Docstoc

03-080 Patient Controlled Analgesia

Document Sample
03-080 Patient Controlled Analgesia Powered By Docstoc
					                                                             Nursing Policy and Procedure Manual
                                                                                   Section III-080
                                                                                           CORE

                                 Murray-Calloway County Hospital
                                  And Long Term Care Division

POLICY TITLE:
Patient Controlled Analgesia (PCA) Infuser, Management of

POLICY STATEMENT:
PCA administration is performed by a nurse who has been educationally prepared to administer
analgesia via a PCA pump and has demonstrated competency to do so. A registered nurse or LPN
under the supervision of an RN sets up the PCA and administers the loading dose. Two nurses
check the set-up, verify various pump readings, and ensure that changes made to the PCA are done
correctly.

In acute care and long term care, count results are viewed and documented by 2 nurses. In Home
Care and Hospice a caregiver may act as a second witness in place of a nurse.

PROCEDURE:
Supportive Data:
Patient controlled analgesia (PCA) allows the patient/resident to self administer small doses
of intravenous narcotics, usually Morphine or Demerol, through an existing IV line. A PCA
consists of three parts: 1) An infusion pump with a chamber that houses a prefilled syringe or
bag (infuser); 2) A timing unit linked to a button that is activated by the patient/resident to
deliver a preset dose of analgesic medicine; and 3) Tubing that delivers the medication from
the infuser to an indwelling IV.

A key is required to open the security door, allowing access to the syringe chamber and the dose
regulating touch switches. This PCA key is checked out of the Omnicell dispensing system in acute
care and from the narcotics drawer in LTC.

The PCA can be programmed for a specific dose, time interval (lock-out), and 1-hour limit to
prevent overdosing. The advantage of a PCA is that it allows a more constant serum level of
narcotic and therefore a more constant level of analgesia.

Analgesia may be administered by a PCA infuser. In the Home Care/Hospice setting, a CADD-
PRIZM is the preferred method of PCA administration due to size, convenience, and ease of use.
(See Nursing Policy & Procedure Manual, III-82, “CADD Infusion Pump, Management of.)

Equipment:
PCA
- PCA pump
- PCA syringe with prescribed narcotic
Management of Patient Controlled Analgesia (PCA)           Nursing Policy and Procedure Manual
Infuser                                                                        Section III-080a

               STEPS                                              KEY POINTS

Management of Patient Controlled Analgesia (PCA) Infuser
                Nursing Policy and Procedure Manual
- PCA tubing (PCA set, mini-bore)
- PCA pump key
- Patient IV access device

I. Set-Up
 1. Review physician order for specific narcotic
       to be used, dose, lock out interval, and 1-hour
       limit. Check against patient/resident allergies.
 2. Sign out PCA narcotic analgesic.                       See Attachment I, "PCA
                                                           Distribution, Administration, and
                                                           Wastage Flow Chart”. In acute care
                                                           scan the PCA vial before beginning
                                                           the set-up.
3.   Explain procedure and dosage ordered to               In acute care, take medication to
     patient/resident. Emphasize signs and                 patient’s room, open the patient’s
     symptoms that should be reported to the               eMAR, scan the patient’s bracelet.
     nurse.
 4. Plug the AC power cord into a grounded
     hospital grade AC receptacle.
 5. Connect the appropriate compatible PCA
     set to 50 ml PCA vial/injector.
 6. Prime the vial and tubing by slowly pushing
     down on the injector until all air is cleared
     from the vial and PCA administration set.
7.   Attach blunt needle to tubing.
8.   Unlock and open infuser security door.
9.   Fit syringe firmly into the holder with the
     syringe barrel flange placed in the slot of
     the holder.
10. Slide the release lever down until it meets the
      top of the syringe plunger flange.
11. Release the lever to engage the anti-siphon
     latch under the syringe plunger flange.
12. Close and lock the cover door.
13. Attach the distal end of PCA set to the
     patient access device.
 14. If primary IV fluids are ordered, check the
     flow of these fluids.
Management of Patient Controlled Analgesia (PCA)           Nursing Policy and Procedure Manual
Infuser                                                                        Section III-080b

                STEPS                                             KEY POINTS


15.   Follow the self-prompt displays on the LCD
      to enter the therapy regimen. Responses are
      entered by pressing the appropriate touch
      switches.

II. Instructions for Start-Up and Programming
 1. Prepare syringe and infusion set.
 2. Place in PCA pump.
 3. Turn on PCA pump; wait approximately
     6 seconds, and observe self test.
 4. Verify cartridge name and revision.
 5. If correct, press Enter. Prime if not done earlier
      by holding down Key #1.
 6. Close and lock cover.
 7. Press Clear to erase old history and enter a new
     prescription.
  8. Select operating mode.
       Press Key #1 for PCA mode.
       Press Key #2 for PCA/Basal mode.
       Press Key #3 for Continuous mode.

III. PCA and Basal /PCA Modes

Date and time     Press Enter to accept the displayed
                  value, or press Clear to change.

Select Units      Press Button #1 for ml or #2 for mg.

Enter Concentration
(if necessary)   If mg units were chosen, enter the
                 concentration of medication in mg/ml.

Enter Dose        Enter the amount of the medication to
                  be given. The maximum dose is 9.9 ml.
                  (or equivalent in mg).

