SMHC Peripheral Nerve Catheters

Updated December 12, 2014
Author:Danielle Currier, PA

Description: Guidelines for Placement and Troubleshooting, and Telephone Followup of PNCs at SMMC

For Mercy PNC Guidelines, click here

Patient Inclusion/Exclusion Criteria

Currently only Interscalene Catheters are being offered at SMHC, on pre-selected patients:

  1. No contraindication to catheter placement: infection, OSA, Severe COPD, morbid obesity, coagulopathy, pre-existing numbness or weakness in upper extremity.
  2. ASA 1 or 2 or 3
  3. BMI < 35
  4. staying postop within 90 mins drive from Southern Maine Hospital- Biddeford
  5. Caretaker present for duration of catheter
  6. Working phone number to contact patient
  7. No pre-op chronic opiate use prior to surgery (previous 2 weeks of opiates acceptable)
  8. Cognitively capable of understanding catheter
  9. Upper extremity surgeries with significant pain expected in interscalene distribution: i.e., total shoulder arthroplasty

Post-op Troubleshooting (Phonecalls from Patient)

Catheter Patient Process Start to Finish FYI

  1. Patient is identified by Dr. Johnson as a catheter candidate. Patient is provided with Spectrum-created information insert regarding the block and catheter.
  2. Anesthesia reviews the patients chart to determine if we will likely place catheter given patient’s history and our exclusion criteria. Currently we are offering these for total shoulders and rotator cuff repairs. There may be other indications at the discretion of the anesthesiologist .
  3. Catheters are currently only offered by anesthesia on the second and fourth Tuesday of the month
  4. Catheter is placed in ACU with site and excess catheter taped and secured.
  5. Orders for elastomeric pump need to be entered into Meditech if pt is going home or submitted on paper if pt will be in house. Meditech order set is pre-populated with necessary information. In house order should read: Ropivacaine 0.2% in 240 ml elastomeric pump to dispense 5 ml/HR.
  6. Patient goes to OR and upon return to PACU has the elastomeric pump attached to the catheter
  7. The pump dispenses 5 ml of 0.2% Ropivacaine every hour and will last for 48 hours.
  8. In order to attach the pump, screw off the top and ensure a bead of medication forms on the top of the open end before hooking up. If this does not occur, there may be an airlock in the tubing. If you have to remove this air, connect a 3-way stopcock and syringe to the connector at the end of the pump’s tubing and aspirate the air out.
  9. Patient recovers in PACU then either is transported to the floor if they are an admission or goes back to ACU for discharge home
  10. If the Patient is going home, they will receive discharge instructions as well as an extra tegaderm in case they need to reinforce the dressing. Discharge instructions can be printed by ACU nursing under “Exit Care”. We will also plan to stock some on the catheter cart. Please ensure you label the form. We will need to make sure to obtain a working phone number so that the patient can be called at home for follow up
  11. The Patient will be responsible for removing the catheter at home about 48 hours from the time of the pump activation. They are to look for a blue tip at the end of the catheter to ensure the whole length of the catheter has been removed.
  12. Follow up: If the Patient is outpatient, they will receive follow up phone calls from either the PA or placing MD on POD #1 and POD #3 to answer any questions and ensure there are no complications. Patients will be given the Spectrum phone number and our call service knows to page the Southern Maine on call MD if a patient should require a call back. Notes should be written to document the conversation. If the Patient is inpatient (admitted), he/she will need to be rounded on while they are in house and the catheter pulled by anesthesia on POD#2 if the Patient and catheter are still inpatient at that time.
  13. Document visits or phone calls with the Patient. POD #3 call content should include:
    1. level of pain control,
    2. whether the patient is taking additional pain medications
    3. insertion site “exam” as subjectively reported (rule out any erythema, edema or drainage),
    4. absence of symptoms of local toxicity
    5. blue tip of catheter being intact after removal, and
    6. any reported residual toe numbness or weakness.
  14. If Patient reports residual block symptoms, we will need to follow up in about one week.
  15. The entire assembly: catheter, tubing, pump and “fanny pack” can all be thrown away. There is no equipment that needs to be saved or returned to the hospital.
  16. Insertion site may be left open to air or covered with a bandage if there is some residual leakage.