2IntroductionPurpose: This inservice presentation is intended to familiarize the clinician with ON-Q C-bloc including Select-A-Flow® and ONDEMAND models for continuous nerve block applicationsCaution: This in-service does not replace the product Directions for Use (DFU). It is imperative that the clinician read and understand the product DFU. The DFU contains detailed product information, including important cautions, warnings and contraindications
3IntroductionThere are inherent risks in all medical devices. Please refer to the product labeling for Indications, Cautions, Warnings and Contraindications. Failure to follow the product labeling could directly impact patient safety. Physician is responsible for prescribing and administering medications per instructions provided by the drug manufacturer. Refer to for product safety Technical Bulletins.
4Objectives At the completion of this inservice, the participant should be able to:Identify common continuous peripheral nerve blocks (CPNB)Identify components of ON-Q C-bloc with Select-A-FlowIdentify components of ON-Q C-bloc with ONDemandAssess pump infusion statusIdentify signs and symptoms of local anesthetic toxicity and appropriate interventionList resources available for product support
5What is ON-Q? Description ON-Q is an elastomeric pump that automatically delivers a continuous regulated flow of local anesthetic over multiple days.It is completely portable.The pump is connected to a catheter placed near a nerve for regional anesthesia and/or pain management.ON-Q is indicated to significantly reduce narcotic use and pain when compared to narcotic-only pain management.
6ON-Q C-bloc Potential Patient Benefits Quicker return to normal Reduced length of hospital staySignificantly better pain relief than narcotics aloneSignificantly less need for narcotics post-surgeryHigher patient satisfaction
7Continuous Peripheral Nerve Block (CPNB) The abolition of painful impulses by temporarily interrupting the sensory nerve conductivity with local anestheticsLocal anesthetic can be delivered as a single injection or as a continuous infusion.Motor function may or may not be affected.The patient does not lose consciousness.Opioids/ General AnesthesiaEpiduralLocal AnesthesiaCPNB
8Nerve Block Applications Majority for orthopedic proceduresIncreasing number on an outpatient basisContinuous Peripheral Nerve Block (CPNB)Local anesthetic administered as a continuous infusionProvides pain management after the surgical procedure.ON-Q C-bloc pump functions as the medication delivery deviceOther Nerve Blocks Include:Intercostal and paravertebral for thoracotomy and rib fracturesTransversus Abdominus Plane (TAP) blocks for abdominal procedures
10CPNB Catheter Placements Upper Extremity BlocksBrachial Plexus BlockUsed for shoulder, arm, hand proceduresBrachial plexus is a network of nerves originating in the upper spine and ending in the main nerves that control movement and sensation in the armApproaches (procedures)Interscalene (shoulder/upper arm)Supraclavicular (below the shoulder)Infraclavicular (arm)Axillary (elbow, hand, forearm)
11CPNB Catheter Placements Lower Extremity BlockApproaches (procedures)Lumbar plexus (hip, leg)Femoral (Upper leg, knee)Sciatic (posterior thigh and knee, foot and ankle)Popliteal (foot and ankle)
12CPNB Procedure Overview Procedure performed by an anesthesiologist trained in regional anesthesia techniquesCatheter placed near a nerve prior to surgery:Anatomical landmarks used to establish location of block areaUltrasound guidance may be used to locate nerve for more accurate block placementNerve stimulator device may also be used to identify location of the nerve.Stimulator provides current to either a stimulating needle or catheterPresence of an appropriate muscle twitch confirms correct locationON-Q C-bloc pump may be connected to nerve block catheter before, during or after surgeryUltrasound GuidanceLandmarksNerve Stimulator
15Select-A-FlowVariable rate controller that allows the flow rate to be adjusted within a predetermined range designated on the device.Model1-7 ml/hr2-14 ml/hrDual: 1-7 ml/site;600 ml volume(750 ml max volume)400 ml volume(550 ml max volume)
16Select-A-Flow Components 1 Rate changing keyAllows titration for optimal pain reliefKey is removable for tamper resistance2 Plastic CoverTamper evident3 Tie WrapLocks plastic coverto Select-A-FlowSelect-A-Flow should be outside of clothing,away from ice or cold therapy.
