During the calls, ask patients about these potential problems:
• Pump/catheter issues. If patients continue to experience exces-
sive pain or the pain pump isn't emptying at a steady rate, the pump
could be malfunctioning, an obstruction could be preventing the med-
ication from reaching the patient or the anesthetic could be slowly
leaking from the catheter.
Ms. Winchester says most at-home issues occur when the section of
the catheter that sits outside the body bends as the patient moves and
the dressing shifts. The part of the catheter that's under the skin isn't
truly kinked or clogged. "If this happens," she says, "nurses can
instruct patients on how to troubleshoot the problem."
If, however, the catheter does become clogged or kinked, the
patient will have to see a doctor or a nurse to have it removed and
replaced. Depending on the comfort level of patients, they could
remove catheters themselves before seeing a healthcare provider.
It's a fairly straightforward process. Patients should carefully remove
the dressing and tape, so as to not tug on the catheter. They should then
hold the catheter at its base, near the entry point, and slowly remove it.
Patients need to make sure the tip of the catheter comes out intact —
holding and pulling the medication delivery tube away from the entry
point during the removal process could cause the catheter to break.
They should also check to make sure there's no swelling or redness at
the insertion site. Minor bleeding isn't uncommon after removal and
can be stopped with a small bandage.
• Toxicity. Ms. Winchester says patients should know to look for
the signs and symptoms of local anesthetic systemic toxicity
(LAST). Although rare, LAST can occur if the large amounts of the
local anesthetic reaches the bloodstream or surrounding tissue.
LAST increases risk of cardiac complications and can cause
seizures. Red flags include ringing in the ears and tingling throughout
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