Enter Delay       Enter the lockout time between inject-
                  tions: 3 to 240 minutes.
Management of Patient Controlled Analgesia (PCA)               Nursing Policy and Procedure Manual
Infuser                                                                            Section III-080c

                STEPS                                                 KEY POINTS


Enter Basal       Enter the basal (continuous infusion)
(Basal PCA        rate 9.9 ml/hr maximum (or
mode only)        equivalent in mg/hr).

Enter 1 Hr.       Enter the maximum amount of medica-
Limit             tion that can be delivered in one hour
                  (excluding bolus doses); 0.1 to 30 ml
                  (or equivalent in mg).

Verify            If the displayed values are correct, press
Prescription      ENTER; otherwise press CLEAR to
                  change the prescription.

Begin Therapy     Press Button #1 to give a bolus dose.
                  (See the instructions for giving a
                  bolus dose.)

                  Press START to begin therapy.

IV. Additional Information: PCA and
    Basal/PCA Modes

History           Press HISTORY until the desired
                  information is displayed. Press
                  START at any time to exit history.

Shift Total/      To check shift totals and the total
Total Given       amount given, press History until
                  the desired information is displayed.
                  Totals and amounts can be cleared
                  by pressing the CLEAR button.

Changing the      The date and time may be changed
Date and Time     (after the initial setting) by turning
                  the pump OFF and back ON.
Management of Patient Controlled Analgesia (PCA)              Nursing Policy and Procedure Manual
Infuser                                                                           Section III-080d

                 STEPS                                               KEY POINTS

V. Continuous Mode

Select Units       Press Button #1 for ml. or #2 for mg.

Enter Con-         If mg units were chosen, enter the
Centration         concentration of medication in mg/ml.
(if necessary)

Enter Rate         Enter the infusion rate; 99.9 ml/hr
                   maximum (or equivalent in mg/hr.)

Enter Amount       Enter the amount to be infused;
                   60 ml maximum (or the equivalent
                   in mg/hr.)

Select KVO        If the primary line is not being used,
at End of         a KVO (Keep Vein Open) infusion rate
Infusion          of 0.5 ml/hr may be desirable to keep
                  the vein open until a nurse can reprogram
                  the pump. Press Button #1 to select KVO.
                  Press Button # 2 if KVO is not desired.

Verify             If the displayed values are correct,
Prescription       press ENTER; otherwise, press
                   CLEAR to change the prescription.

Begin              Press 1 to give a bolus dose. (See the
Therapy            instructions for giving a bolus dose.)

                   Press START to begin therapy.


VI. Giving a Bolus Dose: All Modes

Set Bolus          Enter the amount of medication
                   to be administered. The maximum
                   bolus that may be given is 9.9 ml
                   (or the equivalent in mg.)

Begin Bolus        Press START to begin the infusion.
Management of Patient Controlled Analgesia (PCA)             Nursing Policy and Procedure Manual
Infuser                                                                          Section III-080e

               STEPS                                                 KEY POINTS


While Bolus       Press STOP to interrupt the delivery
Is Infusing       of the bolus dose. Press START to
                  continue, or CLEAR to cancel the
                  remaining bolus.

Bolus             Press START to begin the next
Completed         prescription. Press CLEAR to
                  review the prescription.

VII. 1-Hour Dose Limit
This is a physician-prescribed value that serves to limit the total dosage that can be delivered in any
      1-hour period.
A loading dose is included ONLY if it is administered after the 4-hour dose limit has been
programmed. If it is administered during the initial set up, it will not be included in the 4-hour
dose limit. The loading dose is always included in the total dose delivered.

VIII. Stop Infusion Mode
1. To stop the PCA infusion mode, close
      the clamp on the IV tubing and open
      the cover door, and press the Off/
      Recharge touch switch.
2. To stop in continuous mode, close
      the IV tubing clamp and press the Reset/
      Start touch switch or open the door and
      press the Off/Recharge touch switch.
3. When changing a vial or discontinuing
       medication administration:
      a. If the vial is empty, the nurse disposes
         of the empty vial in the proper receptacle.
      b. Two nurses witness the amount of waste              In Home Care/Hospice a caregiver may
          and document this waste.                           witness with the nurse.


Documentation:
Documentation of PCA administration on the eMAR is done by filing the information after the
medication has been initiated. Further documentation of PCA administration is completed by the
nurse on each shift and documented on the PCA PCS assessment in acute care and/or on forms
appropriate to the care setting. The second nurse’s review of the PCA is also documented in PCS
and/or on forms appropriate to the care setting.
Management of Patient Controlled Analgesia (PCA)        Nursing Policy and Procedure Manual
Infuser                                                                     Section III-080f


Reference:
Life Care 4100 Series System Operating Manual

Approvals:
Nursing Policy and Procedure Committee                                Date: 07/2008
Nursing Leadership Council                                            Date: 07/2008
V/P Nursing Services                                                  Date: ________


Original: 08/1987
Revised: 12/1995; 02/1996; 07/1996, 10/1999; 04/2000; 08/20, 11/2001, 12/2002
Revised: 03/2003, 03/2006, 06/2006, 11/2007, 07/2008

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:98
posted:4/17/2011
language:English
pages:7