Groundbreaking Summit
Article Outline
The American Association of Nurse Anesthetists (AANA, 2003) developed a position statement titled “Provisions of Pain Relief by Medication Administered via Continuous Epidural, Intrathecal, Intrapleural, Peripheral Nerve Catheters, or Other Pain Relief Devices” (1988, reaffirmed 2003). Likewise the “Association of Women's Health, Obstetric and Neonatal Nurses” (AWHONN, 2007) developed an epidural statement titled “Role of the Registered Nurse (RN) in the Care of the Pregnant Woman Receiving Analgesia/Anesthesia by Catheter Techniques (Epidural, Intrathecal, Spinal, PCEA Catheters)” (2001, reapproved 2007). In June 2007, an article was published in Pain Management Nursing titled “Registered Nurse Management and Monitoring of Analgesia by Catheter Techniques: Position Statement” (Pasero, Eksterowicz, Primeau, & Cowley, 2007).
The difference between the American Society for Pain Management Nursing (ASPMN) position statement and the two others mentioned is that if a registered nurse (RN) is educated and supported by an institution, ASPMN's position is that the RN may manage analgesia by catheter. Management includes “reinjection of medication (bolus dose) after establishment of an appropriate therapeutic range and adjustment of drug infusion rate in compliance with a licensed independent practitioner order.”
The AWHONN position statement does not permit for RNs rebolus injection, initiation of a continuous infusion, or increasing or decreasing the rate of the continuous infusion. As president of ASPMN, Nancy Eksterowicz was receiving calls asking why there were differences in the statements and if there were differences between states. This led to a summit conducted during ASPMN's annual convention. There were representatives from AWHONN, Oncology Nursing Society, Academy of Medical Surgical Nurses, ASPMN, and AANA. The goal of the summit was to have consistency in position statements between the organizations.
A great deal of discussion, led by nurse anesthetists centered on the difficulties in establishing a patent airway in the pregnant and laboring mother. This was the rationale for not permitting RNs to change the dose rates, reinject the catheter, or resume an infusion after it has been stopped. Comments by ASPMN members centered around a lack of information about the differences between pregnant and nonpregnant women's airway management.
All present at the summit agreed to integrate these special considerations in position statements. More collaboration was agreed upon. Nancy Eksterowicz agreed to send a summary statement to all parties involved.
Overall, the meeting was very enlightening, respectful, and collaborative and focused on patient safety. Everyone considered this summit for consensus on nursing practice guidelines for patients receiving epidural analgesia via catheter infusion to have been a great success.
References
- American Association of Nurse Anesthetists (AANA) (2003). Provisions of pain relief by medication administered via continuous epidural, intrathecal, intrapleural, peripheral nerve catheters, or other pain relief devices. Position statement no. 2.8. Retrieved September 24, 2009, from AANA Web site: http://www.aana.com/resources.aspx?id=778
- Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) (2007). Role of the registered nurse (RN) in the care of the pregnant woman receiving analgesia/anesthesia by catheter techniques (epidural, intrathecal, spinal, PCEA catheters). AWHONN epidural statement. Retrieved September 24, 2009, from AWHONN Web site: http://www.awhonn.org/awhonn/binary.content.do?name=Resources/Documents/pdf/5H2a_PS_Epidural.pdf
- . Registered nurse management and monitoring of analgesia by catheter techniques: Position statement. Pain Management Nursing. 2007;8(2):48–54
PII: S1524-9042(09)00103-9
doi:10.1016/j.pmn.2009.09.001
© 2009 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.
