Patient controlled analgesia (PCA) pumps deliver a type of pain management that gives the patient control of their pain by controlling the administration of the pain medication. The medication is administered through a computerized syringe pump that pushes the medication through a syringe into a tube that is connected directly to the patient’s IV line. All you have to do is press a button and pain relief is on its way.
Do you have total control over the medication being administered?
While the patient has the control to relieve their pain by the push of a button, the patient controlled analgesia pump is always pre-programmed by a qualified individual such as an anesthetist. The dosages to be administered is already programmed into the PCA pump with limitations on how often you can push the button and get medication. This is not to take away your autonomy but to protect you from overdose and possible addiction.
How will you be prepared for your new PCA pump?
Your doctor will give you most of the information you see here. They will tell you about the PCA pump, how to operate it, the advantages of using it and the possible side effects. They will also give you a list dangerous signs that you should be aware of so that you can report to the emergency room immediately if you discover them. Your family will also be briefs on what to expect and how to identify possible side effects or dangers.
Who should use patient-controlled analgesia pumps?
There are some special cases where pain management is needed regularly to allow the patient to have a normal life outside of the hospital setting.
Some indications for the use of patient-controlled analgesia pumps include:
- Post operative patients
- Burn patients
- Sickle cell crisis
- Trauma patients
- Cancer patients
- Patients unable to take medication orally
Children six (6) years and above can use patient controlled analgesia pumps. Children five (5) years and younger should get Nurse-Controlled Analgesia instead of Patient-Controlled Analgesia.
Who should NOT get a patient controlled analgesia pump?
These are some of the people who will be excluded from using patient controlled analgesia pumps:
- People of unstable or unsound mind
- Children under 5
- People who are unable to operate the machine manually due to physical disabilities
- People with learning difficulties and frequent memory loss
- Critically ill patients
What are the advantages of using a patient-controlled analgesia pump?
There are many advantages to the use of patient-controlled analgesia pumps. Some of these are:
- Lessen the workload of the ER and clinics
- Reduces competition for hospital beds
- Promotes autonomy – gives the patient control over his/her own pain
- Patients get faster relief from pain as pain relief is available to them at home or on the go.
What are the types of medications used in PCA pumps?
Opioids are used for pain relieve in patient controlled analgesia pumps. Ketamine and Non Steroidal Anti-inflammatory Drugs (NSAIDs) may by used as adjunct therapy. Ketamine is also used as the drug of choice when opioids are contraindicated. The opioid of choice is usually morphine. Whenever morphine is contraindicated in a patient, alternatives opioids such as fentanyl, pethidine and oxycodone can be used.
How often can you use your PCA pump to get medication?
Patient-controlled analgesia can be used every time you are experiencing pain. This might lead to addiction to certain medications. The control for this is the limitation in dosages allowed from the PCA pumps and lockout interval
Important terminologies for you to know if you are using a PCA pump
- Bolus dose – This is a larger amount of pain medication administered rapidly to lower the time taken for the body to respond to the medication. This dose has to be carefully selected as a higher dose may lead to sedation or possible respiratory depression. A lower dose may not be effective for pain relief. The optimal dose for morphine is 1mg, for pethidine 10mg and for fentanyl 20 micro-grams (Dr John Haye).
- Patient dose or demand dose – The dose provided by the pump when the patient presses the ‘button’. For example morphine 2 mg. Opioid tolerant patients and patients in severe pain with movement may need more. This is usually administered over a 1 or 4 hour period.
- Loading dose – This is the total dose of pain medication that is required initially to produce analgesia in the patient. This is usually preset in the patient controlled analgesia pump.
- Lockout interval – This is a time interval in which the patient controlled analgesia pump will not administer any further medication despite the request of the patient. This is for the safety of the patient. This reduces the likelihood of complications from overdose and addiction. This time interval is dependent on the pharmacokinetics of the drugs being administered, how the patient’s body responds to the drug and the bolus dose.
- Background infusion – This is a continuous flow of a small amount of medication to the patient. This helps especially if pain wakes the patient out of sleep. some patients should not get background infusion for example neonates and people with renal impairment.
What are the possible side effects of using a PCA pump?
Side effects may arise from the medications being used or the pump itself. Most of the side effects of the medication will improve with time
- The side effects of opioids include:
- Respiratory depression
- nausea and vomiting,
- Urinary retention
- Constipation (does not improve with time and should be controlled)
- Pump issues:
- pump malfunction
- Catheter dislodgement
- Disconnections in the medication circuit
- Infection at the site of attachment (Pruritus/pus will be at the site of the catheter)
PCA pumps have solved a great problem that many people face each day. PCA pumps continue to improve the lives of people around the world by relieving pain and discomfort. Hats off to the PCA pump companies!
What do you think about PCA pumps? I hope the information in this article was useful to you.
Also, take a look at the Top Ten Patient Control Analgesia Pumps available on the market today.