Improve Patient Safety with EPD
CategoriesPatient Handling

What is an Epidural Positioning Device

Did you know hospitals administer tens of millions of epidurals and spinal blocks each year for pain relief? Most providers perform these procedures quickly, efficiently, and with the assurance that their patients are in expert hands. Sometimes, when administering anesthesia for pain relief at the hospital, the staff administering the epidural or spinal block are the victims. Safety measures are essential to protect healthcare staff members from becoming victims of their patients. To avoid nursing injury and staff accidents, medical facilities are now implementing additional safety measures, such as using an epidural positioning device, training, and safety equipment to help reduce the risk of injuries.

What is an Epidural Positioning Device (EPD)

An epidural positioner is a positioning device that helps the patient lean forward into a proper position to receive an epidural while fully supported. It is known as an epidural chair and it consists of an adjustable headrest, chest pad, arm supports, and footrest. These components work together to provide stability and comfort to the patient. Epidural Positioner can reduce injuries and increase patient safety during epidurals and other anesthetic procedures. Devices like this are useful in operating rooms, labor, and pain management centers. The EPDs reduce patients’ and staff’s risk and improve safety by assisting with thoracic, cervical, and lumbar flexion while maintaining stability. EPDs are available in both manual and electric versions. The manual version has a spring-loaded knob for adjusting the midsection and footrest. An electronic controller controls the midsection and footrest in the electric version. EPDs are the best choice for obstetrics, thoracentesis, and obese patients.

What is Thoracentesis?

In this procedure, doctors remove fluid from between the lungs. With the EPDs, the headrest, armrests, and footplate are adjustable for safe and comfortable positioning for the patient. Using EPD for thora’ provides a solution to staff concerns about using the unsafe bedside table. Currently, EPDs for Thoracentesis procedures are becoming the new standard for care.

COVID-19 and the Epidural Positioning Device Use

As COVID-19 spreads, health care providers will continue to suffer disproportionately. Numerous frontline caregivers have been exposed in the U.S. to date. Manual patient handling is put into a new perspective regarding patient and staff safety, including staff distance and behavior. The manual handling of patients exposes nurses to musculoskeletal injuries and can increase their exposure to COVID-19. During spinal blocks and epidurals, the staff must hold the patients in position, increasing the risk of spreading the virus. So unnecessary contact is crucial for protecting the patient and nursing injury and sickness.

Safe Patient Handling and Epidural Positioner

Epidural and spinal blocks are techniques for perioperative pain management with multiple applications in anesthesiology. An epidural injects anesthesia into the epidural space, and a spinal block injects anesthesia into the dural sac that contains the cerebrospinal fluid. It gives immediate relief due to direct access. An epidural is a standard procedure performed during labor and delivery. Although it is useful as a primary anesthetic, its most common application is pain management. It can be a single shot or a continuous infusion for long-term pain relief. Although they are generally safe, there is always a risk of injury to the person administering the medication. Using these medications safely requires that staff be properly trained and equipped.

Safety equipment:

Staff members should use safety equipment when administering epidurals and spinal blocks. This includes gloves, goggles, and masks to protect them from potential infections and other risks and ensure their safety and the safety of the patients.

Training:

Medical staff should receive proper training in safely administering spinal blocks and epidurals. This training should include both classroom instruction and hands-on training, and it should cover the equipment needed, its setup, potential problems, and how to handle emergencies. Staff should also be physically fit. Safely performing these procedures requires physical fitness, precision, and agility. Personnel who are physically fit are less likely to suffer injuries when performing medical procedures.

Epidural Positioning Device and The Proper Technique:

Proper techniques help reduce complications and ensure that patients receive the best possible care. To administer epidurals and spinal blocks safely, staff must know most of the procedures. The epidural chair facilitates positioning. However, there are other traditional methods like the ‘mad cat position’ whereby: – The patient sits on the bed edge or lies on their side on the table or bed – A nurse stacks pillows on an unstable bedside table – The patient leans over it – A nurse places a stool under the patient’s feet In this traditional method, the nurse held the patient in the proper position during the procedure.

Documentation:

The staff should document all procedures, including epidurals and spinal blocks. The documentation can help to identify any potential problems.

Conclusion

A successful mobility program and safe patient handling hinge on buying in, acquiring the right equipment, and providing guidance on the best solutions to improve patient and staff safety. Ultimately, best practices are the key. It only takes one wrong lift to ruin a nurse’s career. It takes only one snap decision to end a nursing career, and we need all our nurses.

