Am I the only one annoyed by these PCA orders? - page 2

by IheartICUnursing 4,063 Views | 13 Comments

So, working in ICU, I never had anyone on a PCA pump w/ demand dosing since most of my patients are not with it enough to use the button so we just have them on continuous infusions. So I finally had one patient who was a&o X3... Read More


  1. 0
    Those orders are there because it is shown that x dose can be safely metabolized in most cases with y time. Ours are 0.2mg/q10 mins, 4mg/4hrs, and cont is usually about .4 a hour. If that's not working, then maybe we need some relaxers, something for anxiety, something else. Keep calling and do what you can. I bet the patient had some choice words for the doc the next time he saw him!
  2. 1
    i had a patient just 2 days ago was like that. Young female with a really big heart surgery d/t a birth defect. Anyway, she was in a lot of pain, more so from the chest tubes than anything.
    We were running into the same issue with her PCA, and the doctor was aware the PCA would shut off and such and such a time (lockout was 20 minutes). We actually ended up getting an epidural in place that i was able to titrate 4-12 depending on patients pain level. he asked i keep it at a minimum and only titrate it if she is in pain. We were able to keep it at a 4-6, so long as she used the PCA pump which was NOT running continuous, only demand.
    At first epidural seemed a little excessive to me, but she was going to need the chest tubes for a while and was so uncomfortable.

    She was so scared to take anything PO, which seems a little backwards to me but whatever, pain was under control
    fiveofpeep likes this.
  3. 0
    That's strange. Most of the patients on my floor are on PCA and the docs don't write a 4-hr lockout at all. We calculate it as a back-up to what we put in, ie, Dilaudid 0.2/0.2/10, 4-hr lockout is 5.6mg. The vast majority of patients do not zonk themselves out on PCA, for the most part I prefer my patients being on a PCA.
  4. 0
    We've always been able to titrate pca's from 0.2-0.8 Q 10 minutes without a lockout, if they're getting too sedated we can turn down the demand dose and we rarely have a continuous rate running. For our opiate tolerant folks we have a different order set with higher rates and higher concentration.
    In one hospital I worked we didn't have high concentration syringes and it was a PITA. I had one pt that I changed the pca syringe (6 ml of dilaudid) 6 times in 12 hrs.
    If I had an oncology pt whose pain wasn't being managed appropriately I would probably ask my NM or house supervisor to intervene and speak with the MD, put a little pressure on him to do right by his patient....or call a rapid response.


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