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Regional Anesthesia Pre-Procedure Checklist

 

1.       Resuscitation equipment immediately available
(e.g. airway devices, suction, vasoactive drugs, lipid emulsion)

2.       Patient identification
(2 criteria)

3.       Patient’s medical history reviewed

    1. Allergies
    2. Anticoagulation status
    3. Pre-existing neurologic conditions (e.g. numbness, weakness, pain)
    4. Lab results

4.       Surgical procedure/consent confirmed

5.       Nerve block plan reviewed

    1. Type of block: ____________________________
    2. Site marked
    3. Risks & benefits discussed
    4. Potential complications accepted by patient
    5. Questions and concerns addressed

6.       Necessary equipment present; drugs/solutions labeled

7.       Appropriate ASA monitors applied;
IV access, sedation, and supplemental oxygen provided if indicated

8.       Aseptic technique used:
hand cleansing performed; mask and sterile gloves used

9.       “Time Out” performed before needle insertion for each new block site if
(a) position changed
(b) separated in time
(c) performed by another team.

 

 

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