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ANESTHESIA ALERT
areas. Those less-accessible placements make it more difficult for
patients to watch and maintain their catheters. In fact, all of the clinically significant catheter infections we've seen at our institution have
occurred with lower-extremity sites. We even saw a (non-infected)
catheter patient who returned for a surgery follow-up exam 30 days
after his surgery with his femoral catheter still in.
Naturally, patients are also more susceptible to falls if their lower
extremity nerves are blocked and they can't feel their legs. That's one
reason proper patient selection and education are of paramount importance with this group. Additionally, any patient who receives a femoral
nerve block, especially a catheter, needs to wear a knee immobilizer at
home.
Ideally, you'll educate patients first in a pre-op clinic, again just
before surgery and again before discharge. Educate family members
or friends who accompany the patient home. Both the patient and the
family need to understand all instructions and all potential problems.
Handouts that reiterate everything, list contact information and
include FAQs are helpful. Don't forget to educate your surgeons about
CPNBs, as they're frequently the first people patients contact when
they have concerns.
When to avoid CPNB
If a patient is going home alone or has a language or other communication barrier, lower extremity CPNB is not a good option. As a case
in point, a schizophrenic patient of ours received a sciatic catheter
and a rescue femoral nerve block for an ankle fracture. He went home
alone without a knee immobilizer and fell, fracturing his femur.
Also check for any predisposing comorbidities or risk factors.
Ultimately, you need to feel confident that the patient is trustworthy
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O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E | S E P T E M B E R 2013
