be deemed competent in the clinical practice and management of Regional Analgesia to safely operate and adhere to requirements of the Australia & New Zealand College of Anesthetists and best clinical practice. Education of the patient prior to procedure or injection MAY be attended by the Anesthetist Anaesthetic Registrar, ICU Team, Emergency medical officer or Pain Team appropriately outlining the practice and management of Regional Analgesia prior to surgery or as a rescue block. 3: Use of the Guideline Procedure: Regional Analgesia using catheter/s or nerve blocks are usually delivered by an Anesthetist Anaesthetic Registrar, ICU team, Emergency medical officer or Acute Pain Team who is deemed competent in the clinical technique of regional nerve blockade either as a single injection or catheter placement for continuous infusion or single top up injection. The nerve infusion catheter will be inserted in the operating theatre or procedure room in theatres or ICU/HDU under a sterile field. Accredited Staff permitted to perform procedures 1. VMO Anesthetist 2. Anaesthetic Registrar 3. Acute Pain Service 4. ICU Consultant / ICU Registrar 5. Emergency Consultant / Emergency Medical Officer
5 Regional Analgesia Infusion using a single lumen catheter Paravertebral Femoral Sciatic Wound Infusion Nerve Catheter for top-up injection only Femoral Sciatic Rectus Sheath Transverses Abdominal Plan (TAP) Subcostal Serratus Pectoralis Single nerve injection as a rescue block Femoral Saphenous Fascia Iliaca Sciatic Transverses Abdominal Plan (TAP) Rectus Sheath Serratus I Subcostal Indications for Regional Anaesthesia Analgesia Patients experiencing pain after surgery / trauma part of a multimodal approach to analgesia to decrease opiate requirements, and avoid side effects to reduce presentations to ICU / HDU and reduce length of stay to health service encourage chest physio and mobilisation and meet goals Contraindications Patient refusal to treatment Previous adverse effects with local anaesthetics Superficial infection at site of potential insertion Inadequate knowledge and clinical skills to perform clinical practice Bleeding disorders When prescribing the local anaesthetic drug for infusion and or bolus dose the following information should be provided:
6 Peripheral nerve infusion or Bolus: Prescription
7 Prescribing Date and time with name of prescribing doctor Type of nerve infusion or block name of local anaesthetic to be infused concentration and total volume to be infused in % and mg/ml hourly rate or frequency of bolus dose if required maximum dose not to be exceeded over a 24 hour period mg / ml total volume site of catheter placement Drug concentration and parameters used within Orange LHS are intended to reduce administration and programming errors. Premixed polybags of Local Anaesthetic solutions are available from pharmacy. The following standard concentrations are used within Orange LHS % Ropivacaine (Naropin) only in 200ml volume % Bupivacaine (Marcaine) in 200ml volume The clinician preparing the Regional Infusion must: Correctly identify and verify the prescription has been completed as per NSW Health Peripheral Nerve Infusion or Bolus chart SMR used within the Western NSWLHD. Correctly identify and prepare the regional infusion pump and equipment within the work environment, wash hands and demonstrate non-touch technique when preparing commencing and connecting the infusion to the patient.
8 Ensure that the principles regarding administration and handling of local solutions are followed; ensuring all lines is labelled and the 5 rights of drug administration are adhered to. Programming of a Nerve Infusion The infusion pump must be programed according to the prescription provided by the medical officer on the Peripheral Nerve Infusion or Bolus chart infusion chart. The nerve infusion prescription must be programmed by two registered nurses or a registered nurse and enrolled nurse with medication endorsement, who have been deemed competent in the practice and management of a regional infusion. In the event that the nerve infusion prescription or program requires changing two registered nurses or registered nurse and enrolled nurse with medication endorsement, may make changes to the infusion pump. The nerve infusion chart must show a record of the new prescription, signed, dated and documented by the treating medical officer in the progress notes and by the nursing staff caring for the patient. Administration of Nerve Infusion No other IV / IM, oral or transdermal opioid drugs or sedatives are to be administered whilst the patient is receiving nerve infusion analgesia, unless reviewed or authorised by the treating medical officer or the Acute Pain Team. In the interests of patient safety, and to prevent large volume administration local anaesthetic drugs being delivered to the patient inadvertently, all nerve infusions must be administered via a dedicated pump used within the local facility. Patients receiving local anaesthetic infusion must have a patent IV cannula insitu for the duration of the infusion and 24hrs post removal. The cannula must be changed every 72hrs, dated and signed in accordance with the WNSWLHD Infection Control Policy. A dedicated infusion pump which is clearly labelled to be used for the delivery of the local anaesthetic. A dedicated infusion giving set which is portless and labelled for regional infusion to be used. Infusion pump settings to be checked at the commencement of each shift on patient transfer to another ward and when the bag is changed.
9 Insertion of catheter details: Catheter site check every 8 hours for - Integrity of dressing - Signs of leakage (if possible) - Signs of inflammation (if possible) Nerve catheter/s sites are to be dressed with a large occlusive waterproof transparent dressing and the catheter and filter secured with snap lock to prevent dislodgment. The "clear window" will allow for routine inspection of the nerve catheter insertion site. This dressing is applied by the proceduralist s at the time of the insertion. A bacterial filter: must be attached to the end of the nerve catheter/s for the entire length of the infusion or top-up. The filter is to be left intact unless it becomes inadvertently disconnected or contaminated. Disconnection: If the nerve catheter/s becomes disconnected from either the filter or the line, DO NOT reconnect. Place a sterile cap on the end cover with sterile gauze and secure. Contact the anaesthetic department and or acute pain team. If after hours, contact the on call medical officer for immediate review of the catheter which may then be removed or reconnected once assessed.
