Pain Pump Protocols

Patient-controlled analgesia (PCA) allows patients to self-administer pain medication through an intravenous device (or "pain pump") regulated by an automatic setting that delivers a preset dosage.



Registered nurses with the appropriate training typically administer the PCA system. In hospitals, a PCA team usually sets up and monitors all such patient-controlled delivery systems. Such teams can consist of nurses, pharmacists and anesthesiologists, and may be assigned to specific hospital wards (e.g., surgical, obstetrics and trauma).

Indications

• Pain pumps deliver medication that relieves chronic or acute pain. Surgical patients may receive morphine dosages through a PCA pump. Patients recovering from severe trauma can also benefit from a PCA system.

  People who experience chronic pain that is not relieved by oral medications may receive PCA treatment.

  Cancer patients may function better in their daily life with the assistance of a PCA system.

Guidelines

• Assessment of the patient's pain level determines the dosage delivered through the PCA pump.

  The patient's pain level should remain below 5/10, allowing him to rest comfortably.

  Equipment needed for the procedure should be at arm's reach, sterile and primed.

  Doublecheck dosage before administering medication.

  Monitor the patient for adverse affects to the medication. If respiration drops below 8, stop the infusion immediately and call a code.

  Report any nausea, consistent pain or pruritis (itching).

  Change the intravenous site and tubing every 72 hours.

Restrictions

• Pain pumps cannot deliver narcotics or sedatives in addition to prescribed analgesic medication without the written consent of the responsible physician.

  Blood transfusions must not be administered through PCA tubing along with pain medications.

  Nurses who program the PCA pump must have a second staff member verify that the prescription and dosage are correct. This staff member should be a pharmacist or a registered nurse.

  Sickle cell patients must have continuous pulse monitoring.

  Hospital staff must keep resuscitation equipment close to the patient's bedside in case of emergency.

Complications

• If respiratory depression occurs, hospital protocol may include administering Naloxone, which is used for opium overdoses.

  Treat anaphylactic shock immediately. Look for hives, itching, swelling and decreased respiration.

  Injection sites can swell from infiltration of fluids under the skin. If this happens, select a new injection site.

  Kinks and knots in the tubing can cause fluids to back up. Ensure that tubing is loose and unobstructed.