Mastering Pre-Procedure Interviews, Room Control, and Positioning for Epidurals

Mastering Pre-Procedure Interviews, Room Control, and Positioning for Epidurals
1. Get Organized & Efficient at Pre-Procedure Interviews and Consent
• Prepare Before Entering the Room
o Do not enter the room until you have at least skimmed the patient’s chart, reviewed her labs, and are prepared for a thorough and efficient pre-op.
o If the patient is in pain, the moment she sees you, the clock to relief starts ticking. Read the room—don’t ask slow, meandering questions while she’s suffering through contractions. That’s torture.
• Develop a Systematic Approach to Pre-Op Interviews
o Memorize a structured, efficient system for pre-op assessments that ensures thoroughness without unnecessary delays.
o Your patients will appreciate the efficiency and will trust you more.
o A recommended method is outlined in the "NEURAXIAL for C/S" page, but use whatever system works best for you—just make sure you get good at it.

2. Control the Room
Administering epidurals is a high-stakes procedure that many patients are apprehensive about. Some will be easy, while others will be frustratingly difficult. The key is staying calm, collected, and confident.
• Maintain Composure and Confidence
o The moment you sound doubtful or hesitant, the patient (and the entire room) will feel it. Confidence is critical.
o If things don’t go smoothly—stay calm. Even experienced providers have had moments where they:
 Dropped every single item in their kit.
 Needed extra equipment or an entirely new kit.
 Had to step out at 4 AM to get more supplies.
 Directed a nurse to retrieve something mid-procedure.
o None of that matters as long as you remain in control and reassure your patient.
• Key Phrases to Maintain Confidence & Reassurance
o “This space is a little tricky, but no worries—I’m working my way in. Are you doing okay? Anything sharp or just pressure? I want to make sure you stay comfortable while I navigate this.”
o “Do you need a quick break? I can pause—just let me know when you’re ready to continue. We’ll get there, don’t worry! We’ll be best friends once this epidural is in and working.”
o “Sometimes this is just a positioning thing—let’s reposition and see if we can get the anatomy to line up a little better.”
o (Drops Tuohy on floor) → “Give me one second, I need to grab an extra piece of equipment for this kit.”
• Acting Matters
o The room could catch fire, and you still need to project calm, confidence, and control.
o A-hem, it’s called acting—many of us have delivered Oscar-worthy performances under pressure.

3. Positioning, Positioning, Positioning
• Poor positioning makes difficult epidurals even harder. Even if you’re the epidural G.O.A.T., bad positioning will close intervertebral spaces and make placement nearly impossible.
• Patients reflexively pull away when you touch them because they anticipate pain. Every time they pull away, they are extending (arching) their back, which narrows the epidural space.
• Be patient and reposition constantly to maintain optimal lumbar flexion.
Key Positioning Strategies
1. Explain the Importance of Positioning
o Tell the patient: “Positioning is the most important part of this procedure.”
o Have her feel your hand on her back and push out against it.
2. Ensure Proper Lumbar Flexion
o Think pelvic tilt—she should tuck her bottom under her rather than arching her back.
3. Correct Common Positioning Mistakes
o Leaning forward from the hips: This actually prevents lumbar flexion and throws off your angles.
o Sitting too slouched or too rigid: The patient should sit straight up like the letter L, relax her shoulders, and push her lower back outward.

Final Thoughts
Epidurals require skill, confidence, and adaptability. Every patient is different, but by preparing efficiently, controlling the room, and mastering positioning, you’ll create a better experience for both the patient and yourself.
Stay calm, focused, and in control—your patients will thank you.