*Pain Mgmt for Sickle Cell Crisis*

[kgriffiRN]

Last night I took care of a patient who was admitted for Sickle Cell and Hypertensive crisis. His main problems were severe pain and HTN. I was giving diludid q 4hr & Lortab q 6hr and he acted as if all of that medicine didn't touch his pain; He never rated his pain below an "8". I know that sickle cell pt's generally have a higher pain med tolerance.... so I guess my question is have any of you ever heard of using a pca to control the pain on a sickle cell pt?

[Penelope_Pitstop, BSN, RN]

I've used PCAs with my sickle cell patients quite often.

Dilaudid Q4 seems like absolutely nothing compared to what I've given these patients. The craziest example is the young lady who received 6 mg IVP Dilaudid EVERY HOUR.

A sickle cell crisis involves crippling pain. Narcotics (often with nausea meds and Benadryl), fluids, and oxygen are the cornerstones of treatment.

I wonder how much of your patient's HTN was due to uncontrolled pain.

[XingtheBBB, BSN, RN]

We almost always used PCAs for SSC pain when I worked in peds. Dilaudid or Fentanyl in older kids and adults (they still came to us) and Morphine in kids over 8. Once upon a time, Demerol in kids about 8-12. I hated that and so did they. It barely touched the pain and they'd end up hallucinating. Thank-god those days are gone. But yes. We use PCAs. We might use a long acting pain med, too... oxycontin, etc. And NSAIDs. And HYDRATE. That may end up being the best pain treatment. Not only do they have a lot of tolerance but there is also the fact that there is some neuropathic pain that opiods really don't treat. Unfortunately, it's a rough life... frequent hospitalizations and a lot of pain and health issues between hospitalizations. Many of these kids are expert manipulators and many adults have given up hope of normal life and become bitter. Suppresses the natural endorphins that should help control pain.

[adub7]

Prior to moving to the ICU I worked 5 years on a hematology floor and frequently took care of Sickle Cell patients. We often used PCAs but patients didn't always like them. Their tolerance to narcs is amazing. I remember clearing a PCA of a young lady who had gotten 140 something mg of dilaudid in 12hrs! Sitting up in bed using her computer.

[sunnycalifRN]

And, in my experience, many adult Sickle Cell patients are very hard sticks, due to their vasculature being trashed by the disease. I remember having to place an IV on the pinkie!

[XingtheBBB, BSN, RN]

And, in my experience, many adult Sickle Cell patients are very hard sticks, due to their vasculature being trashed by the disease. I remember having to place an IV on the pinkie!

Those veins get trashed at a very young age. I always dread sticking Sickle Cell kids. Esp if we are planning to transfuse and I kow it has to be a large vessel.

[kgriffiRN]

Thanks for all of the replies! I thought that somewhere along the way I had heard of using PCAs for sickle cell pain but some of the other nurses looked at me like I was crazy! DeLannaHarvickWannabe, I was thinking the same thing about his pain and htn. I gurantee that if his pain was controlled better, the bp wouldn't be such a huge problem. And guess what... the next night I came back he was on a morphine pca!