Fentynal PCA in Labor

[HeartsOpenWide, RN]

Does your unit use Fentynal PCAs for labor? I have been at my current job since Feb. One of the doctors will occasionally order Fentynal PCA for labor. So far I really like the concept. The patient has more control of her labor which can really be helpful in a situation which you often feel no control at all.

I had my first patient on this last night. I got it set up right during change of shift so I did not have the patient very long. I know that whenever you give a drug in labor you write it on the strip when you give it. (i.e. I press the mark button right when I give slow IVP Fentynal 50mcg and write that on the strip. )

I wrote the loading dose and when I started the PCA on the strip. My question is what you do about the PCA part... The patient had a continuous with a 15 min lock out. Since I very well cannot be in the room for every time a patient gives herself a does, I cannot foresee pressing the mark button every time a self dose is given. How do I chart this on the strip? Do I even need to chart the self doses on the strip?

[chloecatrn]

I don't know about your PCAs, but ours allow us to go back and see what time each dose is delivered. So you should be able to match it up to the time on the strip, right?

[LibraSunCNM, BSN, MSN, CNM]

Our PCA machines keep a record of the basal, bolus, and lockout settings, as well as how often the button is pressed and how much is left in the bag versus how much has infused. Then we have a form that we fill out every 4 hours with all of the info listed above, as well as the patient's pain score and sedation level. I work on a surgical floor, not OB, but assume the answer still applies. Are these Fentanyl PCAs IV or epidural? Haven't heard of IV PCAs being used in labor but if it helps the mom have more control then that's great.

[HeartsOpenWide, RN]

Our PCA machines keep a record of the basal, bolus, and lockout settings, as well as how often the button is pressed and how much is left in the bag versus how much has infused. Then we have a form that we fill out every 4 hours with all of the info listed above, as well as the patient's pain score and sedation level. I work on a surgical floor, not OB, but assume the answer still applies. Are these Fentanyl PCAs IV or epidural? Haven't heard of IV PCAs being used in labor but if it helps the mom have more control then that's great.

They are PCA IVs. Epidurals are cont. rate only and on a locked IV machine.

[klone, MSN, RN]

I didn't realize at first you were talking about a PCA. We give Fentanyl IVP in labor. We do also have PCEAs (not sure what's in them). We're not expected to chart every time the pt gives herself a dose. When a pt has a PCEA, we are expected to chart dermatome levels, sedation level and sensory function level q1h.

[bagladyrn, RN]

They are PCA IVs. Epidurals are cont. rate only and on a locked IV machine.

I have worked with anesthesia providers who set up PCA epidurals with the patient being able to give themselves a bolus as needed.

[wtbcrna, MSN, DNP, CRNA]

PCA means patient controlled analgesia you can use it IV/Epidural/Spinal or if you want to get technical about it even oral. When we are doing a PCA for epidurals it usually written as PCEA so it is not confused with IV PCAs. Spinal PCAs are very uncommon.

PCEA can be continuos only, continuos with PCA, or PCA only with the most common setting probably being continuos with PCA at most L&Ds.

[LDRNMOMMY, BSN, RN]

We had a patient with ITP and her admission platelets were 69,000 so no epidural. A Fentanyl PCA was ordered for her by anesthesia. That was the one and only time in the 1.5 yrs I worked at my last job where the Fentanyl PCA was used. I was not her nurse so I am not sure how the PCA was documented on the strip. Our computer charting had a section on PCA documentation. Also, as others have said you can pull up the dose history on the PCA machine.

[wtbcrna, MSN, DNP, CRNA]

We had a patient with ITP and her admission platelets were 69,000 so no epidural.

Just FYI: In general platelets down to 50,000 are considered okay to do labor epidurals, unless the platelets are dropping precipitously. Old school of thought was no one under 100,000 got an epidural.