2. PATIENT-CONTROLLED ANALGESIA (PCA) IS A METHOD OF PAIN
CONTROL THAT GIVES PATIENTS THE POWER TO CONTROL THEIR
PAIN. IN PCA, A COMPUTERIZED PUMP CALLED THE PATIENT-
CONTROLLED ANALGESIA PUMP, WHICH CONTAINS A SYRINGE OF
PAIN MEDICATION AS PRESCRIBED BY A DOCTOR, IS CONNECTED
DIRECTLY TO A PATIENT'S INTRAVENOUS (IV) LINE.
IN SOME CASES, THE PUMP IS SET TO DELIVER A SMALL, CONSTANT
FLOW OF PAIN MEDICATION. ADDITIONAL DOSES OF MEDICATION
CAN BE SELF-ADMINISTERED AS NEEDED BY HAVING THE PATIENT
PRESS A BUTTON. OTHER TIMES, A PATIENT CAN CONTROL WHEN HE
OR SHE RECEIVES PAIN MEDICATION AND DOES NOT RECEIVE A
CONSTANT FLOW.
https://www.webmd.com/pain-management/guide/pca
WebMD Medical Reference Reviewed by Minesh Khatri, MD on April 30,
2017
4. HOW OFTEN CAN A PATIENT USE
THE PCA PUMP?
THE PUMP CAN BE USED WHENEVER THE PATIENT IS FEELING PAIN,
THEY JUST PUSH THE BUTTON PROVIDED TO THEM. ONCE THE BUTTON
IS PUSHED THE SYSTEM DELIVERS THE PRESCRIBED MEDICATION TO
THE PATIENT VIA IV. ONCE A PATIENT HAS SELF-ADMINISTERED THE
DOSE(S) ALLOTTED FOR THE TIME PERIOD, THE PUMP WILL NOT DELIVER
ANOTHER DOSE, EVEN IF THE PATIENT KEEPS PUSHING THE BUTTON.
WHILE BASAL DOSES ARE FALLING OUT OF FAVOR, THIS CONTINUOUS
INFUSION RATE MAY BE ORDERED. IF BREAKTHROUGH PAIN OCCURS,
THE PATIENT PRESSES THE BUTTON TO RECEIVE ADDITIONAL
MEDICATION. THE NURSE SHOULD TEACH THE PATIENT AND ANYONE IN
THE PATIENTS ROOM THAT THE PATIENT IS THE ONLY TO BE PUSHING
THE PCA PUMP BUTTON. ONCE THE ACUTE PAIN FROM THE ILLNESS OR
SURGERY IS CONTROLLED, THE PATIENT WILL LIKELY BE SWITCHED TO
PILLS FOR PAIN RELIEF.
5. WHAT SAFETY PRECAUTIONS DOES THE
NURSE NEED TO TAKE?
THE NURSE SHOULD MONITOR THE PATIENT CLOSELY AND
FREQUENTLY TO ASSESS PAIN AND SEDATION LEVELS AT LEAST
EVERY 2 HOURS, ESPECIALLY WITHIN THE FIRST 24 HOURS AND AT
NIGHT, WHEN HYPOVENTILATION AND NOCTURNAL HYPOXEMIA MAY
OCCUR. SEDATION LEVEL SHOULD BE REGULARLY ASSESSED WITH A
STANDARD SEDATION SCALE. THE NURSE SHOULD NOTE THE RATE
OF RESPIRATORY DEPRESSION IS MUCH LESS THAN THE 10 PERCENT
OF PATIENTS WHO EXPERIENCE UNDER TREATMENT OF THEIR PAIN.
