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15 Frequently Asked Questions about Patient-Controlled Analgesia (PCA)

Patient Controlled Analgesia

Understanding Patient-Controlled Analgesia (PCA)

Defining Patient-Controlled Analgesia

Patient-controlled analgesia (PCA) refers to a specialized method of pain management that enables patients to self-administer controlled doses of pain medication. This technique involves the use of a programmable infusion pump that delivers predetermined amounts of pain medication, usually opioids, through an intravenous (IV) line or other routes, such as epidural or subcutaneous.

How PCA Works

The PCA system typically consists of a pump, a medication reservoir, and a patient-controlled button. Patients can activate the button to release a preset dose of medication within specified time intervals, ensuring they receive pain relief while maintaining a level of control over their comfort.

Frequently Asked Questions (FAQ)

1. Why PCA is being used?

  • Better pain control

  • Improved patient satisfaction

2. Who can use the PCA?

  • Patient who is mentally, emotionally, and physically able to assess his/her pain needs

  • Children 7 years and older

  • Use cautiously with patients who have history of drug and alcohol abuse, respiratory distress (patient with pulmonary diseases e.g., COPD), and elderly

3. How does a PCA pump work?

  • The physician will order the medication, amount, delivery mode

  • Nurses will program the machine - double verify

  • Patient and family education will be done

  • Patient presses the button to receive the medication

  • The machine is always kept locked

4. What are the PCA delivery modes?

  • Continuous: rarely seen this alone on PCA

  • Bolus: the patient will receive a dose when the button is pushed

  • Both: often small amount of continuous with button bolus

All modes require Normal Saline (NS) infusing to medication through the lines

5. What are the common PCA medications?

  • Morphine sulfate - 1 mg/ml in 30cc NS = 30 mg

  • Fentanyl - 10 mcg/ml in 30cc NS = 300 mcg

  • Dilaudid - 0.2 mg/ml in 30cc NS = 6mg

Always have Naloxone (Narcan) available

6. What is the biggest danger for patient on PCA?

  • Respiratory depression

7. What is the purpose of Naloxone (Narcan)?

  • Narcotic antagonist- Has a short half-life (30 min) - the patient will still be under the influence of narcotic when Narcan wears off

8. What are the PCA rules for the patient?

  • Always put a sign in the room: NO OTHER NARCOTICS

  • The patient is the only person who can press the button

  • Do NOT press if dizzy or sleepy

  • Do NOT eat if he/she is sleepy - aspiration risk

  • Do NOT take any medication not prescribed by the physician

9. What are the common narcotic side effects?

  • Nausea - administer Zofran as prescribed

  • Itching - administer Benadryl as prescribed

  • Constipation - administer Miralax or Colace or Senna as prescribed

  • Drowsiness

  • Bradypnea

  • Hallucination

  • Over sedation

10. What does obtunded means?

  • State of being unable to arouse with vigorous stimulation

11. What to do if the patient is presenting signs and symptoms of respiratory depression?

  • Stop the PCA

  • Administer Narcan as prescribed

  • Notify the physician

  • Monitor the patient closely

12. What to do when the patient still complain of patient despite having the PCA?

  • Assess the patient: signs and symptoms of pain (PQRST), vital signs, other cause of pain or source of pain

  • Check the pump: pump report of usage/frequency and confirm the delivery of medication to the patient, check the patency of the line e.g., kinks

  • Call the physician for another order

13. What are the PCA assessment and documentation?

  • Every hour x 4 then q 4 hours

  • Vital signs

  • Level of sedation

  • Pain

  • Boluses attempted/delivered and total dose received

14. Pointers to remember

  • Always assess the patient

  • Check the pump settings and medication delivery

  • Students do NOT clear pumps

  • Students do NOT set up pumps

  • Students MAY discontinue the pump with supervision

15. How often can a patient administer medication using PCA?

  • The frequency of medication administration is predetermined by healthcare professionals and programmed into the PCA pump. Patients can typically self-administer doses within specified time intervals.

NCLEX: National Council Licensure Examination, OIIQ: Ordre des infirmières et infirmiers du Québec, OIIAQ: Ordre des infirmières et infirmiers auxiliaires du Québec


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