I Can See Clearly Now with Ultrasound

Author

Freddie Caldwell, The University of Texas at El Paso

Date of Award

5-2020

Degree Type

DNP Project

Degree Name

Doctor of Nursing (ND)

Department

Nursing

Chair

Elizabeth Portugal

Abstract

Pregnant women in active labor are presenting to Labor and Delivery units with increased risk factors for placement of labor epidurals for pain management. Anesthesia providers are challenged with providing a safer alternative to the traditional labor epidural placement process. Evidence shows that providers of anesthesia care can have safer outcomes for patients when they place lumbar epidurals with the use of pre-procedure ultrasound assistance. The population affected in this quality improvement (QI) project was pregnant women ages 22 to 35 years of age in active labor and admitted to William Beaumont Army Medical Center’s (WBAMC) labor and delivery unit. These pregnant women were requesting a labor epidural for pain control and who were deemed to be difficult lumbar epidural placements. For the focus of my DNP project, these patients presented with a body mass index (BMI) of greater than 30 kg/m², scoliosis, anatomical abnormalities in the lumbar region, or patients who have had lumbar spine surgery that is from the L2 to L5 interspace. The evidence showed that the use of ultrasound for anatomical visualization has proven to be an asset for use in this client population. Ultrasound-guided neuraxial procedures are more commonplace with anesthesia providers in recent years (Sahin & Balaban, 2018). Ultrasound is also shown to increase the safety and efficacy of regional anesthesia in many anesthesia providers’ current practices. Ultrasound is grossly underutilized at WBAMC when it comes to difficult placement of lumbar epidurals for patients in labor. This patient population can present with obesity or structural problems that can be better identified with the use of ultrasound guidance. My QI project will increase use of ultrasound technology for women with potentially difficult lumbar epidural placements in my workplace facility.

Recommended Citation

Caldwell, Freddie, "I Can See Clearly Now with Ultrasound" (2020). Cohort VIII. 10.
https://scholarworks.utep.edu/cohort_8/10