Understanding PCA settings

nrsang97, BSN, RN · Nov 22, 2008

Lockout is how long before they can press the button again. So if there is a 10 minute lockout then the pt can press the button every 10 minutes and be dosed with pain meds. If they press the button before the 10 minutes is up, they will get nothing.

Basal/continuous rate is how much they will get per hour without pressing the button. So they may have for example morphine at 1mg/hr. That is the basal rate or as some say continuous rate.

Demand dose is how much the pt gets when they press the button.

Loading dose is how much they get before the PCA is started. So you may give a 2mg loading dose of morphine before starting the PCA.

4 hr limit is how much the pt can receive in 4 hours total.

So in report you may hear "Pt has a PCA of Morphine. Settings are Demand dose/PCA of 0.5mg, Basal rate of 1mg/hr, 10 minute lock out, and 4 hour 30mg limit."

Hope this helps.

ChristineN, BSN, RN · Nov 22, 2008

I never have pt w/PCA. Can somebody please explain settings/terms. IE lockout, basal, etc. thanks so much

We get PCA's quite often on my floor (for hospice and sickle cell pts).

Often a pt can use the PCA in 3 ways (any combination of the three ways could be ordered for a pt): Continuous (gets a set amount of the narcotic, all the time, I'm assuming this is also what you mean by basal), Demand(pt gets a pre-set amount only when pt hits the button), and Clinician Bolus (pt can get narcotic when RN administers through PCA, often this amount is larger than Demand). Often I see pt's on Demand, so they can control pain themselves as well as Bolus, for breakthrough pain relief.

A lockout is needed in the order for both Demand and Clinician Boluses. If the doctor does not want a lockout, he needs to specify such in the order. Often you'll see it ordered something like "Demand 1mg, Lockout 6 min, Bolus 5mg, Lockout 1hr" When you review your PCA at the start of your shift, it should tell you how many mls are left in the PCA, as well as the amount of continuous (even if 0), amount of Demand, Demand lockout.

When you go in and review the PCA, it should tell you how times the pt is pressing the button per hour. It will tell you how many times the button is pressed, as well as how many of those times the pt actually got a dose (ie pressed button 10 times, got meds 4). On my floor, we chart how many times the button was pushed as well as doses given. This is charted in ml, so you have to know the concentration of your PCA to figure out the mg/ml. We also chart when we change the PCA CADD (the narcs), as well as when we give boluses. We change the CADD every 24hrs, but some facilities might be different.

GQRN · Nov 22, 2008

I've worked with 3 different PCA pumps. Even though I feel like I know how to work the PCA pump, I've always made sure I had the proper training via in-service and was checked off. This is a high alert infusion, so you must be trained properly.

So make sure you have your manager schedule you an in-service, and get checked off to make sure you know everything.

Whats that popular saying?

"WHEN IN DOUBT, DON'T DO IT. ALWAYS ASK".