| Frequently Asked Questions |
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| Category #25 - Nursing care of CPNB |
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| Troubleshooting CPNB |
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Floor nurses of our facility are wondering if there are certain procedures, or charting mechanisms, that they should be aware of. Our anesthesia people using the blocks repeatedly response, "if at any time there is an issue, call me". Are there protocols for the first line neophytes or older nurses haven't seen these often?
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Thank you for asking this question.
If you go back to the website (http//www.RAEducation.com), you will see there is a section on tutorials. No. 10 on the menu for tutorials is CNBB at home. This is a PDF version of a booklet that I produced on the management of continuous peripheral nerve blocks. You would be welcome to download and print this booklet and you will see that half way through the booklet, there is a section on scenarios starting with "what if". This should give answers to most of the commonly occurring problems and the last of these "what ifs", is "what if you cannot find the answer to your question"? The answer is then to contact the physician that placed the block. There is also a section on "what if I am the physician that gets called for these problems". There are algorithms that cover most of the problems that nurses and physicians may encounter.
I trust that you find this answer satisfactory. Please do not hesitate to contact us if you have any problems downloading or printing this booklet.
Kindest regards,
André Boezaart |
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What are your thoughts on glue to keep the catheter in place?
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It is not necessary if tunneling is implemented, but it may be of value. Since we tunnel our catheters, we have very little experience with this.
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What is the role of the skin bridge?
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The skin bridge acts as an anchor for the catheter and facilitates easy catheter removal. While securing the proximal end of the catheter, the distal end of the catheter is aseptically removed from the patient by lifting up on the skin bridge. Once the distal end is free from the patient, the catheter can be easily pulled free from the patient from its proximal end. With a skin-bridge, catheter removal is easier, but there is a higher incidence of leaking around the catheter entry site. If the catheter is tunneled without a skin-bridge, its removal may be more difficult, but leakage (and probably infection) will be less of a problem.
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What is the maximum length of time that you keep a catheter in place?
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We typically keep them in place for 2-5 days, but have had good success for as long as 7 years. The best judge for how long a catheter should stay in is the patient. We turn the infusion off every day at the morning rounds and after an hour or so ask the patient if the block is still required. If yes, we bolus the block and let it run for another 24 hours. If no, we remove the catheter.
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Who removes your catheters?
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Although we are aware of the practice of others that allow the patient to remove
the catheters, we have the patients visited by a nurse practitioner at his/her
home every day and this nurse removes the catheter. These VNA's (Visiting Nurse
Associations) are available in most cities and towns in the USA, and there is
really no reason not to make use of their excellent services. When the patient
is in the hospital, the nurses of the Pain Service removes the catheters.
(Please see Tutorials # 10 CNPB at Home on the
http://www.RAEducation.com website)
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Where can I as nurse/physical therapist/family physician get to learn more about nerve blocks?
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We have just produced a booklet "Understanding Nerve blocks". This has all the
blocks, for what surgery and what to be careful of. You can get at
http://RAEducation.com. This booklet
is especially valuable for nurses, physical therapists and other professionals like
family physicians.
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