Date of Award

Spring 5-6-2022

Document Type

DNP Project

Project Team Faculty Member

Dr. Leah Baecht

Project Team Faculty Member

Dr. Rebecca Collier


Accidental dural puncture management, continuous intrathecal/spinal catheter management, continuous intrathecal analgesia and anesthesia, difficult labor patient, quality improvement, educational assessment


Labor epidural analgesia is the most common method used to control pain associated with labor and vaginal delivery in the United States. However, the epidural catheter placement can cause accidental dural puncture in about 1 to 6% of laboring patients. Initiation of continuous intrathecal analgesia provides a good alternative to another attempt of epidural placement in certain types of the laboring population. While other countries have published referral guidelines of managing accidental dural puncture, the United States lacks such practice standards. The application of Accidental Dural Puncture Management with Intrathecal Catheter (ADPMIC) guidelines, used in other countries for difficult epidural placement in parturients, have offered effective and safe analgesia and anesthesia with fewer complications, and better patient outcomes. The anesthesia providers at the host institution had limited understanding of continuous intrathecal catheter’s benefits and uses. The purpose of this project was to educate anesthesia providers on ADPMIC principles and introduce a management protocol for laboring patients customized to host facility resources. An educational PowerPoint presentation was used to lecture on the ADPMIC principles and introduce the evidence-based protocol. A post-presentation survey was used to assess protocol understanding and willingness towards implementation. Survey results verified providers improved comprehension of the ADPMIC principles. Additionally, anesthesia providers expressed a high intent to implement the protocol into their practice. The immediate impact of the project was appreciated by provider adoption of the standardized reference tool for a visual and modifiable step-by-step when anesthesia providers encounter difficult epidural placement in laboring patients.

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