• Turn on the pump and choose menu by pressing the red stop button
• Enter Level one code: 700 followed by green arrow button
• The first screen that appears is to Prime the pumps: Enter level one code 700 followed by the green arrow button
• The pump will now prime with 5mls

You now have to select the Obstetric protocol:

• ‘Select protocol’ will appear as the second option on the screen following priming
• Press the green arrow button followed by the Level one code 700 followed by the green arrow button to confirm
• Confirm it is a new patient with the green button (No Patient ID needed)
• Choose SJH Obstetric using the arrow keys followed by the green button
• Confirm with the orange bolus button followed by the green button
• The protocol you have chosen is 7mls of a programmed bolus every 60 minutes and a PCEA dose of 7mls every 20minutes. There is an initial lockout of 20minutes of PCEA when you commence the protocol.

Test dose

There are a number of different ways to give a test dose:

1. 4mls 2% Lignocaine- This has been used for many years and you may wish to continue to use this or change practice to using bag mix as a test dose
2. 10mls Bag mix taken out prior to priming and given via syringe via the epidural catheter
3. 10mls Test dose of bag mix via the pump using a Clinician bolus

• Following selection of the obstetric protocol, the screen ‘Start auto-bolus’ will be displayed
• Press the third option orange bolus button ‘for loading Dose and Start’ in order to give a clinician bolus, rather than an auto bolus
• Press the green button to confirm
• Enter level 2 code 855 followed by the green button
• Enter 10mls followed by the green button to confirm

The next programmed bolus is delayed from when you commence the protocol so the programme bolus will be given in 60minutes and the PCEA will be available in 20minutes..

Establishing the epidural: Loading Dose

Following a test dose, you may wish to then give a further loading dose. The options for this are either to use an auto-bolus from the pump of 7mls or give a clinician bolus of e.g 10mls from the bag but this depends whether you have given your test dose via syringe or via the pump.

Auto-bolus

• If you have given a test dose via a syringe, then when you have initiated the protocol you will see the screen displaying ‘Start auto-bolus’
• Press the green button to confirm and 7mls will be administered
• The 7mls intermittent bolus will be given immediately and there will be a 20minutes lock out for the PCEA

IF YOU HAVE GIVEN A TEST DOSE PLUS LOADING DOSE BY SYRINGE THEN YOU MAY WISH TO DELAY THE AUTO-BOLUS

• Press the +/- delay auto bolus which is the second option on the ‘start auto-bolus’ screen and it will be delayed for 60 minutes and the PCEA delayed for 20minutes.

Clinician bolus

Test dose given by a syringe

• If you have given a test dose via syringe but want to give 10mls clinician bolus rather than 7mls auto bolus
• Press the third option of the orange bolus button followed by the Level 2 code 855
• Press the green button to confirm.

Test dose via Clinician bolus

• If you have given a clinician bolus of 10mls as a test dose you can give a further clinician bolus as a loading dose
• Press the red button to stop
• Press the orange bolus button followed by the Level 2 code 855
• Press the green button to confirm
• Enter the amount to bolus e.g 10mls followed by the green button

NB: The auto bolus and PCEA dose are not delayed when you give a clinician bolus so they may get an additional bolus soon after.