PCA Pumps

PCRA is typically accomplished by inserting a small catheter into the affected site, and then attaching the catheter to some type of pump that enables the patient to self-administer small amounts of medication as needed. For example, a PCA system has been used to deliver local anesthetics such as bupivacaine and ropivacaine into the subacromial space following acromial decompression surgery.3,27 Likewise, PCRA can be used to deliver a local anesthetic to the area around a peripheral nerve (sciatic, popliteal, and so forth), and 

Disposable models of external PCA pump are also available, offering a simple and less costly method for pain management.32,42 Rather than using sophisticated electronic controls, these disposable pumps are typically activated when the patient squeezes a 

Feature Abbott AMP II Abbott LifeCare 4100 PCA Plus II Baxter 6060 Baxter PCA II 

Power source Wall plug in AC 2 X 9-volt alkaline battery NiCd rechargeable battery pack Wall plug in AC one 8-volt sealed lead-acid battery 2 X 9-volt alkaline or lithium batteries external lead-acid battery pack Four D-cell alkaline batteries AC power kit with two rechargeable NiCd batteries 

Comments Meets all basic requirements for performance, safety, and ease of use. Performs adequately, but has a number of minor drawbacks in its ease of use and safety features. Meets most requirements has a mix of minor advantages and disadvantages ease of use is only fair. Meets most requirements and offers some advantages, but also has some drawbacks, most notably in its data logs and alarms. 

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Opioids maybe administered in a variety of routes including oral (tablet and liquid), sublingual, rectal, transdermal, transmucosal, intravenous, subcutaneous, and intraspinal. While the oral and transdermal routes are most common, the method of administration is based on patient needs (severity of pain) and characteristics (swallowing difficulty and preference). Oral opioids have an onset of effect of 45 minutes, so intravenous or subcutaneous administration maybe preferred if more rapid relief is desired. Intramuscular injections are not recommended because of pain at the injection site and wide fluctuations in drug absorption and peak plasma concentrations achieved. More invasive routes of administration such as PCA and intraspinal (epidural and intrathecal) are primarily used postoperatively, but may also be used in refractory chronic pain situations. PCA delivers a self-administered dose via an infusion pump with a preprogrammed dose, minimum dosing interval, and maximum hourly dose. Morphine, fentanyl, and hydromorphone are commonly administered via PCA pumps by the intravenous route, but less frequently by the subcutaneous or epidural route. 

TV) line. The catheter is then connected to a PCA pump (see later), and small intermittent doses of the analgesic are administered through the catheter and delivered directly into the systemic circulation. This technique is often effective in allowing the patient to regulate his or her level of analgesia for a short period of time (e.g., for the first few days after surgery). 

FIGURE 17-2 Schematic representation of an implantable vascular access port that can be used with PCA. The port can be connected to a PCA pump via a percutaneous needle, and a catheter leads from the port to a large central vein. [From Knox LS. Crit Care Nurse. 1987 7 71 with permission.]... 

FIGURE 17-3 T Schematic illustration of PCA spinal delivery. The catheter delivers the analgesic into either the epidural or intrathecal [subarachnoid] space. Catheters for long-term use are tunneled under the skin (dashed line) and can either be connected directly to an implanted PCA pump, or exit the anterior-lateral flank for connection to an external pump. 

Table 17-2 BASIC FEATURES OF SOME COMMON PCA PUMPS ...

FIGURE 17-5 An example of an implantable, electronically controlled PCA pump. This pump is implanted surgically in the patient s abdomen and can be refilled periodically through a self-sealing septum. 

Misprogramming PCA device Failure to clamp or unclamp tubing Improperly loading syringe or cartridge Inability to respond to safety alarms Misplacing PCA pump key... 

Failure to understand PCA therapy Misunderstanding PCA pump device Intentional analgesic abuse... 

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... 

Lockout interval The minimum amount of time that must expire between each dose of medication that is administered by patient-controlled analgesia (PCA). The PCA pump is inactivated during the lockout interval so that the patient cannot self-administer excessive amounts of drugs. 

High-risk drugs opiates and narcotics Limit floor-stock availability, double check patient-controlled analgesia (PCA) pumps Remove from floor stock ... 

In the oncology setting, pain management practices vary greatly. The pharmacist may assist in the management of an acute pain crisis with a PCA pump. After an adequate analgesic level is reached, the patient will need to be converted to oral therapy. In other patients, initial regimens can be developed as outpatients. The patient is then followed closely and monitored with medication adjustments when necessary. 

The client who has had an abdominal surgery has returned from the post-anesthesia care unit (PACU) with a patient-controlled analgesia (PCA) pump. Which intervention should the nurse implement ... 

The male client diagnosed with renal calculi is receiving pain medication via a morphine patient-controlled analgesia (PCA) pump. The HCP prescribed the nonsteroidal anti-inflammatory drug (NSAID) indomethacin (Indocin) in a rectal suppository. Which action should the nurse take ... 

The client can push the button on the PCA pump whenever the client feels pain. There is a 4-hour lock out programmed into the machine to prevent overdose. 

Request a patient-controlled analgesia (PCA) pump for the client. 

The client should have intravenous pain medication until hemodynamic stability and unimpaired tissue perfusion return. The PCA pump provides an intravenous route, and the client can control the amount of medication administered with the PCA, ensuring safe limits of pain medication. 

Crampy pelvic pain commonly occurs within the first 24 h of UAE and is usually controlled with a patient controlled analgesia (PCA) pump using morphine or another narcotic. Patients should be placed on an anti-inflammatory prior to the embolization and while in the hospital. Toradol intravenously prior to the embolization and during the hospitalization appears to be very effective. It is reasonable to develop a set of standard orders that the patient will receive to cover the most common eventualities. 

There is no doubt that medical device design engineers do design good equipment, including that of IV and PCA pumps. However, no pump is perfect. Engineers are not users and therefore HF evaluations are critical. These evaluations can provide salient information in two critical areas. 

Chisholm S., Kramer S., and Lockhart, J. Heuristic comparison of two PCA pumps. Cognitive Ergonomics Research Laboratory, University of Calgary, 2005. 

Santell JP (2005). Preventing enors that occnr with PCA pumps. US Phannacist 2005 30 58-60.htlp //www.usphamiacist.coni/index.asp show-aiticle page=8 1414.htm (Accessed 2006/01/27)... 

After removal of the common femoral artery vascular sheath and proper hemostasis is achieved, the patient is placed on monitoring for 4-5 h and patient controlled analgesia (PCA) pump and i.v. hydration are initiated. At the end of the monitoring period and if no untoward events are noted the patient is sent to the floor. Routine nursing checks and care are adequate thereafter. P.R.N. medication should include (in addition to the morphine or fentanyl PCA pump), anti-nausea and additional pain medication for breakthrough pain. Hydration is critical not only because of the patient s NPO status prior to the procedure and possible nausea, but more importantly to mitigate the consequences of a possible tumor... 

Medications Patient controlled anesthesia pump (PCA pump, separate order sheet)... 

PCA pumps are a class of infusion pump used to administer pain relief medication. They are employed for self-administration where a patient is able to request pain relief in controlled amounts when they need it. The patient interacts with the PCA pump using a single button, which is used to request additional predefined doses of drug. The intended infusion parameters are programmed in advance by clinicians. In the current generation of infusion pumps, clinicians program infusion parameters by interacting with buttons on the user interface. 

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