10 If the dressing is loose but still intact, the registered nurse is to reinforce it by placing another large sterile transparent film dressing over the site and reinforcing the edges of the dressing, making sure to cover any loose edges. Duration of infusion and or Top-up: Current practice is to continue nerve infusions or top-up for the minimum duration of 48 hours with review by the treating team. The risks/benefits of continuing regional analgesia should be considered daily by the treating team and documented in the patient s progress notes. Adequate resuscitation equipment must be available on the ward or working area and a working IV cannula insitu prior to injection. Patient MUST have full monitoring for the duration of the procedure and one hour post. Documentation and observations are recorded in the progress notes and Adult observations chart SAGO. Patients with nerve blocks to lower limbs may mobilise with support following assessment of limb strength. Ensure that limbs with motor block are supported at all times and pressure area care is carried out.
11 Observations for Continuous Infusion are to be recorded hourly for 6 hours, then second hourly or more frequently if patient s clinical condition warrants when a local infusion is in progress. When a single Nerve Block or Top-Up bolus has been given observations are reordered 15minly for 1hour and nursing staff informed prior commencement.
12 Pain Scores are to be determined from a pain assessment with the patient at rest and with relevant movement (such as deep breathing and coughing) utilising either the numerical pain scale 0 to 10 or verbal pain scale; no pain, mild pain, moderate pain, severe pain and worst possible pain. Pain score at rest to be recorded with the letter R Pain score with movement to be recorded with the letter M Removal of Catheter/s: Local anaesthetic infusion catheters can be removed by registered nurses who have been assessed as competent in aseptic technique If the catheter feels as if there is some resistance do not force removal, contact the acute pain team or the anaesthetist on call for advice. Check the catheter after removal to ensure the entire length has been removed and catheter intact. Procedure for Removal of Catheter Wash hands as per correct hand hygiene Gather equipment and a small dressing and gloves
13 Explain the procedure to the patient Position the patient comfortably where access to the catheter is easiest Remove the catheter slowly Observe the site for leakage, fluid or signs of infection. Check catheter to ensure tip is complete if not contact Acute Pain Team for advice. Clean with NaCl 0.9% and apply adhesive dressing over site Document in progress notes and on the Nerve Infusion chart Local Anaesthetic Toxicity Local anaesthetics, if prescribed correctly, will rarely cause toxic effects however if there is direct infusion into a vein or the solution is absorbed rapidly or a patient is unduly sensitive then the signs and symptoms of toxicity may occur. All staff working with local anaesthetic infusions should be aware of the signs and treatments of LA toxicity. If not acted upon in the early stages then respiratory and cardiac arrest can occur which is very difficult to reverse because the acidotic arrest state causes more of the drug to enter the cells and worsen the situation. Whilst treating the signs and symptoms symptomatically there are also directions for Intralipid Infusion treatment if the patient condition deteriorates. The infusion rate should be regularly checked and compared with the prescription to ensure correct rate is running and the site of infusion checked for leakage. Local anaesthetic toxicity can occur, especially if there is rapid absorption into the blood stream, or if inadvertently administered intravenously. This is very rare but it is important that the signs are recognised. If symptoms are: Mild Restlessness/confusion Light-headedness Numbness of tongue and lips (lip smacking) Tinnitus Double vision, blurred vision Moderate Heaviness of limbs Muscular twitching Convulsions
14 Severe Cardia arrhythmias Hypotension Respiratory arrest Cardia arrest Management of Local Anaesthetic Toxicity: Stop local anaesthetic infusion and follow Between the Flags protocol Continue all monitoring of the patient and observations Maintain oxygenation and a patent airway Consult with medical team, pain team or on call anaesthetist Continue to observe closely with the need to escalate response The standardisation of this Guideline promotes best practice in prescribing, pain assessment and management of adverse effects in those patients receiving a peripheral nerve infusion or local anaesthetic solution. 4: Document Retention Document Type Retention Schedule Retention Period e.g. Clinical Audit GDA Destroy after 6 years 5: References and Links 1. Australia & New Zealand College of Anaesthetists and Faculty of Acute Pain Management Scientific Evidence Fourth Edition 2015 available at publications/acutepain.pdf which has been endorsed by the National Health and Medical Research Council (NHMRC).
