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Clinical governance

There should be formal induction courses and regular updates for doctors, nurses, theatre staff and recovery staff who will be responsible for supervising patients receiving CPNBs. The acute pain service or a clearly designated consultant anaesthetist from the anaesthesia department will be responsible for the immediate supervision of patients receiving local anaesthetic infusions. The National Patient Safety Agency (NPSA) ([131]) recommends that in addition to routine training and regular updates, additional training should occur when changes are made to protocols, medicinal products or medical devices.

Competencies

Nurses who monitor patients with a CPNB should have knowledge of:
  • the anatomy and physiology of the spinal cord and column and the neurological system
  • the purpose of the peripheral nerve catheter for pain management
  • the CPNB process and signs and symptoms of peripheral nerve catheter misplacement
  • the effects of medication administered for a CPNB
  • untoward reactions to medication and management of complications.
Nursing care responsibilities include:
  • observation
  • any necessary procedures (e.g. reinforcing dressings or catheter removal)
  • an understanding of the infusion pump in use
  • documentation of care
  • removal of the catheter once treatment has been discontinued.
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