wrist PCA's

  1. With the recent seasonal increases in patient population, our hospital has had to use the old mechanical (spring loaded) wrist PCA's as we haven't had enough of the other. These are worn on the wrist by the patient, are black and I guess were around before the battery operated type were invented. We had a situation the other night where it looks like a patient got too much MSO4 because the thing malfunctioned (although our pharmacy denies this is possible with this device).

    Have any of you had any experience with these and ever had one of these malfunction?

    Thanks!
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  2. 8 Comments

  3. by   frustratedRN
    ive never even seen those...how do they work?
  4. by   P_RN
    Never heard of them either and I worked on a pain management unit!

    Our pca machines were the huge Abbotts. For our epidural pca's we had the smaller Bard pumps that were battery operated but still not small enough for a wrist.

    I had no idea these even existed! We did use a spring loaded marcaine pump that was kind of like an abboject syringe with a spring in it. It was usually used after shoulder surgeryand sometimes after knee scopes too. But never for a narcotic.
    Usually in those the rate was controlled by the size of the orifice and the diameter of the tubing. I don't think they were precise enough to use for narcotice. This is very interesting. What was the outcome of the pharmacy vs. nurses opinions on the OD?

    Was it something like one of these?

    http://www.accessdevice.com/body_products.html#5
    Last edit by P_RN on Sep 23, '01
  5. by   frustratedRN
    are you sure you arent talking about the patient ID bands? maybe thats why they dont work?
    lol

    sorry i couldnt resist. im just kidding. sleep deprivation will do that to you sometimes.
  6. by   bagladyrn
    Yes, I have seen and used the kind you are referring to- didn't like them as there is no way to adjust the dose and really wasn't convinced they work consistently. I know I was concerned what would happen if button stuck in down position. Please post here and let us know what you find out- I'd be interested if I ever run into them again at another hospital.
  7. by   CEN35
    sounds like something way way before my time? never heard of them.........guess it's always good to keep a few civil war collectables around? lol :d
  8. by   waahoolio
    I had not ever seen one of these until I worked at this hospital. They are black as I said, and the strap that goes around the wrist is the same material as the straps used on fanny packs. the button itself isn't much wider than the strap with two sets of tubing coming from the syringe that is attached. The button, I am told is spring loaded. If it is a full-strength, half-strength, etc. depends on the concentration by the pharmacy - unlike the pumps we use, which is programmed in and a standard cartridge is used - either morphine or demerol. Once the patient pushes the button, due to the spring mechanism it is supposed to have a 6 minute lock-out like the regular pumps in that the spring slowly comes back up and can't be pushed again for 6 minutes. With this situation, the button was popped out and it could be pushed over and over again. It was VERY hard to see that the button was very slightly out from it's normal position. Since it is on the wrist, the patient could have been laying on it for all we know. The syringe is about the size of the cartridge used in the traditional PCA, yet it has what appears to be a collapsable balloon in it which I guess causes it to contract and give a dose each time the button is depressed. It fits in a fine white mesh bag that is safety pinned to the patients gown and the bag is transparent enough to see through to identify the label on the syringe.

    I will let you know what I find out. There are several of us who witnessed the fact that the button was able to be repeatedly depressed without any lockout time, after we removed the PCA from the patient. However, our pharmacy stands by the fact that it couldn't malfunction. One nurse on our unit says these type of PCA's were used WAYYY back when she started nursing in the 70's. I can't believe at a hospital where we have so much high tech equipment otherwise, that we are using something so ancient and potentially harmful!
  9. by   waahoolio
    I found this at http://www.aomc.org/abysurg.html

    It mentions the wrist PCA as well, but shows no photo.

    Patient-Controlled Analgesia
    Your doctor may order you patient-controlled analgesia (PCA) to help you manage your pain independently. PCA allows you to administer your own IV pain medication as you need it with a small watch-like bracelet you wear on your wrist, or with an IV pump which administers a measured amount of pain medication. You can watch an educational video about PCA on the medical center's WELL-TV channel. It airs three times per day for your convenience. A brochure is available to explain PCA with the most commonly asked question and answers on PCA. If you will be receiving PCA, your nurse will discuss it with you and answer your questions. Many patients like PCA for the comfort and convenience it offers to them. Your nurse will help you gain confidence in using PCA so you can use it beneficially as you recover.
  10. by   frustratedRN
    thanks for the info...it certainly is strange that you would be using those now

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