15 2. Australian and New Zealand College of Anaesthetist Guidelines for the Management of Major Regional Analgesia htm 3. AAGBI Safety Guideline produced by a Working Party that comprised: Grant Cave, Will Harrop- Griffiths (Chair), Martyn Harvey, Tim Meek, John Picard, Tim Short and Guy Weinberg. This Safety Guideline is endorsed by the Australian and New Zealand College of Anaesthetists (ANZC 4. Greater Western AHS 2007, Administration of Medications by Endorsed Enrolled Nurses 5. Greater Western AHS 2009 Medication Handling in Public Hospitals Patient Care Areas _Patient_Care_Area.pdf 6. NSW Health, 2007 Infection Control Policy, PD2007_ NSW Health Hand Hygiene Policy PD2010_ Clinical Excellence Commission Between the Flags program, 9. Pain Interest Group Nursing Issues, Agency for Clinical Innovation (ACI): Standardisation of NSW State Pain Forms: NSW Health Peripheral Nerve Infusion (Adult) SMR Appendix 1. PERIPHERAL NERVE INFUSION (ADULT)
16
17 Appendix 2.
18
19
PAEDIATRIC NERVE BLOCK / WOUND INFILTRATION
PAEDIATRIC NERVE BLOCK / WOUND INFILTRATION Addendum to the MULTIDISCIPLINARY GUIDELINES FOR ACUTE PAIN MANAGEMENT IN CHILDREN AND YOUNG PEOPLE Policy Owner: Approved by: Ratified by: ABMU HB Pain Management
More informationParavertebral policy. The Acute pain Management Dept, UCLH
UCLH PARAVERTEBRAL BLOCK (ADULTS) POLICY Paravertebral policy. The Acute pain Management Dept, UCLH DEFINITION A Paravertebral block is a method of providing effective analgesia using a local anaesthetic.
More informationCredentialing for Insertion of Adult Peripheral Intravenous (IV) Cannula
F Policy Compliance Procedure Credentialing for Insertion of Adult Peripheral Intravenous (IV) Cannula This PCP relates to HNEH Policy HNEH 07/XX: HNEH Adult Peripheral IV Cannulation PCP Number Sites
More informationCLINICAL GUIDELINE FOR AN EPIDURAL INFUSION IN CHILD HEALTH 1. Aim/Purpose of this Guideline
CLINICAL GUIDELINE FOR AN EPIDURAL INFUSION IN CHILD HEALTH 1. Aim/Purpose of this Guideline 1.1. The purpose of this guideline is to provide guidance on caring for children who are receiving epidural
More information1 Recognition. 2 Immediate management. 3 Treatment. 4 Follow-up. AAGBI Safety Guideline. Management of Severe Local Anaesthetic Toxicity
AAGBI Safety Guideline Management of Severe Local Anaesthetic Toxicity 1 Recognition 2 Immediate management 3 Treatment Signs of severe toxicity: Sudden alteration in mental status, severe agitation or
More information2. The Guidance This document outlines the potential and actual use of Local Anaesthetic within RCHT and the precautions and care required.
POLICY UNDER REVIEW Please note that this policy is under review. It does, however, remain current Trust policy subject to any recent legislative changes, national policy instruction (NHS or Department
More informationFascia Iliaca Compartment Block. Angela Stewart ANP 22/08/17
Fascia Iliaca Compartment Block Angela Stewart ANP 22/08/17 Motivation Anaesthetist Dr Joellene Mitchell from acute pain service Ayr hospital produced a guideline to allow Non-medical prescribers (NMP)
More informationFascia Iliaca Compartment Block. Angela Stewart ANP 10/11/17
Fascia Iliaca Compartment Block Angela Stewart ANP 10/11/17 1 Driving force Dr J. Mitchell from acute pain service Ayr hospital produced a comprehensive guideline to authorise Non-medical prescribers (NMP)
More informationGuidelines for the Conduct of Epidural Analgesia for Parturients
Page 1 of 6 Guidelines for the Conduct of Epidural Analgesia for Version Effective Date 1 Feb 1993 (Reviewed Feb 2002) 2 Oct 2012 Document No. HKCA P4 v2 Prepared by College Guidelines Committee Endorsed
More informationCLINICAL GUIDELINES ID TAG Continuous Peripheral Nerve Block Guideline Dr Peter Merjavy and Dr Aidan Cullen
Title: Author: CLINICAL GUIDELINES ID TAG Continuous Peripheral Nerve Block Guideline Dr Peter Merjavy and Dr Aidan Cullen Speciality / Division: Directorate: Anaesthetics / ATICS Acute Date Uploaded:
More informationAll about your anaesthetic
Patient information leaflet All about your anaesthetic Regional anaesthesia 4 and associated risks For patients having a surgical procedure at a Care UK independent diagnostic and treatment entre This
More informationPain relief after major surgery
Page 1 of 6 Pain relief after major surgery Introduction The aim of this leaflet is to tell you about the main pain relief options available after major surgery. You will probably only need this for the
More informationTRANSFUSION OF BLOOD COMPONENTS ADMINISTRATION. All blood components are administered according to BOP DHB Policy and NZBS Guidelines.
STANDARDS All blood components are administered according to BOP DHB Policy and NZBS Guidelines. EQUIPMENT IV administration set with 260 micron filter either integrated blood filter; or add on blood filter
More informationThe Newcastle upon Tyne Hospitals NHS Foundation Trust. RVI Paravertebral Continuous Infusion Guideline
The Newcastle upon Tyne Hospitals NHS Foundation Trust RVI Paravertebral Continuous Infusion Guideline Version No.: 1 Effective From: 11 August 2016 Review date: 11 August 2019 Date Ratified 25 July 2016
More informationGUIDELINES FOR PERIPHERAL NERVE / PLEXUS BLOCK CATHETER MANAGEMENT DEPARTMENT OF ANAESTHESIOLOGY AND INTENSIVE CARE HOSPITAL KUALA LUMPUR
GUIDELINES FOR PERIPHERAL NERVE / PLEXUS BLOCK CATHETER MANAGEMENT DEPARTMENT OF ANAESTHESIOLOGY AND INTENSIVE CARE HOSPITAL KUALA LUMPUR INTRODUCTION Regional block provides superior pain relief, compared
More informationEpidural analgesia in labour Guideline for care
This is an official Northern Trust policy and should not be edited in any way Epidural analgesia in labour Guideline for care Reference Number: NHSCT/12/523 Target audience: This policy is directed to
More informationThe Management Of Regional Analgesia Using A Nerve Catheter. Lead Nurse Acute Pain Specialist Nurse CLINICAL GUIDELINE
Lancashire Teaching Hospitals NHS Foundation Trust The Management Of Regional Analgesia Using A Nerve Catheter KEY WORDS REF NO: Acute Pain, Regional Analgesia, Nerve Catheter. Local Anaesthetic Infusion
More information1.3. A Registration standard for conscious sedation has been adopted by the Dental Board of Australia.
