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31.01 Patient Controlled Analgesia (PCA)

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Overview

PCA is patient controlled analgesia for usually postop pain

Nursing Points

General

  1. PCA 
    1. Patient-controlled by a button
    2. Usually to manage postoperative pain
    3. Sometimes for acute pain–> cancer
    4. Connected to patient’s IV
  2. Things to consider
    1. Age
    2. Cognitive ability
    3. Ability to use the pump
    4. Obstructive sleep apnea
    5. Renal failure
  3.  Medications used in the pump
    1. Hydromorphone
    2. Fentanyl
    3. Morphine
  4. Administration
    1. Pump set up and programmed
      1. Double nurse verification
    2. Loading dose (if ordered)
      1. This will give the patient quick relief
    3. Bolus
      1. Controlled by the patient–> push the button
      2. A lockout is set so they do not administer too much to themself  
  5. Discontinuing
    1. Wean dose down per orders

 

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Video Transcript

Today we’re going to be talking about patient-controlled analgesia or PCA.
In this lesson, we will talk about what a PCA is used for and the process of administration and some special considerations.

The main medications used are morphine, hydromorphone, and fentanyl. Let’s look at what a PCA is.

So what is a PCA? Well just like it says it is controlled by the patient. This is done by a button that they push and it is set on a pump so they get the ordered amount and not too much, which we will talk about in a few slides. Why would we use a PCA Well it is usually to manage postoperative pain and sometimes for acute pain like with cancer. And this is connected to patient’s IV. You can see in this image you have the medicine, here is the IV line going to the patient, the button for the patient to have and push. This must be pushed by the patient, that is super important to remember. And this pump is programmed for the amounts allowed. So let’s dig dipper into that.

 

This the pump will be programmed specially for each patient. The pump is set up and programmed. This will be double nurse verification. This will vary per hospital policy but usually this double verification will happen at set up, shift handoff, and then discontinuing to waste the excess narcotic. A loading dose (if ordered) will be programmed. This will give the patient quick pain relief. Then a bolus is set. So this is the part that is controlled by the patient. They hit a button and a bolus is given. A lockout is set so they do not administer too much to themself. So this means they can only get so many button pushes or so much narcotics administered in a set amount of time. They can still push the button but nothing will happen if they have reached that lockout. It is hard to see the screen on the previous slide image so let me try to draw this for you. So you have your screen and you will have something like this- Loading dose____ Basal____ Next Bolus___ Total infused___ lockout time____.

There is some things to keep in mind. Age, are they old enough to understand, do they have the cognitive ability to push the button when they have pain. Are we putting them at risk for respiratory failure? This is a narcotic so we need them to be able to metabolize and excrete it right? So how about that renal sufficiency? And obstructive sleep apnea. is this going to put them in a deep sleep where we are going to make the sleep apnea worse? So these are not contraindications but things to keep in mind.

 

Let’s review. Medications used are usually morphine, fentanyl, and hydromorphone. This is patient controlled by a button. Remember nurses program and double verify. Take into account and considerations like cognition and age. They have to be able to do this since they have to push the button. And something not mentioned before but important is when you discontinue. You will get an order and it will probably be a weaning order where the dose is cut down before fully stopping the infusion.

We love you guys! Go out and be your best self today! And as always, Happy Nursing!

 
Module 0 – Pharmacology Course Introduction
Module 3 – Disease Specific Medications

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