Transcript Palliative Care in Critical Care Unit

Palliative Care in Critical Care
Unit
PCA PUMP
MATA, ERA G.
ICN - IIIA
Palliative Care in Critical Care Unit
PCA Pump
Most common sources of patient
distress when dying in the CCU
include:
 pain
 dyspnea
 delirium
Patient-Controlled Analgesia (PCA)
What is PCA?
General use
The most common form of this is the paracetamol,
that many keep in their bathroom. If a complaint,
e.g. a headache, does not resolve with a small dose
of painkiller then more may be taken up to a
maximum dose.
PCA Pump
Patient-Controlled Analgesia (PCA)
Hospital use
 an electronically controlled infusion pump that
delivers a prescribed amount of intravenous
analgesic to the patient when he or she activates a
button.
 Opioids are the medication most often
administered through PCAs.
 PCA was introduced by Dr. Philip H. Sechzer in the
later 1960s and described in 1971.
Benefits of PCA
 It saves time
 It reduces workload of the nursing staff
 It reduces the chances for medication errors
 Patients can receive medicine when they need it
Benefits of PCA
 Patients who use PCAs report better analgesia and
lower pain scores
 PCA provides a measurement of how much pain an
individual patient is experiencing from one day to
the next.
 It involves patients in their own care, giving them
control and ultimately rendering better patient
outcomes
Disadvantages of PCAs
 Patients may be unwilling to use the PCA or be
physically or mentally unable to.
 The pumps are often expensive and may
malfunction.
Who Can Use the PCA Pump?
 Patients recovering from surgery
 Can be used by people coping with other kinds of
pain.
 Children who are four to six years old Children
who are as young as seven can independently use
the PCA pump.
 Nursing mothers after a cesarean section
How Often Should the PCA Pump Be Used?
 whenever the patient is feeling pain.
 Once the acute pain from surgery is controlled, the
patient will be switched to pills for pain relief.
Is it Safe?

PCA pumps have built-in safety features. The
total amount of analgesic (pain reliever) that the
patient can self-administer is within a safe limit.
When prescribing PCA
 Require the use of PCA standard order sets (all
sections completed) and limit verbal orders to dose
changes.
 Always dose PCA opiates in mg or mcg, not by
volume (mL).
 Check patient allergies before selecting the opiate
used with PCA.
 Use morphine as the opiate of choice.
 Use hydromorphone for patients who need very
high doses of opiates.
When prescribing PCA
 Reserve meperidine for patients who are allergic to
both morphine and hydromorphone.
 Consider other medications that the patient has
received (e.g., analgesics taken at home,
intraoperative medications) or currently has
prescribed (e.g., antihistamines, nighttime
sedatives) when determining the loading and
maintenance doses.
 Reassess the appropriateness of PCA therapy at
regular intervals.