Policy Statement 6.17 Conscious Sedation in Dentistry 1 (Including the ADA Recommended Guidelines for Conscious Sedation in Dentistry and Guidelines for the Administration of Nitrous Oxide Inhalation Sedation
More informationVAN WERT COUNTY HOSPITAL. Policy/Procedure: Departmental No.: N 11-36A. Issue Date: 7-97 By: Nursing No. of Pages: 6
VAN WERT COUNTY HOSPITAL Policy/Procedure: Departmental No.: N 11-36A Issue Date: 7-97 By: Nursing No. of Pages: 6 Reviewed: 9-14, 8-11, 8-10 Revised: 9-14 Distribution List: All Nursing Departments Concurrence:
More informationLRI Children s Hospital
LRI Children s Hospital Guideline for the Care of Neonates, Children and Young People Requiring Epidural Analgesia Staff relevant to: All Health Professionals who care for neonates, children and young
More informationBetter Post-Op Pain Control Starts Here
Better Post-Op Pain Control Starts Here POST-OP PAIN CONTROL PUMP It s Easy to Get Started About the ACCUFUSER Pump Thank you for considering the This brochure makes it easy for For complete information
More informationOBJECTIVES OF TRAINING FOR THE ANAESTHESIA TERM
College of Intensive Care Medicine of Australia and New Zealand ABN: 16 134 292 103 Document type: Training Date established: 2007 Date last reviewed: 2014 OBJECTIVES OF TRAINING FOR THE ANAESTHESIA TERM
More informationCENTRAL IOWA HEALTHCARE Marshalltown, Iowa
CENTRAL IOWA HEALTHCARE Marshalltown, Iowa CARE OF PATIENT POLICY & PROCEDURES Policy Number: 4.84 Subject: Policy: Purpose: Continuous Epidural Analgesia Acute or chronic pain relief provided to a patient
More informationCONTROLLED DOCUMENT. Guidelines for the use of subcutaneous hydration in palliative care (hypodermoclysis) Controlled Document Number: CG259
Guidelines for the use of subcutaneous hydration in palliative care (hypodermoclysis) CONTROLLED DOCUMENT CATEGORY: CLASSIFICATION: Controlled Document Number: Version Number: 1 Controlled Document Sponsor:
More informationBASINGSTOKE AND NORTH HAMPSHIRE NHS FOUNDATION TRUST. Clinical Policy for Peripheral Venous Cannula Insertion and Management (Adults)
BASINGSTOKE AND NORTH HAMPSHIRE NHS FOUNDATION TRUST Clinical Policy for Peripheral Venous Cannula Insertion and Management (Adults) Reviewed in accordance with The Health and Social Care Act 2008: Code
More informationSign up to receive ATOTW weekly
PERIPHERAL NERVE BLOCKS GETTING STARTED ANAESTHESIA TUTORIAL OF THE WEEK 134 PUBLICATION DATE 18/05/09 Dr Kim Russon, Consultant Anaesthetist Dr Helen Findley, ST3 Anaesthetics Dr Zoe Harclerode, ST3 Anaesthetics
More informationSurgical Care at the District Hospital. EMERGENCY & ESSENTIAL SURGICAL CARE
Surgical Care at the District Hospital 1 14 Practical Anesthesia Key Points 2 14.1 General Anesthesia Have a clear plan before starting anesthesia Never use an unfamiliar anesthetic technique in an emergency
More informationDOCUMENT CONTROL PAGE
DOCUMENT CONTROL PAGE Title Title: UNDERGOING SPINAL DEFORMITY SURGERY Version: 2 Reference Number: Supersedes Supersedes: all other versions Description of Amendment(s): Revision of analgesia requirements
More informationDRUG GUIDELINE. HYDRALAZINE (Intravenous severe hypertension in pregnancy)
DRUG GUIDELINE HYDRALAZINE (Intravenous severe hypertension SCOPE (Area): FOR USE IN: Labour Ward, HDU, Theatre and ED EXCLUSIONS: Paediatrics (seek Paediatrician advice) and other general wards. SCOPE
More informationTrust Guideline for the Management of Patient Controlled Analgesia (PCA) in Adults
Patient Controlled Analgesia (PCA) in Adults A clinical guideline recommended for use For Use in: In all Clinical Areas By: Anaesthetists, Ward Nurses, Recovery Staff Acute Pain Service Staff For: Adult
More informationPneumonectomy (lung removal)
Patient information (lung removal) i Important information for patients undergoing lung surgery. Golden Jubilee National Hospital Agamemnon Street Clydebank, G81 4DY (: 0141 951 5000 www.nhsgoldenjubilee.co.uk
More informationDOCUMENT CONTROL PAGE
DOCUMENT CONTROL PAGE Title Title: GUIDELINES FOR THE MANAGEMENT OF CONTINUOUS EPIDURAL INFUSION IN CHILDREN Version: 3 Reference Number: Supersedes Supersedes: All previous versions (1998, 2007) Description
More informationPCA PRESCRIPTION is valid for a maximum of 4 days unless ceased earlier. Date: BINDING MARGIN - NO WRITING BINDING MARGIN - NO WRITING
Attach ADR Sticker THESE INSTRUCTIONS EXPLAIN WHEN TO MAKE A CLINICAL REVIEW OR RAPID RESPONSE CALL, YOUR LOCAL ESCALATION PROTOCOL WILL EXPLAIN HOW TO MAKE A CALL PCA ALLERGIES & ADVERSE DRUG REACTIONS
More informationYour anaesthetic for heart surgery
Your anaesthetic for heart surgery Information for patients and carers First Edition 2018 www.rcoa.ac.uk/patientinfo This leaflet gives you information about your anaesthetic for adult heart (cardiac)
