PCA Patients

Think about the pain range and types that your typical PCA meds address. Now think about the surgeries that leave lingering post-op pain for a few days.

I see them quite often on my floor for s/p abd surgeries. I'm talking opens, not laps.

If the pt's balance/loc is not compromised by the PCA, they can walk with the pole. Or have assistance with the pole. Usually we just do room trips.

Cancer patients experiencing severe mucositis. Or any patient that experiences any pain regardless of how brief or mild or even looks funny from the corner of your eye if a certain attending is on. We have even given patients PCA's because they might later get pain when Dr. Button is on.

Oh yes, we certainly use PCAs in ortho! Our docs dc the PCA on POD 1 (except for our spine doc who allows it until POD 2 & sometimes beyond; that's a whole 'nother thread *sigh* ) .

Also have had them for cancer pts & as continuous for end of life care.

About anytime I have any pt (ortho or not) with morphine or dilaudid q1h IVP available & they're using it that often, I call to ask for a change to PCA.

I see them commonly with the spinal surgery patients. Less common with the joint replacement patients.

Laporotomies and hernia repairs. One breast surgeon who refuses to instill local into the wound anesthetics have to prescribe in recovery, who also refuses to use the allied health services properly and insists on a 5 day inpatient stay (arrgh!)

We have a fantastic acute pain service of a consultant anesthesiologist and a NP candidate who review every pt on a PCA every day and are an amazing resource for the ward nurses. They will bridge the pt over to orals as appropriate. Our PCA machines are stored in recovery and to get one you need to send down a slip off the PCA prescription chart, this alerts the pain team to a new pt and they will be reviewed on the round. (Can you tell we work with a paper based system?)

I see them all the time on my floor (primarily GI surgical) for everything from bowel resections to Whipples. We even get occasional wired jaw patients or amputees who have them. It all depends on the doctor and the patient though, so there's not really just one group of procedures or conditions which would always require a PCA no matter what.

Sickle cell crisis. And as blondy already stated, Cancer/bone marrow pts with severe mucositis.

I had a VATS myself... post op pain was very minimal - mostly associated with the chest tube. After it was pulled (24h post op), PCA was DC's and oral pain meds worked fine.

Usually we see them with ortho patients, and always with our spinal surgery kiddos.... our pathways from nearly every surgeon have PCAs for at least one day if not three. :) It all depends on the doctor.

I work on GI surgery/surgical oncology and we have a lot of PCAs. Usually open colectomies, bowel resections, whipples...TAH BSOs....what I don't like is my hospital has just introduced q2h vitals for all PCA pts...whereas it used to be q4h. Waking a patient up q2h overnight feels like torture to me, especially if they aren't using it much and their pain is well controlled.

Thanks everyone! You are all right, I was able to pull charts of the patients receiving PCAs in our PACU (with permission) for the past 3 days and sure enough a lot of what you all suggested were there (especially the big belly cases).

K+MgSO4 we have a computerized system but paper for the PCA flowsheet. I have to check with our Pain management team to see how often they see the PCA patients because I like the sound of how your team functions! Thanks again all :)