Pre‐procedure

ActionRationale

1. 1.Show
   Explain and discuss the procedure with the patient. Obtain informed verbal consent from the patient.
   To ensure that the patient understands the procedure and gives their valid consent and to ensure the patient has time to assess information and ask questions (NMC [159], C).

Procedure

1. 2.Show
   Ensure patient's privacy and dignity are maintained throughout the procedure by use of curtains or screens.
   To maintain privacy and dignity.
2. 3.Show
   Explain to the patient that they need to report:

   • if the temperature of the ice/cold changes or becomes warmer
   • if they cannot feel the ice/cold sensation at all.
   This will indicate the dermatome level at which the epidural/intrathecal analgesia is working.
3. 4.Show
   Remove any clothing that may restrict the assessment.
   The ice or spray needs to be applied directly to the skin to undertake the assessment. E
4. 5.Show
   Test the ice/cold pack or spray on an area of the body that should not be affected by the epidural/intrathecal infusion (the face or the back of the hand).
   To ensure the patient can feel the cold sensation. P
5. 6.Show
   Starting at the top of the chest (just above nipple level), place the ice/cold pack/spray above the incision or level of pain and ask the patient if this feels as cold as when placed on the test area. Continue this procedure down the torso and the legs if appropriate for the level of epidural/intrathecal analgesia and on the right and left of the body.
   To check sensory block level and assess effectiveness and safety of epidural block.
6. 7.Show
   Replace patient's clothing.
   To maintain privacy and dignity.

Post‐procedure

1. 8.Show
   Document at what level the patient can detect a change as per the dermatome chart (see Figure 22.11).
   To maintain accurate patient record.