More informationPATIENT CARE MANUAL POLICY
PATIENT CARE MANUAL POLICY NUMBER VII-A-15 PAGE 1 OF 3 APPROVED BY: CATEGORY: Vice President and Senior Operating Officer; Rural Health Services & Professional Practice Lead Body Systems; Central Nervous
More informationNHS Grampian Protocol For The Prescribing And Administration Of Oral Opioids Following Trauma Or Surgery in Adults. Consultation Group: See Page 5
NHS...... Grampian Acute Sector NHS Grampian Protocol For The Prescribing And Administration Of Oral Opioids Following Trauma Or Surgery in Adults Co-ordinators: Consultant Anaesthetist, Lead Acute Pain
More informationAustralian and New Zealand Registry of Regional Anaesthesia (AURORA)
Australian and New Zealand Registry of Regional Anaesthesia (AURORA) Overview of Results First 4000 procedures recorded to - www.anaesthesiaregistry.org June 1st 2011 to February 2012 Background Australian
More informationUrinary Catheters. Prevalence of Infections
Urinary Catheterisation Urinary catheterisation is defined as an intervention to enable the emptying of the bladder by insertion of a catheter. Catheters can be short term less than 28 days or long term
More informationNHS Grampian Protocol For The Prescribing And Administration Of Oral Opioids Following Trauma Or Surgery
Acute Sector NHS Grampian Protocol For The Prescribing And Administration Of Oral Opioids Following Trauma Or Surgery Co-ordinators: Dr Karen Cranfield, Consultant Anaesthetist, Lead Acute Pain Sector
More informationGuideline for the Post Operative Management of Women who have received Intrathecal or Epidural Opioid Analgesia for Caesarean Section
Guideline for the Post Operative Management of Women who have received Intrathecal or Epidural Opioid Analgesia for Caesarean Section Speciality: Maternity Approval Body: Labour Ward Forum Approval Date:
More informationHaving an Anaesthetic Your Questions Answered
PATIENT INFORMATION Having an Anaesthetic Your Questions Answered This leaflet explains what you can expect when having an anaesthetic for a planned operation. What is anaesthesia? Anaesthesia means loss
More informationAUSTRALIAN AND NEW ZEALAND COLLEGE OF ANAESTHETISTS ABN
PS51 (2009) AUSTRALIAN AND NEW ZEALAND COLLEGE OF ANAESTHETISTS ABN 82 055 042 852 GUIDELINES FOR THE SAFE ADMINISTRATION OF INJECTABLE DRUGS IN ANAESTHESIA 1. INTRODUCTION 1.1 Current data suggest that
More informationEpidural Infusions for Pain Relief Including Discharge Advice
Royal Manchester Children s Hospital Epidural Infusions for Pain Relief Including Discharge Advice Children s Pain Team- Information For Parents and Carers This leaflet aims to provide information for
More informationInformation about Your Anaesthetic and Pain Control After Surgery
Information about Your Anaesthetic and Pain Control After Surgery Information for patients Specialist Support If you require this leaflet in another language, large print or another format, please contact
More informationStandard operating procedures for preparation and administration of intramuscular injections. No Action Rationale
Standard operating procedures for preparation and administration of intramuscular injections Preparation Overview No Action Rationale 1 Collect and check all equipment 2 Check that the packaging of all
More informationAnalgesia for ERAS programs. Dr Igor Lemech VMO Anaesthetist Wagga Wagga Base Hospital
Analgesia for ERAS programs Dr Igor Lemech VMO Anaesthetist Wagga Wagga Base Hospital Disclosure I have received honoraria from Mundipharma and MSD The new Wagga Wagga Rural Referral Centre Scope Analgesic
More informationDynamic hip screw (sliding hip screw)
Dynamic hip screw (sliding hip screw) Trauma and Orthopaedics Patient Information Leaflet Introduction This leaflet is about an operation called a dynamic hip screw, sometimes also known as a sliding hip
More informationGUIDELINE FOR THE POST OPERATIVE MANAGEMENT OF WOMEN WHO HAVE RECEIVED INTRATHECAL OR EPIDURAL OPIOID ANALGESIA FOR CAESAREAN SECTION
GUIDELINE FOR THE POST OPERATIVE MANAGEMENT OF WOMEN WHO HAVE RECEIVED INTRATHECAL OR EPIDURAL OPIOID ANALGESIA FOR CAESAREAN SECTION Originator: Maternity Services & Anaesthetics Dept Date Approved: January
More informationGoing Home with Your Peripheral Nerve Catheter and Pain Relief Pump
Northwestern Memorial Hospital Patient Education CARE AND TREATMENT If you have any questions about the pain relief pump, please call the Anesthesia Pain Service. Going Home with Your Peripheral Nerve
More informationLatex and Occupational Dermatitis Policy Incorporating Glove Selection
Latex and Occupational Dermatitis Policy Incorporating Glove Selection DOCUMENT CONTROL: Version: 3 Ratified by: Risk Management Sub Group Date ratified: 17 July 2013 Name of originator/author: Health
