the blocked extremity. "If a patient reports any of these symptoms,
they should clamp the catheter on an elastomeric pump or turn an
electronic pump off, and immediately go to an emergency room for
care," says Ms. Winchester.
• Infection. Infection rates associated with continuous catheters are
very low, says Ms. Winchester. Indications of infection include fever,
red or warm-to-the-touch skin at the insertion site, or a foul-smelling
discharge present where the catheter is placed. Patients who suspect
the incision site is infected should contact a healthcare provider,
remove the catheter and seek follow-up care.
"You have to explain to patients very carefully in a short period
of time how the system they'll be going home with will work, how
to monitor the catheter placement, when it's supposed to come out
and what to look for while it's still inside them," says Dr. Margulis.
"I've therefore found that continuous catheters are most effective
for patients who are active participants in their own care and able
to follow detailed discharge instructions, and who have a support
structure in place at home."
Choosing to place CNBs should ultimately be done on a case-by-
case basis. Don't let concerns about managing the blocks from afar
prevent your patients from experiencing the benefits of longer-lasting
pain relief that CNBs provide. With proper oversight and planning, the
analgesic benefits far outweigh the potential patient safety risks.
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