Lisa E. Bell

Date of Award


Document Type

Independent Study

Degree Name

Master of Science (MS)


Spinal hematoma formation continues to be a risk factor following neuraxial anesthesia. This is largely due to the challenges that nurse anesthesia providers are faced with when patients present with altered coagulation. Anticoagulation guidelines have been formulated, but anesthesia professionals have been unable to arrive at a common consensus regarding the implementation of spinal and epidural procedures. Therefore, nurse anesthetists are required to make decisions based on their best judgment, rather than a consistent guideline, in attempt to ensure patient safety. The purpose of this independent project was to explore the association between neuraxial anesthesia, anticoagulant medications, and spinal hematoma formation. Commonly administered anticoagulants, essential laboratory data, and timing of needle placement and catheter removal were reviewed and presented to Registered Nurse Anesthetists and students in training. The ultimate goal of the presentation was to increase the knowledge and comfort level of anesthesia providers performing regional techniques .

A comprehensive literature review that included: available guidelines, retrospective reviews, case reports, and prospective studies was conducted. The findings were compiled and presented in a power point format, which displayed the association between spinal hematoma formation and anticoagulation therapy. The physiologic framework of adaptation and homeostasis was used as the theoretical basis for the project. An informational pocket guide that explored the doses, frequency, and timing of anticoagulant medication administration in relation to the neuraxial anesthetic technique was developed. Relevant laboratory data that should be assessed prior to needle placement or catheter removal was also incorporated into the guide. The pocket guide was distributed to anesthesia providers and students in training to serve as a reference for the safe administration of regional anesthesia.