Patient Controlled Analgesia (PCA) & Nursing Management
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Patient Satisfication:
Costs:
Overall, patient's were more satisfied with IV injection than the PCA pump.
Research Example:
- Adverse Effects
- Cost
Cost of post op pain management, including materials, drugs and care, was higher in PCA patient's than IV patient's.
Cost for nursing care for pain management was much lower in PCA patients than IV injection patient's.
Summary:
Nurse-Patient Interaction:
Comparing Effects of Intravenous
Patient-Controlled Analgesia
and Intravenous Injection in
Patients Who Have
Undergone Total Hysterectomy.
Overall, Nurses spent more time observing PCA patients, but more time administering medications to IV injection patients.
**There were no time differences in documentation or communcation.
Adverse Reactions:
- Importance of PCA and pain management
- How the pump work for the patient
- Patient must be cognitively and physically able to press control button
- Advantages & Disadvantages
- Importance of Patient Education
- Nurse's Assessment and Management of PCA pump
- Research Example
PCA patients had more adverse effects (nausea and vomiting) than IV injection patients.
POD 2
PCA: 41%
IV: 18%
POD 1:
PCA: 31%
IV:5%
Post Op Pain:
IV injection patients reported higher levels of pain, especially during the first 12 hours after surgery.
Who gets to use a PCA pump?
Constant Level of Pain Control
- Psychological acceptance of technique
- Cognitive and physical ability to manipulate the dose button
- Ability to comprehend the relationship between pain and pushing the PCA button
- Expected need for parenteral opioid to be at least 1–2 days
Advantages:
- Sense of Control
- Quick and Consistent Pain Relief
- Constant Level of Pain Relief
- Eliminates Need for Repeated Injections
- Saves Time
Disadvantages:
- Expense of PCA Pump
- Requires 2 Nurses to Program Pump
- Reinforced Teaching May Be Necessary to Ensure Effectiveness
What is Patient Controlled Analgesia?
Questions or Comments
Group Discussion:
- PCA allows patient's to control the dosage of opioid received.
- PCA help to close the gap of inadequate pain management.
- Commonly used for post-operative and cancer pain management.
Patient Education:
Overdose/ Adverse Effects:
- Call Physician Immediately
- Assess patient's readiness to learn about PCA.
- Address any anxiety or fears about PCA.
- Only the patient should be pressing the control button.
- Press during onset of pain.
How does PCA work?
What do you already know about Patient Controlled Analgesia?
Group Discussion: What do nurses need to look or watch out for with patient's using PCA?
- Connected to patient's IV line.
- Hand Remote/Control Button
- PCA pumps contain the syringed medication
- Placed bedside next to the patient
Common PCA Opioids:
- Morphine
- Fentanyl
- Hydromorphine
Benefits for Nurse:
Assessment:
- Higher Patient Satisfaction
- Better Pain Management
- Less Run Around for Pain Medications
PCA's have...
- Patient's pain level
- IV Site and Tubing
- Infusion Rate
- Vital Signs
- Sedation Level
- Amount of Drug Used
- Side Effects of Opioids
- Demand Dose
- Lockout Interval
- Continuous Infusion
Objectives:
Biblography:
- Define PCA and How it works?
- Who gets to use PCA?
- Advantages and Disadvantages
- What nurses need to look for?
- Importance of Patient Education
- PCA Research Article
Chumbley, G., & Mountford, L. (2010). Patient- controlled analgesia infusion pumps for adults. Nursing Standard, 25(8), 35-40.
Hong, S., & Lee, E. (2014). Comparing effects of intravenous patient-controlled analgesia and intravenous injection in patients who have undergone total hysterectomy. Journal Of Clinical Nursing, 23(7/8), 967-975. doi:10.1111/jocn.12221
Ignatavicius, D., & Workman, L. (2013). Medical-Surgical Nursing:Patient-Centered Colloborative Care (7th ed.) St.Louis, MO: Elsevier.
Surprise, J. & Simpson, M. (2014). PCA: Is that Patient-or Provider- Controlled Analgesia? Journal of Radiology Nursing, 18-22.
Patient Controlled Analgesia (PCA) & Nursing Management