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Next Reply: Re:Patient Controlled Analgesia Pump Monitoring
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Post Patient Controlled Analgesia Pump Monitoring
Author: marfew
Date: Nov 18, 2008 4:24 pm
I am setting up our PCA pump flow-sheet & guidelines and have a question regarding the frequency of checking the pump settings (and the patient of course!)

I have not been able to find any Best Practice Guidelines for this, and any literature I have found has been related to ACUTE PCA pump management(Post Op) suggesting reducing dose/rate based on q4h checks and sedation levels + respiratory rates.

Not a logical approach at end of life

It would be very helpful to have evidence from several sources regarding your current practices.
Thanks!

Replies: order by [Date] [Author] [Subject]
Re:Patient Controlled Analgesia Pump Monitoring (by mrabow on 11/20/2008)
Hi, There is a fast facts that may be helpful to you. You can find it at http://www.eperc.mcw.edu/fastFact/ff_92.htm.

If set correctly, PCA's are quite safe for patients... as they stop pressing the bolus button when they are sedated. For patients with significantly depressed mental status, one key is making sure family caregivers understand about the risk of over-sedation with bolus use... as they may be using pressing the button for the patient. If desired, an hourly maximum can be helpful, although simple education of family members is generally sufficient to have all working on the same goals of care.

At the end of life, in the hospital, in particular, frequent assessment of pain/distress/sedation is quite reasonable. In particular, non-invasive monitoring (observation, respiratory rate) is useful for adjusting palliative interventions and the frequent assessment is typically a source of comfort to the family.

Michael W. Rabow, MD
Associate Director,
UCSF Palliative Leadership Center


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