The SPH Medical EPD improves patient safety
CategoriesPatient Handling

Epidural Trends and the Epidural Chair

Current Epidural Trends in Hospitals and the Epidural Chair

Now more than ever in Labor and Delivery departments and in General Surgery areas the trend is to utilize the Epidural Chair to improve patient comfort and safety.  Equally important is the opportunity to improve safety for nursing and Anesthesia staff.  It is well known that the experience of childbirth is extremely painful for the mother. Modern medicine has advanced to provide mothers with epidural anesthesia for pain during labor. Epidural pain relief can make the child birthing experience less traumatic and exhausting for the mom. Epidural anesthesia depends on the technical abilities of the anesthetist. This requires assessing the risks that are present for the patient, positioning the patient for safe administration, and gathering the necessary staff to help with positioning. An often overlooked factor in patient outcomes in regard to pain relief is the ergonomics that nurses must respect during patient positioning to prevent themselves from developing musculoskeletal injury from repetitive patient positioning over their career. We will discuss these points in this article.

Proper positioning of the patient for safe and effective epidural pain relief can be understood with respect to the anatomy of the spinal column. The spinal cord is protected by the vertebral column. When a patient flexes their core, the posterior vertebral column spinal processes spread apart, allowing direct access to the dural sac that covers the spinal cord for anesthesia administration. Often, the nursing staff must help the patient remain in a still-flexed position to allow for safe administration. Depending on the patient’s body habitus, it can be difficult for nursing staff to hold the patient without compromising their own ergonomics. Patient positioning during administration of spinal anesthesia is very important.  EPD, commonly known as an epidural chair, has been implemented to help place patients flexed, allowing for effective anesthesia delivery.  The epidural positioning chair also doesn’t require nursing staff to put their bodies in stressful contortions, minimizing musculoskeletal injuries in the workplace.

Epidural pain relief is often significant to some expecting moms as they fear the pain during labor. Although it is a commonly performed procedure, epidural anesthesia does not come without its risk. Because the medication is being delivered near the dural sac and spinal cord, there is a risk of medication being administered within the dural sac. Risks seen during epidural anesthesia include a severe drop in blood pressure. Other side effects include difficulty urinating, nerve damage, nausea, vomiting, and infection.

Prevent Injury to the Spinal Cord

Injury to the spinal cord can also occur, with paralysis being a possible outcome. It is essential to understand these risks to help minimize negative outcomes. The Epidural chair helps decrease this risk by allowing the patient to be put in a fixed position that won’t disturb the anesthetist. Safety and reliability are of utmost importance in healthcare, and the EPD can provide proper positioning with adjustments in respect to the patient’s body habitus. Although there are many factors that go into the safe delivery of anesthesia, the utilization of an epidural chair can help mitigate the risk with respect to the proper positioning of the patient.

EPD can be used outside of the labor and delivery floor. With respect to spinal blocks and spinal taps, the chair is used because both procedures require the exact positioning. Spinal taps come with similar risks and can be mitigated similarly with the use of the chair. Often time patients who may need a spinal tap for therapeutic or diagnostic purposes must have a risk assessment which includes the ability to position the patient properly. In the pediatric population, a chair is not as helpful as children often require some form of sedation to help with patient positioning because of their age. In the adult population where body habitus is varied, an EPD chair that can be adjusted to reproduce the same position can help improve patient outcomes.

The Epidural Anesthesia

Epidural anesthesia can also be used to supplement general anesthesia for surgery and to help with pain alleviation during post-operative recovery. Surgeries that occur in the lower extremities can often be excruciating in the post-operative recovery period. Supplemental pain relief can help the patient feel more comfortable, and reduced pain perception can help a patient recover faster by complying with post-operative therapy. The utilization of an Epidural Positioning Device can help mitigate a safe and quick administration of a spinal block even in spite of staff not being able to be present for patient positioning. This kind of anesthesia helps reduce the usage of opioids for patients who refuse or patients with a history of opioid abuse.

Overall The utilization of an epidural positioning chair can help deliver safe and reliable anesthesia while reducing the risks of the procedure, the requirement of staffing, and the risk of musculoskeletal injuries. This chair can be utilized in similar procedures such as the spinal tap or even thoracentesis, which shows promising application outside of just epidural anesthesia. This trend to improve patient and staff safety using the EPD is increasing. Word is spreading in clinical circles that the simplicity and ease of use of the EPD drives compliance and therefore reduces risk, a very positive trend indeed.

References:

Comparing Three Different Modified Sitting Positions for Ease of Spinal Needle Insertion in Patients Undergoing Spinal Anesthesia by Sussan Soltani Mohammadi, Mohammadreza Piri, and Alireza Khajehnasiri 2017

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