use of Cadd pumps in pain management

[jwelhwel]

The hospice I work for almost never approves the use of a CADD pump for the administration of morphine due to the high cost of using a pump. I feel that sometimes we are providing inadequate pain control because of this.What is the experience of other hospice nurses with this situation?

[josville]

as a manager, will you approve the use of cadd if the patient or mpoa request it notwithstanding those other conditions that you wrote on your post reply?

patients have been asking me what cadd stands for; can you help me?

josville

[chris_at_lucas_RN, RN]

as a manager, will you approve the use of cadd if the patient or mpoa request it notwithstanding those other conditions that you wrote on your post reply?

patients have been asking me what cadd stands for; can you help me?

josville

If the physician ordered it, and it made the difference between pain management and not, then what kind of nurse would I be to not approve it, even if I had it in my power to override a physician's order?

I've never had a patient or MPOA request such a thing. We had one patient who had a CADD, it was placed by the oncologist when there was absolutely no relief from pain for the patient (27 year old male with an endstage--days left--hepatobiliary carcinoma).

In my experience, patients and family members are interested in comfort--we provide that. Because it is hospice, we try routes that preserve dignity and do not involve injections, whenever possible. Consequently, IV's, IM's, SQ's and pr's are not high on our list of routes. We have found that topicals, SL's and po's work very well, even with patients who are no longer swallowing (even tabs can be crushed, mixed with a bit of fluid and placed sublingually).

As for what the acronym CADD stands for, I regret I must admit I cannot remember, nor can I find it online. I have telephoned the manufacturer's support line and asked them for that info. Whether they actually call me back is another matter altogether.

Christine

[chris_at_lucas_RN, RN]

.... don't think that if you have a home situation where you think diversion is an issue that it's not possible to divert out of a CADD pump. My professional experience has shown me otherwise.

Agreed--those sufficiently inclined to get drugs however and whenever will not stop at robbing the terminally ill, nor would they let a little think like a lock stop them.

Some things we cannot control and must simply resolve to do our best and let go.

[Sabby_NC]

I have used many pumps of late and I like them very much.

We use Gemstar pumps. Easy to use and families find them easier to use and change over the bags etc.

I like them because pts are not peaking and troughing with their pain levels. Pain is controlled much more on a steady level.

I have a Fentanyl infusion at present and recently had a Dilaudid infusion. I am considering a Morphine infusion for one of my other cancer patients if her pain is not settled after this last increase in her MS Contin.

The Gemstar allows the patients to have continuous BG infusions with boluses that pts can give when and if required.

They are small and do not impede in the way too much so patients can get up and move around, if possible.

I agree to go the oral or PR routes first but these SC infusions are good too!

[MQ Edna]

continuous ambulatory drug delivery

[grace111]

Can anyone help me with procedure for connecting a CADD pump to an epidural line?

[chris_at_lucas_RN, RN]

Can anyone help me with procedure for connecting a CADD pump to an epidural line?

I believe I would get as much hands on support from the CADD supplier and/or (and maybe preferably) the pharmacist involved.