[chris_at_lucas_RN]

Well, I admitted my patient with his CADD pump.

He is on MS 1 mg IV q 1 hr cont infusion plus 2 mg IV push q 20 minutes for breakthrough.

He also has duragesic 150 on.

And still he winces.

My CADD (the Legacy) does not have a PCA attachment--no pushing buttons for this guy, his scheduled dose is programed.

But he really does seem to need it, and I don't see him surviving long enough to change out the cassette (which is supposed to last a week).

[doodlemom]

If he doesn't have a pca button, who is giving the q 20 minute 2 mg dose? Is that programmed in? If he is still wincing, then he probably needs an increase.

[chris_at_lucas_RN]

There doesn't seem to be a way to program in the prn doses. This CADD is used generally for chemo--the onco's office loaned it. The wife is giving the prn doses. I thought they said he uses the prn a lot, turns out it is still a little rare.

The wife is very young also, but has learned a lot and the onco has confidence in her. I didn't see any of the usual flags for concern about "loose" morphine in the house (makes me wonder why there's little concern for Roxanol at twice the strength, but worry about other forms ), and I did also ask.

As for increasing the dosage, he resists that. He does not want to be out of control, doesn't want to feel at all fuzzy. Would rather tolerate the discomfort.

At 27, he seems to be fighting dying while being OK with his impending death. I did talk with him about kicking the crap out of the pain before it gets a good grip, maybe that will help him.

[RN4hospice]

Has the team considered discontinuing the duragesic and increasing the morphine to cover the patch dosage? Maybe he's not absorbing the duragesic.

[SCgirl1962]

That's been a consideration. Gotta get with his MD on this. Wish we'd never started it though. It's harder to convince a patient that they can get the same relief by taking po meds once they've started on a pump.

[earle58]

i understand pts forfeiting more aggressive analgesia while opting to maintain their alertness.
but still, this man does not sound like he's attained the desired balance.
i think more can be done for him.

leslie

[ReluctantMonk]

The Hospice I work with uses CADD Pumps if the MD orders it, either IV or SQ. We shy away from Duragesic patches if the patient can take po or if there is no body fat to absorb meds this way.

[clemmm78]

I'm not sure what a CADD pump is, but our palliative care residence (a nine bed residential site) uses syringe drivers to give 24 hour s/c pain relief. We find them to be very useful, for the most part when used with breakthroughs. If we give what we feel to be too many breakthroughs, the dosage in the syringe driver is adjusted.

Our drug combos can be dilaudid or morphine with medaz and/or maxeran, usually.

[cookie102]

i was always instructed that at EOL have the patient free of as much tubing as possible, manage pain with po, liquid, patches....let the patient be as "normal" as possible...none of us would like to be connected to a pump, picc line,, and carry a little bag with us all day. we use hopice pharmacia and they are great at converting dosages.

[doodlemom]

A CADD pump is a very small pump that is made to be portable for people in non hospital settings. For ambulatory patients on the go, they can carry them in back packs or waistpacks. I think that many people use the CADD name (like saying "kleenex' instead of the generic tissue name), but there are several small pumps made by different companies for the same purpose. I think many people refer to all of them as CADD pumps since this seems to be the most popular name..

Originally Posted by clemmm78

I'm not sure what a CADD pump is, but our palliative care residence (a nine bed residential site) uses syringe drivers to give 24 hour s/c pain relief. We find them to be very useful, for the most part when used with breakthroughs. If we give what we feel to be too many breakthroughs, the dosage in the syringe driver is adjusted.

Our drug combos can be dilaudid or morphine with medaz and/or maxeran, usually.