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Hellena



Oct 4, 06 - 3:06 PM 		epidural catheter removal

we need to rewrite our guidlines on epidural removal. Can I ask who you allow to remove, what instructions you give, and what about timing for patients on s/c heparin (how long do you wait?)

thanks
Ann



Oct 5th, 2006 - 2:09 PM 		Re: epidural catheter removal

Trained nurses are allowed to remove ours as long as they have done the pain/epidural training day.
The catheter should be removed 12hrs after last dose & 4hrs prior to the next dose of sc anti-coag.Hope its of help.
Dee



Oct 5th, 2006 - 2:11 PM 		Re: epidural catheter removal

Removal of epidural is included in our epidural competency, so, registered nurses who have had epidural training and fulfilled the competency can take them out.

Re anticoagulants, our advice is:

Do not remove until 12 hours after the last dose of Tinzaparin or 4 hours after Heparin. Do not give any Tinzaparin or Heparin for 2 hours after the epidural catheter has been removed.

HTH
Dee
Jane donn



Oct 6th, 2006 - 12:07 PM 		Re: epidural catheter removal

Hi all,

I would recommend a paper I stumbled across the other day.

Douketis J, Dentali F (2006) Managing anticoagulant and antiplatelet drugs in patients who are receiving neuraxial anesthesia and epidural analgesia: a practical guide for clinicians. Techniques in Regional Anesthesia and Pain Management 10:46-55.

This paper summarises all the evidence for management with a wide range of anticoagulants.

Also
Broadman L (2005) Non-steroidal anti-inflammatory drugs, antiplatelet medications and spinal axis anesthesia. Best Practice & Research Clinical Anesthesiology 19(1):47-58

Horlocker T (2001) Low molecular weight heparin and neuraxial anesthesaia. Thromb Res 101:v141-v154

Douketis J et al (2002) Anticoagulant effect at the time of epidural catheter removal in patients receiving twice-daily or once daily low-molecular weight heparin and continuous epidural analgesia after orthopedic surgery. Thromb Haemost 88:37-40

As with others, removal of an epidural is one of the epidural trained nurses competencies. The actual removal is not rocket science - its the appreciation of anticoagulation effect.


Hope this helps

Jane The Pain
Kirsteen



Oct 11th, 2006 - 8:41 AM 		Re: epidural catheter removal

Epidural catheter removal is a mandatory component of our Epidural competency for those staff in the Labour & Delivery unit. In other areas the APS nurse removes the catheters. Re coagulation. We wait 12 hours post LMWH if it is a q12h dose and 18 hours if it is a once daily dose. For LDUH we wait 6 hours after the last dose. For both LDUH and LMWH the staff must wait 2 hours after the removal of the catheter before giving the next dose of anti-coagulant. Hope this is of some use.
Sarah E



Oct 16th, 2006 - 11:14 AM 		Re: epidural catheter removal

Any trained nurse that has attended our epidural study day can remove cathereters.

With regards to LMWH it is 12 hrs post last dose. No guideline on when they can have the next following removal. If a patient is on warfarin we like to see what the INR is. In our Trust INR is to be 1.5 or less for removal. HTH
cheryl



Oct 17th, 2006 - 11:49 AM 		Re: epidural catheter removal

Incidentally, I wonder what the actual figures are for haematoma risk, and how the 12 hour figure is arrived at? INR assessment seems much more reliable but a bit of a faff! Otherwise, our Trust is the same as the others here - 12 hours post LMWH and no further dose given for 2 hours.


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