17Select-A-Flow To Change Flow Rate Insert rate changing key into the dialTurn the dial until the new flow rate is selectedMake sure you hear the dial “click” into place and the selected flow rate is aligned in the window with the ml/hr mark on the Select-A-FlowCaution: Dial must “click” into place to ensure accurate flow rate. Flow rate is unpredictable if it is dialed between rate settings.
18Select-A-Flow To Discourage Tampering Remove the rate-changing key from the dial by pulling the key straight out.Put the key in a safe place for later use.Close the cover over the Select-A-Flow.For increased tamper resistance, the cover may be locked to the Select-A-Flow using the tie wrap.
19Select-A-Flow Dual Site 600 ml volume pump with dual Select-A-Flows.Flow rate range 1-7 ml/hr per catheter site.Allows infusion from one pump through two nerve block catheter sites.Example CPNB applications:Femoral and SciaticFemoral and Popliteal
21Infusion StatusA change in appearance and size of the pump may not be evident for more than 24 hours after surgery.Over time, outside bag on pump will become looser and creases will begin to form in the bag.As medication is delivered, pump balloon will gradually become smaller.Pump appearance afterapproximately 24 hours
22End of InfusionDepending on size and volume of pump, infusion typically lasts 2-5 days.Infusion is complete when delivery time has passed and pump is no longer inflated.A hard tube will still be present in the middle of the pump.Dispose according to your institutions protocol.TubeContact physician for catheter removal instructions
23Accessories/Patient Instructions Disposable Carrying CaseThe pump is completely portablePatients can wear the ON-Q C-bloc pump in a convenient fashion such as around the waist, over the shoulder or around the neckPatient GuidelinesIncluded with each pump
24Checklist Follow these 5 simple checks: Keep clamp(s) open Tubing is not kinkedFilter is not taped or coveredFlow ControllerFixed Flow Rate Restrictor – taped to skin, away from cold therapySelect-A-Flow and ONDEMAND - outside of clothing, away from cold therapyFlow Rate (Select-A-Flow)Verify flow rate, making sure the flow setting is aligned withthe ml/hr mark on the face of the Select-A-Flow
26Patient Monitoring Assess pain and sensory/motor function. Assess catheter site for redness, drainage, leaking.Maintain transparent dressing.Avoid injury due to sensory/motor loss.Educate patient on proper measures to take to avoid injuryProtect limb with slingUse crutches or walker for weight bearingTake care when placing warm or cold items on extremityAssess for signs/symptoms of local anesthetictoxicity.
27Patient MonitoringWhen assessing pain, ask patient location of pain to differentiate between operative site pain and other types of pain.ON-Q C-bloc will reduce or eliminate pain around the operative area, as part of a multi-modal approach to post-op pain management.Administer post-op pain medications as needed.
28Patient Monitoring Signs and Symptoms of Local Anesthetic Toxicity Numbness/tingling around mouth, fingers or toesDrowsinessConfusionCaution Close tubing clamp to stop infusion and report any of thefollowing to physician:Dizziness, light headednessBlurred visionRinging, buzzing in earsMetal taste in mouth
29Discharge Instructions Follow physician’s instructions, keeping inmind the following:Do not drive or operate machineryKeep catheter site clean and dryProtect the limbDo not allow weight bearing on affected limbInstruct patient and caregiver on signs of local anesthetic toxicity and infectionsInstruct patient how to turn off the pumpProvide a 24-hour contact number for emergencies and medical adviceEnsure patient has ON-Q Patient GuidelinesFollow physician’s instructions for catheter removal
31Frequently Asked Questions Can patients shower with ON-Q C-bloc?Refer to physician’s orders for patient bathing or showeringPump and catheter site should be protected from water
32Frequently Asked Questions What should I do if my patient continues to complain ofpain?Check the tubing for kinksMake sure clamps are openCheck to be sure the Select-A Flow dial is set to the ordered flow rate, and not Ø or between settingsMake sure the catheter is in place and has not been dislodgedAdminister pain medications as orderedContact physician if patient’s pain continues