More informationOFFICE BASED PROCEDURES IN AUSTRALIA
INTRODUCTION OFFICE BASED PROCEDURES IN AUSTRALIA (Excluding Liposuction and/or Fat Transfer) The Royal Australasian College of Surgeons (RACS), the Australian and New Zealand College of Anaesthetists
More informationPeripherally Inserted Central Catheter (PICC) Booklet
Aintree University Hospital FT PICC Booklet: a real world example This local booklet is an example used in the NICE medical technology guidance adoption support resource for SecurAcath for securing percutaneous
More informationCurraheen, Co. Cork. Guidelines on the Management and Care of Central Venous Access Devices
Curraheen, Co. Cork. Guidelines on the Management and Care of Central Venous Access Devices Date re-approved: 27 th Jan 2015. Version No: 2 Revision Due: 2018 Index code: CLIN028 Disclaimer: The information
More informationINTRATHECAL ANALGESIA IN CANCER PAIN A RESOURCE FOR HEALTH PROFESSIONALS
INTRATHECAL ANALGESIA IN CANCER PAIN A RESOURCE FOR HEALTH PROFESSIONALS Canterbury Regional Cancer and Haematology Service Palliative Care Service 2014 CONTENTS Introduction Associated Resources Nursing
More informationClinical Guideline for Intravenous Opioids for Adults in Recovery Areas The Recovery Protocol
Clinical Guideline for Intravenous Opioids for Adults in Recovery Areas The Recovery Protocol 1. Aim/Purpose of this Guideline 1.1. To Provide safe and efficient administration of Opioids in Recovery.
More informationUnderstanding your HICKMAN CATHETER
Understanding your HICKMAN CATHETER Patient Information What is the purpose of this information sheet? This information sheet has been written by patients, members of the public and health professionals.
More informationCHEMOTHERAPY NETWORK GROUP POLICY FOR ADMINISTRATION OF CYTOTOXIC CHEMOTHERAPY
CHEMOTHERAPY NETWORK GROUP POLICY FOR ADMINISTRATION OF CYTOTOXIC CHEMOTHERAPY Version 4.0 March 2016 Review date March 2018 Introduction It is the purpose of this policy to provide clear guidelines that
More informationPilonidal Sinus. Whiston Hospital Warrington Road, Prescot, Merseyside, L35 5DR Telephone:
Pilonidal Sinus Whiston Hospital Warrington Road, Prescot, Merseyside, L35 5DR Telephone: 0151 426 1600 Author: General Surgery Department: Colorectal Document Number: STHK1059 Version: 002 Review date:
More informationAnaesthesia and pain (Daycase Patient) Patient information Leaflet
Anaesthesia and pain (Daycase Patient) Patient information Leaflet February 2018 INTRODUCTION Welcome to Tameside Hospital, this leaflet gives basic information to help you prepare for your anaesthetic,
More informationBrachial Plexus Block
Brachial Plexus Block Information to help patients prepare for a brachial plexus block Excellent Care with Compassion Introduction This leaflet describes what happens when you have a brachial plexus block,
More informationAbout general anaesthesia Day Surgery Unit Patient Information Leaflet
About general anaesthesia Day Surgery Unit Patient Information Leaflet Originator: Nahla Farid - Consultant Anaesthetist Date: November 2011 Version: 1 Date for Review: November 2014 DGOH Ref No: DGOH/PIL/00560
More informationAnaesthetic Procedure Packs Ensuring maximum barrier precautions
Anaesthetic Procedure Packs Ensuring maximum barrier precautions vygon@vygon.co.uk www.vygon.co.uk Anaesthetic Procedure Packs Ensuring maximum barrier precautions It has been estimated that infections
More informationHealthcare Associated Infection (HAI) catheter care aide memoire
Healthcare Associated Infection (HAI) catheter care aide memoire Hospital: Ward/Department: Inspector: Date: Guidance note and methodology: This aide memoire has been developed to align with the guidelines
More informationCATHETER ACCESS KIT. For use with Prometra Programmable Infusion Systems
CATHETER ACCESS KIT Caution: Federal (USA) Law restricts this device to sale by or on the order of a physician. Table of Contents Contents... 3 Description... 3 Indications... 3 Contraindications... 3
More informationIV Fluids. Nursing B23. Objectives. Serum Osmolality
IV Fluids Nursing B23 Objectives Discuss the purpose of IV Discuss nursing interventions in IV therapy Identify complications of IV therapy Differentiate between peripheral line, central line, and PICC
More informationCompetency Title: Caring for a patient with an arterial line
Appendix 2 Competency Title: Caring for a patient with an arterial line Aims and objectives Following completion of this competency document the practitioner will be able to: Discuss the indications for
More informationGUIDELINES ON CONSCIOUS SEDATION FOR DENTAL PROCEDURES
