use of Cadd pumps in pain management

  1. 0 The hospice I work for almost never approves the use of a CADD pump for the administration of morphine due to the high cost of using a pump. I feel that sometimes we are providing inadequate pain control because of this.What is the experience of other hospice nurses with this situation?
  2. Visit  jwelhwel profile page

    About jwelhwel

    From 'Indpls, IN, USA'; Joined Feb '00; Posts: 14; Likes: 4.

    30 Comments so far...

  3. Visit  afkiser profile page
    0
    As a nurse manager, I have approved the use of a CADD pump for our patients in certain situations. My experience has been that most pain can be controlled with oral and/or rectal medications (Generally OxyContin or MS Contin and OxyFast or immediate release morphine. If all other pain control measures have been exhausted, I believe a pump is appropriate. The needs of the patient must take precedence over the cost of the care.


    [This message has been edited by afkiser (edited April 07, 2000).]
  4. Visit  gailgalloway profile page
    0
    We do use CADD pumps when other methods are not effective, but we are using more and more SQ. We either just put a butterfly in or put it on the Graysby pump...so much cheaper to give meds this way and it seems to work better when pts are no longer swallowing and meds are not absorbed rectally. Most everything can be given SQ.
    Originally posted by afkiser:
    As a nurse manager, I have approved the use of a CADD pump for our patients in certain situations. My experience has been that most pain can be controlled with oral and/or rectal medications (Generally OxyContin or MS Contin and OxyFast or immediate release morphine. If all other pain control measures have been exhausted, I believe a pump is appropriate. The needs of the patient must take precedence over the cost of the care.


    [This message has been edited by afkiser (edited April 07, 2000).]
  5. Visit  ilovelilac profile page
    0
    i have worked at 3 hospices -- the first was a 600+ pt nonprofit where i was one of 2 infusion nurses -- we typically had between 10 and 20 pts on iv of one sort or another (which sounds like a lot, but really its a small percentage). that organization preferred to spend the money on iv rather than duragesic patches, and also did other stuff such as dopamine and dobutamine drips from time to time. the 2nd hospice said they didn't but actually did maybe 3 over an 8 month period (they had approx 200 pts). the hospice i work for currently has approx 300-350 pts and uses it when needed (for instance, i have a pt who has a picc and is getting 135mg/hr mso4 plus boluses. we could not deliver the equivalent in duragesic or any other form (can't swallow, multiple types of pain in mult areas) and has been receiving iv morphine for approx 3 mos in her home. hope this helps.
  6. Visit  mary o profile page
    0
    Our Hospice has purchased small (will fit in the palm of your hand) CADD-type pumps for less than $300 each which have been fairly easy for our staff to teach families how to use. We only use the about 4-5 x a year. The tech support good if any problems have been replaced and/or repaired quickly.

    Originally posted by jwelhwel:
    The hospice I work for almost never approves the use of a CADD pump for the administration of morphine due to the high cost of using a pump. I feel that sometimes we are providing inadequate pain control because of this.What is the experience of other hospice nurses with this situation?
  7. Visit  teamrn profile page
    0
    In my hospice we use pumps for medication administration (usually MSO4) if there is no oral route, and enteral or transdermal routes are ineffective. Yes, the cost is there, but if we feel the quality of life will be enhanced, and the family is willing/able to learn pump administration under the guidance of the case manager, we'll make a 'go' of it and have had alot of success.
  8. Visit  chris_at_lucas_RN profile page
    0
    We are admitting a patient tomorrow on a CADD morphine infusion with a med port.

    I've not used the CADD before, nor have my nurses.

    Anyone know an URL or willing to give me a quickie lesson on how to? I am also going to the oncologist's office in the a.m. for a demo, but I figure the more info I have the better off I will be.

    Thanks a bunch!
  9. Visit  doodlemom profile page
    0
    Quote from gailgalloway
    We do use CADD pumps when other methods are not effective, but we are using more and more SQ. We either just put a butterfly in or put it on the Graysby pump...so much cheaper to give meds this way and it seems to work better when pts are no longer swallowing and meds are not absorbed rectally. Most everything can be given SQ.
    I am curious how your hospice is finding this cheaper than sl or oral meds. We find the solution alone is much more expensive than the oral alternative and if you have to rent the pumps - even more $$. What is the difference between a Graysby and a Cadd pump? We use some other pump that all of us call a CADD but it's actually some other brand. We tend to use alot of methadone as a long acting. It comes in a 10 mg/ml solution that can be given sl. Then of course, Roxanol for breakthrough. There are patients who need more though and we start them on a pump. If the patient has a central line, we will use that - otherwise we will start a sq infusion.
  10. Visit  chris_at_lucas_RN profile page
    0
    Quote from mary o
    Our Hospice has purchased small (will fit in the palm of your hand) CADD-type pumps for less than $300 each which have been fairly easy for our staff to teach families how to use. We only use the about 4-5 x a year. The tech support good if any problems have been replaced and/or repaired quickly.
    Is there anything unusual or magical about the CADD? I mean, except that it is small and portable? Any info, insight, experience, suggestions, errors I can learn from, etc. would be so helpful....

    TIA
  11. Visit  SCgirl1962 profile page
    0
    We use CADD pumps occasionally - usually when pain cannot be controlled with oral meds and/or other methods of pain control have failed. I currently have a patient on a CADD pump for a morphine drip. When I checked his usage, he only pushed the button once in 4 days! To me, he probably doesn't need this pump. When I questioned him about what he was on prior to the pump, he said, " Duragesic and Darvocet!! " Can you believe it???? He said he told his MD that the pain medication was too weak and the MD put him on the pump. ( He was admitted with orders for the PCA morphine, so we really didn't have any input. ) But believe me, I will be talking to the MD about switching him to long acting morphine with immediate release breakthrough He is ambulatory, eats well and there is just no reason for him to be on this pump except for MD ignorance.
  12. Visit  chris_at_lucas_RN profile page
    0
    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).
  13. Visit  doodlemom profile page
    0
    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.
  14. Visit  chris_at_lucas_RN profile page
    0
    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.


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