Pain pumps

lindaloo51 · Feb 8, 2009

We have the same problem. Our rep told us that someone puts out theBupivicaine in a larger size. Still waiting on the information. If I learn anything, I'll let you know. It's cut down on the pain pumps at our facility since our docs no longer use them for shoulders but only for total joints.

Editorial Team / Admin · Feb 8, 2009

Pain pumps seem to get used in spurts where I work. We have one OB/GYN who routinely uses them on her TAH/BSOs, and some of the ortho docs use them on their total knees, but that's about it. We've never had the prefilled, and usually end up emptying out the Pyxis just for two of them. Never seen the larger vials, ours are all 30cc.

$fracturenurse$ · Feb 8, 2009

In our OR they started considering them durable medical equipment and it takes an act of god to get one. Thank god, I hate opening all those bupivacaine bottles, it's a pain! We had the 30cc bottles as well...

sbnursing · Feb 8, 2009

We just recently had our pharmacist go to a seminar and he informed us that "anything over 100mls had to be filled by a pharmacist" So what we have to do is bring the written order with medication and amount and a pain pump to the pharmacist and then he brings it back to the surgery desk and then the pump is attached after the dressing is on. The MD primes the catheters and threads them and then the scrub tech or nurse attaches the pain pump. I think this is crazy. Has anyone else heard of this?

nursinadream · Feb 9, 2009

SB, That really sounds like a pain. You gotta wonder where a pharmacist gets this info. Why is there so much political stuff going around? Our pharmacist is going to block our prefilled cylinders, I'm quite sure. And your pharmacist says they have to fill them, and YOU, the OR staff has to take it to him? oh please.....

Yes, fracture nurse, it is a pain to open those bottles. As I said, we use about 30 per week. All bariatric cases get them, some thoracic and some ortho and gyn oncology. Which is why we hope to get the prefilled cylinders.

Thanks all for reading and posting, I enjoy reading what's going on out there.

Deb in KY

shodobe · Feb 9, 2009

I have usually filled them myself as the circ. This does save time and doesn't ake the scrub away from the field. It is a pain, though to have to fill with so many bottles!

SandraCVRN · Feb 13, 2009

We use Naropin=ropivicaine which comes in 100 ml bottles. Only have to open 3 or 4 depending on the size ballon. But the scrub still has to load it 60 cc's at a time. Their part seems harder than mine. Some of the docs that use differnt meds still need 10 or more bottles opened.

nw31705 · Apr 11, 2009

This is true according to jacho the pharmacy has to fill the pumps now.All the hospitals here are doing it now.

KayceeCA · Apr 11, 2009

We are still filling ours in the OR. I guess word that pharmacy has to fill anything over 100mL hasn't spread here yet.

It's definitely a "pain" (sorry, couldn't resist) having to open all those bottles, although we do have 50mL bottles so we only have to open 6 for the pain pump we use. We only have one surgeon who routinely uses pain pumps for his gastric bypass patients, but he does 4 or 5 gastric bypasses a week, so we have to fill them pretty often. I'm glad we don't have the type of pain pump that requires 12 bottles to fill. Ugh!

We had an OnQ rep tell us that larger bottles were becoming available. He also mentioned the pre-filled cylinders. It sounds like that's going to be the way to go, especially with the standards changing to where we won't be able to fill anything over 100mL in the room.

Fun2, BSN, RN · Apr 11, 2009

This is true according to jacho the pharmacy has to fill the pumps now.All the hospitals here are doing it now.

We aren't...nor have I heard of this. ?????

answerman · Mar 8, 2011

The best way to fill a pain pump is for the pharmacy to fill and dispense as with any sterile medication according to the USP 797 regulations that basically says that mixing at the back table is a "high risk" procedure for infection and that compounding under a Class II hood in pharmacy would reduce this to a "moderate risk".

The surgeon who orders the use of the pain pump is taking on the liability of this risk in the O.R. His or her M.D. superceeds that of the Pharm D or R.Ph.

If there is no policy & procedure written (which is often the case) then nursing may be open to risk as well.

When there is a law suit ( and many lawyers are going after "pain pumps" using fenestrated catheters at the close of the procedure when they are placed in a position that allows the local anesthetic to come in contact with the tendons which may be causing Chondrolysis > see NYS Time article: http://www.nytimes.com/2010/01/27/sports/27painpump.html ).

Some hospitals are not protecting the nurse from litigation when the nurse is performing a task that has not been vetted by the institution.

The lack of a written policy & procedure usually happens by omission rather than commission. It is alway best to write a policy, train according to your policy and annually review such policies, especially in the abscence of any industry guidance. No one can find fault if you are making the conscious effort to protect the safety of the patient.

If the pump is to go home there may be issues concerning the proper labeling of the device with the drug and RX, etc. Many hospitals may be in violation of their state pharmacy laws since they may not have an out-patient pharmacy license or have no documention for what is dispensed as is often the case when the pump is filled in the O.R.

There are now national and local "closed door pharmacy" companies that fill cassettes, pumps, reservoir bags with bupiv or ropiv for about $80.00 and often bill the patient directly if they have coverage for RX drugs. Therefore there is no cost to the facility, more documentation and less risk for nursing.

An electronic, resuable pain pump is often best since accuracy is +/- 6% versus +/- 15% plus temperature variations for elastomeric pumps and again the electronic resuable pump gives HX for the Rx, patient activation of bolus doses as well as VTBI and Total Volume Infused.

If it isn't documented... it isn't done!

There is a PCA pump on the market that costs just about $800 and is considered "DME". When used for chemo or chronic pain this device is billable under HCPCS E0781 & A4222 yielding revenue of $242 per month (even if used for a day, week or month) for rental of the pump and $42 for the cassette.

There may be some reimbursment for the pump and associated pain control kits that would reduce the cost versus a purely disposable device costing $175-$300 dollars. This is a state by state regulation.

For orthopaedics the use of Continuous Regional Anesthesia & Post-Op Analgesia using a contiuous nerve block vs a single shot yields better pain mgt. than a fenestrated catheter in the wound. It also has the added benefit of blocking pain in a non-narcotic mode before, during and up to 3-5 days after surgery. It is placed "remote" from the surgical site and has a lower incident of catheter infection.

Anesthesiologist now have the benefit of using ultra-sound placement technique which reduces the the "art" of establishing a good block beyond using paresthesia / stimulation.

Reimbursement for placing a catheter is about $300 or up to $1,000+ for workers comp cases. Narcotic dependent patients are a small sub-set of surgical pateints that greatly benefit from the CPNB technique.

MedSurgReps