Pre‐procedure

ActionRationale

1. 1.Show
   Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [129], C).
2. 2.Show
   Decontaminate hands and apply personal protective equipment
   To reduce the risk of cross‐infection (NHS England and NHSI [122], C).

Procedure

1. 3.Show
   Explain to the patient that they need to report:

   • if the temperature of the spray changes or becomes warmer
   • if they cannot feel the cold sensation at all.
   This will indicate the dermatome level at which the epidural analgesia is working. E
2. 4.Show
   Remove any clothing that may restrict the assessment.
   The spray needs to be applied directly to the skin to undertake the assessment. E
3. 5.Show
   Test the spray on an area of the body that should not be affected by the epidural infusion (the face or the back of the hand).
   To ensure the patient can feel the cold sensation and to provide a point of comparison. P
4. 6.Show
   Starting at the top of the chest on one side of the torso (start at T1; see Figure 10.10), spray the ethyl chloride and ask the patient whether this feels as cold as when it was sprayed on the test area. Continue this procedure down one side of the torso and the leg (if appropriate for the level of epidural analgesia). Repeat on the opposite side of the body. Take note of the point at which the patient feels the stimulus become warmer or is unable to feel it at all.
   To ensure the highest and lowest points of the epidural block are assessed. E

Post‐procedure

1. 7.Show
   Document at what level the patient can detect a change as per the dermatome chart (see Figure 10.10).
   Good record keeping will reveal a trend or pattern of the block that will help with the pain assessment of the patient. E