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Pca Training
2
by the Pain Team
Pca Training
Introductions
Introduction
The Pain Team
- Who are we?
- What do we do?
aim
- Competent in PCA management
aim
Objectives
objectives
By the end of the session you should be able to:
1
Practice safe PCA care by demonstrating how to review the PCA programme, change a bag/ repeat the last infusion, how to remove air/ occlusion in the line, and how to use the ‘hard’ keys.
2
Recount your responsibilities in PCA management and know where to seek further help
3
Evaluate why good pain management is important, list the common complications of poorly managed pain, identify the advantages and contraindications of PCA management, and understand how opioids work in the body.
definition
Pain
theory
“An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage,”
Why Control pain?
International Association for the Study of Pain (IASP) 2018
‘failure to relieve pain is morally wrong and ethically unacceptable'
Royal College of Surgeons of England and the College of Anaesthetists (1990) Pain after surgery.
WHo analgesic ladder
analgesia
strong opioid
weak opioid
Non-opioid
What can happen if we don’t control pain?
Opinion
1) Go to PollEv.com
2) Enter GRACERING309
but wait...
how do opioids work?
Biopsychosocial
Advantages?
- Don’t have to wait for analgesia
- Rapid delivery – quicker onset
- Potential to administer large doses of opioid more safely
- Avoid peaks and troughs (mountains and valleys)
- Saves on nursing time ?
- Patient satisfaction ?
what is pca?
Who can use it?
Patients must understand the concept
-Language and learning difficulties, confusion
Patients need to be able to press the button
-physical + cognitive
Patients must be willing to self-administer
click here!
patient types
patient types
When am I likely to see PCA in practice?
Post-op after major surgery
- likely as no oral route
-pain not controlled by other routes
Individual requirements unknown
- opioid naive/ opioid tolerant
look at the graph
- What do you notice about the route of PCA?
- How does it compare with other routes?
Display of the 'peaks and troughs' of analgesia routes.
the pump
pca in practice
prescriptions
pca prescriptions
We no longer have a 4 hourly limit of IV morphine via PCA
Fentanyl
Morphine:
Intravenous PCA morphine
100 mg morphine in 100 ml
1 mg bolus, 5 minute lock-out
Intravenous PCA Fentanyl
3000 mcg in 300 ml = 10 mcg/ml
20 mcg bolus, 5 minute lock-out.
notice!
alert!!
Labeling changes:
Morphine- now 103ml
Fentanyl- now 303ml
Change the line- 96hrs!
pca variables
- Loading dose
- Drug concentration
- Bolus dose
- Lock-out interval
- No maximum dose limit