Delivery of bolus dosing regime | |
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1. | Do baseline blood pressure, heart rate, respiratory rate, oxygen saturations, sedation score and pain assessment |
2. | Position patient operated side up prior to administration of the bolus dose |
3. | Clamp the thoracic pigtail drain and/or intercostal catheter if in situ |
4. | Independently double check the pre-programmed bolus against the prescription and patient with a 2nd Registered Nurse |
5. | Administer the bolus dose (The time of dose delivery is volume dependant and may take as long as 12 minutes to deliver) |
6. | Continue observations as above every 5 minutes for the next 30 minutes. But after 20 minutes from commencement of bolus delivery, unclamp the pigtail drain and/or intercostal catheter |
7. | Document and sign the Pain Management Prescription form |
8. | Observe the drain to ensure patency |
9. | Position patient in a comfortable position |
10. | Perform further observations as above after 30 minutes. |
11. | Then hourly observations until the next bolus is due (excluding the Blood Pressure) |
Monitoring of the patient | |
1. | Observations are to be performed as detailed above for delivery of a bolus |
2. | More frequent observations are required if clinically indicated or as stated in each child’s care plan. Observations include: |
· Respiratory rate | |
· Heart rate | |
· Blood pressure - not required 1 hour after bolus delivery unless clinically indicated | |
· Pain score at rest and on movement (not required if the patient is sleeping) | |
· Continuous oxygen saturations | |
· Sedation score | |
· Cumulative dose/deliveries | |
· Any adverse events | |
· Temperature and site check every 4 hours | |
Adverse events | |
1. | If adverse events occur during a bolus, cease the bolus immediately. |
Notify Acute Pain Service (APS)/Anaesthetist for all Adverse Events: | |
· Horner’s Syndrome – facial palsy, droopy eyelid, red eye, hoarse voice | |
· Hypotension | |
· Pneumothorax | |
· Infection | |
· Pain score greater than or equal to 4/10, check catheter, give multi-modal analgesia | |
· Leaking at the wound - reinforce if sterility maintained | |
· Disconnected catheter - cease infusion, wrap in sterile gauze keeping the catheter tip below the level of the incision, contact APS and inform Surgical Team of the APS decision ) | |
· Signs and symptoms of local anaesthetic toxicity are: | |
➢ Facial tingling/numbness | |
➢ Tinnitus | |
➢ Metallic Taste | |
➢ Twitching | |
➢ Seizures | |
➢ Apnoea | |
➢ Hypotension | |
➢ Cardiac arrhythmia/arrest | |
2. | In the event of an emergency (including signs and symptoms of local anaesthetic toxicity) |
· Stop the infusion immediately/unclamp chest drain if applicable | |
· Press emergency button, call emergency number | |
· Give oxygen/resuscitate if necessary | |
· Obtain intralipid 20% from Paediatric Intensive Care Unit | |
· Notify APS/Anaesthetist |