AUSTRALIAN AND NEW ZEALAND COLLEGE OF ANAESTHETISTS ABN 82 055 042 852 ROYAL AUSTRALASIAN COLLEGE OF DENTAL SURGEONS ABN 97 343 369 579 Review PS21 (2003) GUIDELINES ON CONSCIOUS SEDATION FOR DENTAL PROCEDURES
More informationPain and Itch Assessment and Management for the Burns Patient (Adults) Type: Clinical guideline Register No: Status: Public
Pain and Itch Assessment and Management for the Burns Patient (Adults) Type: Clinical guideline Register No: 15025 Status: Public Developed in response to: Best Practice Contributes to CQC Regulation 9,11
More informationChapter 8 ADMINISTRATION OF BLOOD COMPONENTS
Chapter 8 ADMINISTRATION OF BLOOD COMPONENTS PRACTICE POINTS Give the right blood product to the right patient at the right time. Failure to correctly check the patient or the pack can be fatal. At the
More informationTitle and contents page 1 Who should read this document 2 Scope of the Guideline 2 Background 2 What is new in this version 2
Temporary Transvenous Pacing Guideline Classification: Clinical Guideline Lead Author: Dr Peter Woolfson Additional author(s): Dr Alan Fitchet Sister Joanne Hughes, Matron Julie Winstanley Authors Division:
More informationAnalgesia. The modern approach. Dr. Mark Haworth MB.ChB.DA.MRCA.
Analgesia The modern approach Dr. Mark Haworth MB.ChB.DA.MRCA. What is pain? An unpleasant sensory and emotional experience associated with actual or potential tissue damage. (Melzac and Wall) How is pain
More informationJanuary Adult Burn Injured patients
Guideline Full Title of Guideline: Author (include email and role): Division & Speciality: Scope (Target audience, state if Trust wide): Review date (when this version goes out of date): Explicit definition
More informationRobot Assisted Laparoscopic Radical Prostatectomy
Robot Assisted Laparoscopic Radical Prostatectomy Robot Assisted Laparoscopic Radical Prostatectomy is an alternative to Open Radical Prostatectomy. It will be performed by your Consultant Urologist at
More informationMORPHINE ADMINISTRATION
Introduction Individualised Administration Drug of Choice Route of Administration & Doses Monitoring of Neonates & high risk patients Team Management Responsibility Morphine Protocol Flow Chart Introduction
More informationCurrent evidence in acute pain management. Jeremy Cashman
Current evidence in acute pain management Jeremy Cashman Optimal analgesia Best possible pain relief Lowest incidence of side effects Optimal analgesia Best possible pain relief Lowest incidence of side
More informationFACULTY OF PAIN MEDICINE
PM4 (2005) FACULTY OF PAIN MEDICINE AUSTRALIAN AND NEW ZEALAND COLLEGE OF ANAESTHETISTS ABN 82 055 042 852 GUIDELINES FOR PATIENT ASSESSMENT AND IMPLANTATION OF INTRATHECAL CATHETERS, PORTS AND PUMPS FOR
More informationTranscatheter Aortic Valve Implantation Procedure (TAVI)
Page 1 of 5 Procedure (TAVI) Introduction Aortic stenosis (AS) is a common heart valve problem associated with heart failure and death. Surgical valve repair or replacement is recommended if AS patients
More informationEducation for Self Administration of Intravenous Therapy HOME IV THERAPY PICC. Portacath
HOME IV THERAPY PICC Portacath Who To contact Cardio-Respiratory Integrated Specialist Services (CRISS) Office hours 0800 1630 hours Ph: 364 0167 Weekends and after hours, phone Christchurch Hospital operator
More informationCLINICAL PRACTICE GUIDELINE Regional Anaesthetic Infusion/Blocks Children s Pain Management Service (CPMS) Royal Children's Hospital, Melbourne
CLINICAL PRACTICE GUIDELINE /Blocks Children s Pain Management Service (CPMS) Royal Children's Hospital, Melbourne Disclaimer: This pain management guideline was written by the staff of the Children's
More informationVascular access device selection & placement. Alisa Seangleulur, MD Anesthesiology Department, Faculty of Medicine, Thammasat University
Vascular access device selection & placement Alisa Seangleulur, MD Anesthesiology Department, Faculty of Medicine, Thammasat University How to make the right choice of vascular access device.. Peripheral
More informationATI Skills Modules Checklist for Central Venous Access Devices
For faculty use only Educator s name Score Date ATI Skills Modules Checklist for Central Venous Access Devices Student s name Date Verify order Patient record Assess for procedure need Identify, gather,
More informationTrust Guidelines. Title: Guidelines for chest drain insertion
Trust Guidelines Title: Guidelines for chest drain insertion Authors: Dr JCT Pepperell; Dr J Tipping; J Hansford Ratified by: Planned Care and Emergency & Urgent Care Divisional Governance Committees Active
More informationNOTE: The first appearance of terms in bold in the body of this document (except titles) are defined terms please refer to the Definitions section.
