PCA Pump Settings

[Scoobiedoo]

I am an LPN and soon to be (30 days) an RN graduate! YEAH!

However, in my facility on the Med-Surg floor Rn's start the PCA pumps when the surgical patient arrives from PACU.

I see things like 10-10-80 or something for PCA pump orders. Can anyone EXPLAIN to me just WHAT this means?

I don't get it...

Thanks,

[leosrain, BSN, RN]

The order may be different but it generally means something like (using your numbers):

10mg/hour infused, 80mg dolus, 10min lockout

This means the PCA will continually give them 10mg/hour, when they push the button they get an 80mg dose, and there is a 10min lockoout between button pushes.

Makes sense?

[Scoobiedoo]

Thanks!

I didn't think a PCA pump GAVE a continuous dose! I thought it was all ON DEMAND!

Hmm...

[lovetoride]

10/10/80 would mean 10mg dose when the button is pressed given in one dose, the second 10 is the mimimum amt of time allowed between doses and 80 is the max dose allowed in a 4 hr time limit.

[lovetoride]

Oh,and you can set it for a continuous dose and patient controlled dose also. We hardley ever use the continuous dose feature at our hospital.

[DutchgirlRN, ASN, RN]

We use continuous frequently along with on demand. My best advice would be to never initiate or change a PCA setting without the presence of another RN. I've been a nurse 31 years and I still never go it alone. I can't tell you how many PCA's have come to the floor set incorrectly by surgery. I can recall 2 incidences where Narcan was used. Scary stuff. Our pumps are set with a 1 hour limit rather than a 4 hour limit.

[CritterLover, BSN, RN]

thanks!

i didn't think a pca pump gave a continuous dose! i thought it was all on demand!

hmm...

pcas generally give such low doses of pain medication, that a low continuous dose is really helpful for when people are sleeping. when they are sleeping, they arn't pushing the button (and family should never push the button). if they don't get a small dose of pain med while they are sleeping via the continuous infusion route, then they often wake up in significant pain, and then have to play "catch up."

most pain management experts will tell you that a pca should have a basal rate. a lot of providers, however, are "afraid" of the continuous function because they feel the patients will overdose.

thing is, most basal (another word for "continuous") rates are very low. i've usually seen morphine 1mg/hr, with 1 mg allowed q6 min on demand. for most patients, 1mg/hr really isn't all that much. however, i have seen it be enough to cause respiratory depression in some patients, usually the elderly. this effect is rare, though.

when the basal rate isn't low, it is usually because the paient has chronic pain issues, and they need the higher dose. our hospice always uses a basal rate, an the amount can be quite high.

[leosrain, BSN, RN]

We often have continuous rates included, but not always. And I agree with DutchgirlRN...never change settings alone. In fact, it's policy where I am to have two RNs sign off on the PCA dose when changing it.

[leosrain, BSN, RN]

10/10/80 would mean 10mg dose when the button is pressed given in one dose, the second 10 is the mimimum amt of time allowed between doses and 80 is the max dose allowed in a 4 hr time limit.

This makes sense too. Make sure to read the orders carefully as they should be explicit as to what the different numbers mean. If they aren't explicit, clarify with the docs before ordering.

Sean

[Roy Fokker, BSN, RN]

I work a surgical floor and we have standing PCA order sheets that come with the medication of choice (Morphine, Dilaudid or Fentanyl) along with choices for anti-emetics (Zofran, Kytril, Reglan or Phenergan), anti-pruritis (Nubain or Benadryl) and anti-constipation drugs (MOM, Surfak etc.). Also, there is a standing Narcan order.

Standard PCA orders at our facility:

Morphine:

Loading dose - 2 mg

PCA: 1mg - q 10 minutes - 30mg/four hours

Dilaudid:

Loading dose - 0.4 mg

PCA: 0.2mg - q 10 minutes - 6 mg/four hours

Fentanyl:

Loading dose - 20-40 mcg

PCA: 20 mcg - q 8 minutes - 300 mcg/fours hours

We see basal rates only in patients with unresolved pain and before we go to basal rate, we usually switch pain meds aound. If it is still unresolved, a pain doctor is almost always consulted exclusively for pain management.

This is standard protocol unless patient has epidural/femoral/fascia block managed by anesthesia - in which case any and all questions/issues are to be resolved by anesthesia.

cheers,

[NPinWCH]

If the actual order reads "Demerol PCA 10/10/80" I would have to call to clarify the order. I need more info. You also need to be familiar with the type of PCA pump available at your facility, since different pumps program differently, and I've seen some places have more than 1 type of pump.

At my facility all PCA orders must be on the PCA order sheet. All blanks must either be filled in or crossed off, then PCA orders are verified by 2 RNs. The pump is programmed by 2 RNs who both then sign off on orders. Our pumps can deliver a loading dose also, by policy PCA can be either Morphine or Demerol and we only have one concentration of each drug. Orders typically look like this:

Morphine PCA:

Pt may receive Morphine 2-4mg IVP q 30 min PRN pain, until PCA initiated

Loading dose 4mg

Basal rate 1mg (this is the amount of drug the pt gets continuously)

PCA dose 1mg (this is the amount they get when they push the button)

Lockout rate 10min (minimum amount of time between pt given doses)

Lockout dose 7mg (maximum amount pt gets in 1 hr)

Benadryl 25mg IVP q 4 hours PRN itching

Zofran 4mg IVP x1 dose PRN nausea/vomiting

If pt is unarousable, spO2 less than 90 or respiratory rate less than 12, apply 5-10L O2, give Narcan 0.4mg IVP, discontinue PCA and notify doc.

[Scoobiedoo]

We often have continuous rates included, but not always. And I agree with DutchgirlRN...never change settings alone. In fact, it's policy where I am to have two RNs sign off on the PCA dose when changing it.

Yea, our hospital too. MUST have 2 RN's to do it.