7/24/2014 Epidural Monitoring - Davis, Aurora

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Epidural Monitoring
Fabulous people,

I heard through the grapevine that folks might need a little refresher on how to monitor epidural infusions.
It's true, we don't get a lot of them up on this unit, so here's an overview.

1) Monitoring is similar to PCA monitoring, with the addition of dermatomes, motor strength, and
catheter site Q4H. This means you should monitor and chart RR and sedation rate Q1H x 12H, Q2H x 12H,
then Q4H for the remainder of the time they have an epidural. (There's a cheat sheet for the Moline-
Roberts Sedation Scale on the EPIC Dashboard under UCH-Central-->Scales-->Moline-Roberts Sedation
Scale Chart and also Instructions.) But you must ALSO monitor (and chart) pt's dermatomes, motor
strength, and epidural catheter insertion site Q4H. What does that mean? Well...

2) Q4H Dermatome monitoring. Anyone remember dermatomes? A dermatome is the area of skin
covered by a single spinal nerve. If an area of skin is numb, it correlates to the innervation of a specific
spinal nerve. There's a dermatome cheat sheet (affectionately referred to as the Dermatome Man) on your
EPIC Dashboard under UCH-Central-->Guide-->Dermatome Guide. This guide shows you which areas of
skin are associated with particular spinal nerves.

How do you test if an area of skin is numb? Ice! Ice, my friend, a small amount in a plastic baggie placed
right on the skin of the torso. Start at the umbilicus on one side of the torso and move up. When the
patient says they can feel cold, that's the dermatome level. Do the same thing on the oher side of the
torso, starting at the umbilicus and moving up. Then, repeat on each side of the torso, this time moving
down from the umbilicus. Dermatome monitoring can be added and charted under the Pain/Med Mgt tab
on EPIC.

So what's the big deal with dermatomes? Why do we monitor them? Changes in dermatome level can
indicate that an epidural has migrated. That means it may become less effective at controlling your
patient's pain. On the other hand, it could become too effective and migrate to an area that means it
interferes with respiratory function. If your dermatomes are above the nipple line, you should notify the
Acute Pain Service immediately!

3) Q4H Motor strength monitoring. You need to assess limb strength Q4H to look for any sudden
weakening of an arm or leg that might indicate epidural migration. This is also found under the Pain/Med
Mgt tab.
Davis, Aurora
Sun 4/27/2014 2:21 PM
To:UCH-AIP 11th Onc RN <UCH-AIP_11th_Onc_RN@uchealth.org>;
1 attachment
BACK TO THE BASICS SERIES - Epidurals.doc;
7/24/2014 Epidural Monitoring - Davis, Aurora
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4) Q4H Epidural Catheter site montoring. Epidurals can be pulled out just like IVs, and therefore, the site
needs to be monitored and charted on just like an IV. You can add the epidural site charting under the
Pain/Med Mgt tab.

5) APS--the Acute Pain Service--owns all epidurals and is your go-to resource for epidural questions
and problems. If you have issues with pain control and the patient is on an epidural, APS should be your
first call. They are the ones who decide if the patient gets changes on their epidural or additional
narcotics. They should also be notified of problems like decreased RR, oversedation, weakness in
extremities, dermatomes above the nipple line, or compromised epidural sites.

An updated Back to the Basics tip sheet on Epidurals is attached.

Questions? Comments? Let me know!

Aurora

Aurora Davis, RN, BA, BSN, OCN
Relief Charge Nurse
Oncology and Bone Marrow Transplant Unit
University of Colorado Hospital
Aurora.Davis@uchealth.org