Pharmacology Book

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Patient Controlled Analgesia

Aka: Patient Controlled Analgesia, PCA Pump
  1. See Also
    1. Opioid
    2. Bowel Regimen in Chronic Narcotic Use
    3. Narcotic Overdose
  2. Step 1: Calculate hourly dose for Morphine
    1. Typical Hourly Morphine Dose (mg/hour): (100 - age)/24
      1. Age 30: 3 mg hourly Morphine dose
      2. Age 50: 2 mg hourly Morphine dose
      3. Age 70: 1.25 mg hourly Morphine dose
    2. Typical hourly higher Morphine dose (double dose)
      1. Age 30: 6 mg hourly Morphine dose
      2. Age 50: 4 mg hourly Morphine dose
      3. Age 70: 2.5 mg hourly Morphine dose
  3. Step 2: Set Lockout periods and Maximums
    1. Maximum Lockout: 20 minutes
    2. Typical lockout period range: 6 to 12 minutes
    3. Set one hour or four hour maximums
      1. Example for one hour Morphine maximum: 10 mg
      2. Example for four hour Morphine maximum: 40 mg
  4. Step 3: Consider background infusion
    1. Indications
      1. Opioid Dependence
      2. Severe pain on awakening
    2. Calculation
      1. Set background rate <50% of anticipated requirements
      2. Typical adult background Morphine rate: 1 mg/hour
  5. Step 4: Determine PCA bolus Dose
    1. Bolus dose: (higher dose per hour)/(doses per hour)
    2. For lockout at 10 minute intervals: 6 doses
      1. Example: 30 year old with higher Morphine dose: 6 mg
      2. Dose: 1 mg IV Morphine boluses up to q10 minutes
  6. Step 5: Convert from Morphine to other medication
    1. Hydromorphone (Dilaudid) 1.5 mg per Morphine 10 mg
    2. Meperidine (Demerol) 75 mg per Morphine 10 mg
  7. Examples for typical 30 year old
    1. Morphine
      1. Boluses: 1 mg
      2. Background infusion rate: 1 mg/hour (optional)
      3. Hourly maximum: 10 mg
      4. Lockout: 6 minutes
    2. Hydromorphone (Dilaudid)
      1. Boluses: 0.1 mg
      2. Background infusion rate: 0.1 mg/hour (optional)
      3. Hourly maximum: 1.5 mg
      4. Lockout: 6 minutes
  8. References
    1. Etches (1999) Surg Clin North Am 79(2):297-312 [PubMed]

Intravenous analgesia unit (C0181331)

Definition (UMD) Infusion pumps that are designed to deliver a predetermined amount of analgesic drug on demand, i.e., when requested Infusion pumps designed to deliver a predetermined amount of analgesic drug on demand (i.e., when requested by the patient) as well as delivering continuous pain control. To prevent tampering or diversion, PCA pumps typically offer a method of securing the controls and medication container, which is connected to a proprietary administration set. The administration set tubing is connected to an intravenous catheter or other infusion device (e.g., epidural catheter, subcutaneous injection/infusion port). Typically, PCA pumps are programmed to deliver in any one of the following modes: demand dose, demand dose plus continuous infusion, or continuous infusion only; the pumps can also be programmed to deliver one-time doses (i.e., bolus or loading doses). PCA pumps are designed with specific safeguards that restrict the amount of drug that can be requested and delivered over a specific period of time (e.g., 1 mg of drug every 6 minutes for a total of 10 mg per hour). PCA pumps allow narcotic analgesics (e.g., morphine, meperidine, hydromorphone) and fentanyl to be administered as needed by the patient while keeping the amount within the prescribed limits and preventing unauthorized access to the medication. The software inherent in the PCA pump is typically capable of storing cumulative data regarding number of doses delivered, date/time of each dose delivered, number of requests received, and total volume of drug delivered. PCA pumps are intended for patient control of pain by permitting self-administration of analgesics (i.e., patient-controlled analgesic pumps) within pre-established limits; they are typically mounted on poles or used on tabletops but dedicated ambulatory pumps are also available.
Definition (SPN) An infusion pump is a device used in a health care facility to pump fluids into a patient in a controlled manner. The device may use a piston pump, a roller pump, or a peristaltic pump and may be powered electrically or mechanically. The device may also operate using a constant force to propel the fluid through a narrow tube which determines the flow rate. The device may include means to detect a fault condition, such as air in, or blockage of, the infusion line and to activate an alarm.
Concepts Medical Device (T074)
SnomedCT 73571002
HL7 PCA
English PUMP, INFUSION, PCA, PCA Pumps, Patient-Controlled Analgesia Units, Infusion Pumps, Demand Analgesia, Intravenous analgesia unit, device, pca pumps, pca pump, Infusion Pumps, Patient-Controlled Analgesic, Intrathecal Analgesia Units, Epidural Analgesia Units, Infusion Pumps, Analgesic, Patient-Controlled, Analgesic Infusion Pumps, Patient-Controlled, Analgesia Units, Intravenous, Intravenous analgesia unit, Patient controlled analgesic infusion pump, Intravenous analgesia unit, device (physical object), PCA Pump
Spanish bomba de infusión analgésica controlada por el paciente, unidad para analgesia intravenosa (objeto físico), unidad para analgesia intravenosa
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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