6. WEANING
CHANGING FROM PCA TO ORAL OR PRN DOSING CAN CAUSE CONFUSION AND
DISTRESS. IT MAY TAKE AS LONG AS 15 MINUTES BETWEEN WHEN THE
PATIENT REQUESTS PAIN MEDICATION AND THE NURSE BRINGS IT.6 CONTROL
OF PAIN IS NO LONGER AT THE PATIENT’S FINGERTIPS. THE NURSE’S ROLE IS
TO EMPOWER PATIENTS TO UNDERSTAND THE MEDICATION REGIMEN AND
NOT OVERLOOK THE IMPORTANCE OF EDUCATING THE PATIENT TO ASK FOR
THE MEDICATION BEFORE PERFORMING AN ACTIVITY OR PROCEDURE THAT
MIGHT BE PAINFUL.6
THE NURSE SHOULD ANTICIPATE WEANING FROM PAIN MEDICATION WILL BE
SYSTEMATIC AND SLOW, DECREASING THE DOSE FROM 25-50 PERCENT EVERY
24-48 HOURS. USING AN EQUIANALGESIC DOSING CHART WILL HELP THE
WEANING PROCESS. SWITCHING FROM PCA TO ORAL OPIOIDS INVOLVES
CALCULATING THE OPIOID DOSE OVER 24 HOURS AND DETERMINING THE
EQUIANALGESIC DOSE FOR THE NEW ORDER
http://nursing.advanceweb.com/patient-controlled-
analgesia/
7. REFERENCES
1. OSTROWSKI, M. (2003). THE FIFTH VITAL SIGN? RN, 66(6), 9.
2. D’ARCY, Y. (2008). KEEP YOUR PATIENT SAFE DURING PCA. NURSING, 38(1), 50-55.
3. D’ARCY, Y. (2007). PAIN POINTERS: SAFE PAIN RELIEF AT THE PUSH OF A BUTTON. NURSING MADE INCREDIBLY EASY, 5(5), 9-
12.
4. SMELTZER, S., ET AL. (2008). TEXTBOOK OF MEDICAL SURGICAL NURSING (11TH ED.). PHILADELPHIA: LIPPINCOTT.
5. KING, S., & WALSH, K. (2007). “I THINK PCA IS GREAT, BUT.” SURGICAL NURSES’ PERCEPTIONS OF PATIENT-CONTROLLED
ANALGESIA. INTERNATIONAL JOURNAL OF NURSING PRACTICE, 13(5), 276-283.
6. D’ARCY, Y. (2011). NEW THINKING ABOUT POSTOPERATIVE PAIN MANAGEMENT. OR NURSE, 51(11), 28-36.
7. MARDERS, J. (2004). PCA BY PROXY: TOO MUCH OF A GOOD THING. NURSING, 34(4), 24.
8. LEGAL EAGLE EYE NEWSLETTER FOR THE NURSING PROFESSION, (AUGUST 2009).
9. SCHEIN, J., HICKS, R., NELSON, W., SKIRICA, V. & DOYLE, D. (2009). PATIENT-CONTROLLED ANALGESIA-RELATED
MEDICATION ERRORS IN THE POSTOPERATIVE PERIOD. DRUG SAFETY, 32(7), 549-559.
10. INSTITUTE FOR SAFE MEDICATION PRACTICES. (2004, JULY 29). MISPROGRAM A PCA PUMP? IT’S EASY! RETRIEVED APRIL 9,
2009 FROM THE WORLD WIDE WEB: HTTP://ISMP.ORG/NEWSLETTERS/ACUTECARE/ARTICLES/20040729_2.ASP
11. HAGLE, M., ET AL. (2004). RESPIRATORY DEPRESSION IN ADULT PATIENTS WITH INTRAVENOUS PATIENT-CONTROLLED
ANALGESIA. ORTHOPAEDIC NURSING, 23(1), 18-27.
12. ASCHENBRENNER, D., & VENABLE, S. (2012). DRUG THERAPY IN NURSING, 4TH ED. PHILADELPHIA: LIPPINCOTT WILLIAMS
AND WILKINS.
13. INSTITUTE FOR SAFE MEDICATION PRACTICES. (2008, AUG. 28). MISPROGRAMMING PCA CONCENTRATION LEADS TO
DOSING ERRORS. RETRIEVED APRIL 9, 2009 FROM THE WORLD WIDE WEB:
HTTP://ISMP.ORG/NEWSLETTERS/ACUTECARE/ARTICLES/20080828.ASP
14. AHMAD, S., HEWITT, D., & DAMARAJU, C. (2007). FENTANYL HCL IONTOPHORETIC TRANSDERMAL SYSTEM VERSUS
INTRAVENOUS MORPHINE PUMP AFTER GYNECOLOGIC SURGERY. ARCHIVES OF GYNECOLOGY AND OBSTETRICS, 276(3), 251-
258.
