Patient-controlled analgesic pumps

Source Adapted from Patient-controlled analgesic infusion pumps. Health Devices. 2001 30 168, 169,182 with permission. 

An infusion control device (ICD) is a device that maintains a constant infusion rate in a gravity flow system (controller) or via a positive pressure pump. A positive pressure pump is a device that provides mechanical pressure (2-12 psi) to overcome the resistance to flow in the vessels. The types of positive pressure pumps are categorized according to how they deliver the solution and their degree of precision in the flow rate. Positive pressure pumps include peristaltic pumps, cassette pumps, syringe pumps, non-electiic or disposable pumps, and patient-controlled analgesic... 

Using Fhtient-Co ntro lied Analgesia. Patient-controlled analgesia (PCA) allows patients to administer their own analgesic by means of an IV pump system (Fig. 19-1). The dose and die time interval permitted between doses is programmed into die device to prevent accidental overdosage. 

Parenterals are administered to the body by injection. They must be sterile, nonpyro-genie, and particulate-free. Examples of compoimded parenterals include high-dose analgesics for patient controlled analgesia (morphine sulfate 50 mg/mL), antiemetic injections, fentanyl and bupivacaine injections for ambulatory pump reservoirs, oncology combinations, and others (Table 10). 

Medico-technical instruments such as infusion pumps can be used in PCA (patient-controlled analgesia, Fig. 1) to provide patient-orientated and therapy as required, e.g. with morphine injection solutions. Depending on the patients perception of pain, they may add small doses of analgesics to the basic infusion by means of an electrically controlled infusion pump. The physician specifies the basic dose, which is infused independent of patient demands, the boluses that can be demanded, an hourly maximum dose and a refractory time that cannot be reduced between two doses. The infusion may be given intravenously, subcutaneously, epidurally or intraspinally. 

The client is postoperative for a cervical laminectomy and is prescribed meperidine (Demerol), a narcotic analgesic, by patient-controlled analgesia (PGA) pump. Which instruction regarding pain control should the nurse teach the client ... 

When the oral route is unavailable opioids may be administered by continuous infusion (pump) and when appropriate under control by the patient - advantage constant therapeutic plasma level disadvantage indwelling catheter. When constipation becomes intolerable morphin can be applied near the spinal cord permitting strong analgesic effect at much lower total dosage. 

PCA allows the patient to self-administer a small amount of analgesic medication on a relatively frequent basis. This technique has been used to administer drugs such as opioids and local anesthetics. PCA can often provide better pain control with smaller quantities of the drug and a lower incidence of side effects. The patient is allowed to self-administer a small dose of the drug by pressing a button that is connected to some type of pump. These PCA pumps vary in cost, level of sophistication, and location (external versus surgically implanted), but all pumps... 

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