TITLE PARENTERAL NUTRITION ADMINISTRATION AND MONITORING SCOPE Provincial: Acute Care APPROVAL AUTHORITY Clinical Operations Executive Committee SPONSOR Pharmacy Services, Nutrition Services, and Health
More informationAsthma Management Policy
Asthma Management Policy Asthma is a chronic health condition, which is one of the most common reasons for childhood admission to hospital. Correct asthma management will assist to minimise the impact
More informationPain relief after surgery. Patient Information
Pain relief after surgery Patient Information Author ID: JT Leaflet Number: Pain 003 Version: 5 Name of Leaflet: Pain after surgery Date Produced: April 2017 Review Date: April 2019 This leaflet describes
More informationEmergency First Response (EFR) Assessment Sheets September 2011
Emergency First Response () Assessment Sheets September 2011 Airway Management & Ventilation Current Version: Version 2 (Sep 2011) Airway Management & Ventilation TRAUMA JAW THRUST 1 Hand position 2 Perform
More informationCLINICAL GUIDELINE FOR USE OF A PATIENT CONTROLLED ANALGESIA OR INTRAVENOUS OPIATE INFUSION IN CHILD HEALTH. 1. Aim/Purpose of this Guideline
CLINICAL GUIDELINE FOR USE OF A PATIENT CONTROLLED ANALGESIA OR INTRAVENOUS OPIATE INFUSION IN CHILD HEALTH. 1. Aim/Purpose of this Guideline Guideline for children with a Patient Controlled Analgesia
More informationCentral venous access devices for children with lysosomal storage disorders
Great Ormond Street Hospital for Children NHS Foundation Trust: Information for Families Central venous access devices for children with lysosomal storage disorders This information explains about central
More informationPATIENT CARE PLAN FOR CARE OF PERIPHERAL MIDLINE. Manufacturers specific recommendations should be noted and adhered to by individual practitioners.
PATIENT CARE PLAN FOR CARE OF PERIPHERAL MIDLINE The care plan is designed to be used in conjunction with CINS Guidelines for vascular devices. Manufacturers specific recommendations should be noted and
More informationBest practice in the management of epidural analgesia in the hospital setting
Best practice in the management of epidural analgesia in the hospital setting FACULTY OF PAIN MEDICINE of The Royal College of Anaesthetists Royal College of Anaesthetists Royal College of Nursing Association
More informationIndwelling Urinary Catheter Template for Care Plan Development Problem No: be a last resort when all suprapubic catheter in CAUTI
Indwelling Urinary Catheter Template for Care Plan Development Problem No: Name: DOB Address: Indwelling Urinary Catheter (Urethral/ Suprapubic) Date Assessed Need GOAL INTERVENTION Evaluation of intervention/
More information1. Intrathecal must never be abbreviated to IT on a prescription form True / False
Appendix 1: Intrathecal SACT Assessment Questions Core General Questions must be completed by all staff. 1. Intrathecal must never be abbreviated to IT on a prescription form 2. Intrathecal SACT must be
More informationCardiac Catheter Labs Intravenous Drug Therapy Guide
Title of Guideline (must include the word Guideline (not protocol, policy, procedure etc) Contact Name and Job Title (author) Cardiac Catheter Lab IV Medicines Guideline Helen Buxton ( Senior Cath Lab
More informationIf viewing a printed copy of this policy, please note it could be expired. Got to to view current policies.
If viewing a printed copy of this policy, please note it could be expired. Got to www.fairview.org/fhipolicies to view current policies. Department Policy Code: D: PC-5575 Entity: Fairview Pharmacy Services
More informationAppendix E: Overview of Vascular
Appendix E: Overview of Vascular 56 Peripheral Short Catheter, less than 3 inches (7.5 cm) in length; over-the-needle catheter is most common. Inserted by percutaneous venipuncture, generally into a hand
More informationSt George Hospital Renal Department Internal Policy
SUMMARY: TROUBLESHOOTING POOR BLOOD FLOW IN VASCATHS: Please see the flow chart at the end of the protocol describing possible causes to be considered and how to deal with these in a systematic fashion.
More informationPERCUTANEOUS NEPHROLITHOTOMY
PERCUTANEOUS NEPHROLITHOTOMY AN INFORMATION LEAFLET Written by: Department of Urology May 2011 Stockport Tel: 0161 419 5698 Website: www.stockport.nhs.uk Tameside Tel: 0161 922 6696/6698 Website: www.tameside.nhs.uk
More informationPatient Group Direction for LIDOCAINE INJECTION (Version 02) Valid From 1 October September 2019
Version Control This PGD has been agreed by the following organisations FCMS PDS Medical Doncaster CCG Lancashire CCGs including East Lancashire, Fylde and Wyre and North Lancashire CCGs Change history
More informationIV Fluids Nursing B23 Objectives Serum Osmolality 275 to 295 Isotonic
1 IV Fluids Nursing B23 2 Objectives 3 Serum Osmolality Serum osmolality solute concentration of a solution Higher osmolality means greater pulling power for water Normal serum osmolality is 275 to 295
More informationBPG 03: Continuous Renal Replacement Therapy (CRRT)
BPG 03: Continuous Renal Replacement Therapy (CRRT) Statement of Best Practice Patient s requiring Continuous Renal Replacement Therapy (CRRT) will receive appropriate therapy to meet their individual
More information