Summary of Meeting on Epidural Top-Ups

After fairly extensive discussion, it was decided that the midwives would continue to administer the top-ups, both boluses and infusions, with the provisos that: -

1. The anaesthetists provide training to the midwives at the end of which those who qualify would receive a certificate. Dr. Bachan Singh has graciously volunteered to be in charge of the course. He will be responsible for the for the overall planning and implementation of the program including the delivery of lectures, tutorials, and so on, but all anaesthetists concerned will have to give a helping hand especially in the practical training.
2. Where the midwife has acted under the instructions of the anaesthetist to the best of her abilities, the final responsibility for any mishaps would lie with the anaesthetist concerned.
3. All top-ups and changes of syringes are to be counter-checked with another qualified midwife.
4. To reduce the risk of the wrong drugs being administered, the anaesthetists are encouraged to use the continuous infusion technique. This will reduce the number of top-ups required. An additional benefit is a reduction of the workload on the midwives, which will ultimately lead to an improvement in the care that the midwives can provide to the patients.

To this end, the 100 ml 0.125 % plain Marcain solution will be made available. It would be desirable for the anaesthetist to prepare the infusion solution that he has chosen and then to: -
1. label the bottle correctly including: -
1. the total amount of the drug/s added,
2. its/their final concentration/s,
3. the range of permitted infusion rates,
4. the date and time of starting the infusion, and
5. the particulars of the patient including name and medical record number.
2. The anaesthetist should then draw up 50 ml of the solution in a syringe and connect it up to the syringe pump setting the rate at the initial rate that he has chosen.
3. The midwife will draw up 50 ml aliquots of the solution into a new 50 ml syringe, as necessary, connect it to the syringe pump, and run it at the rate specified by the anaesthetist.
5. The administration is encouraged to give preference to those midwives who have prior experience in the management of epidurals.