Care of the Patient with Peripheral Nerve Infusion

Policy PCS P-2.14

Nursing Responsibility

• to change the tubing,

• to change medication solution,

• to program the pump according to the prescription, and

• to deliver via the pump any intermittent bolus doses ordered by the Anesthesiologist

Types of Peripheral Nerve Catheters

• Femoral

• Sciatic

• Brachial Plexus

Femoral Catheter

• cover the femoral nerve, which runs along dermatome levels L2-L4.

• This will cover the front of the knee, but not the posterior or lateral aspect of leg.

• If a patient complains of pain outside of the Femoral Nerve Distribution (FND) additional pain medications will be required.

Femoral Nerve Distribution

Sciatic Nerve Catheters

Sciatic Catheters cover the sciatic nerve, which runs along dermatome levels of S1-S3.

These are often used in conjunction with Femoral Nerve Catheter to cover anterior and posterior knee for postoperative pain.

The sciatic catheter will cover the back of the knee, and medial/lateral aspect of leg.

If a patient complains of pain outside of the Sciatic Nerve Distribution (SND) additional pain medication may be required.

Sciatic Nerve Distribution

Brachial Plexus Catheter

Brachial Plexus Catheters cover the entire upper extremity in the C5-T1 distribution.

Peripheral blockade of the brachial plexus is used for analgesia of the entire extremity from shoulder down to fingers.

Brachial Plexus Distribution

Special Considerations

• When contacting “Anesthesia” you may contact the NPs Monday- Friday 8a-4p via beeper first. All other times, including Holidays contact the Anesthesiologist on call.

• Be sure that patient is aware of which “button” does what e.g. the PCA button versus the peripheral nerve infusion button, if these are not already marked- do so for the patient.

Peripheral Catheter Troubleshooting using Algorithm

Peripheral Nerve Catheter Troubleshooting Algorithm

Uncontrolled Pain Leakage Disconnection Knee Buckling

Bupivacaine

Toxicity

Review patient education &

understanding

Pain beyond Specific Peripheral Nerve

Distribution (SPND) give pain med

Check for connection

problems- tubing etc.

Check for pump problems intervene

prn or get new pump

ContactAnesthesia (NPs or

MDs)

Check connections

Cover with ABD dressing

Assess pain over Specific Nerve Distribution.

Cover with sterile dressing

Turn off pump

Give alternate pain medication prn

Contact Anesthesia(NPs or MDs)immediately

Instruct patient to stop bolus use

MonitorIf resolves ok to

resume

If unresolved Contact Anesthesia

for dose adjustment

Observe for signs: Metallic taste Perioral tingling Ringing in Ears Atypical Headache

Stop infusion & Contact Anesthesia

Immediately.

Poor pain control over SPND or ABD saturatedContact Anesthesia