Patient controlled analgesia (PCA) is a way to provide pain medicine using a pump. The PCA pump allows the patient to receive pain medicine safely when it's needed most. Your child will be able to control when a medicine dose, called a “boost,” is received by pressing a button. Your child does not have to wait for the nurse to give it.
Only your child should push the pump button unless the doctor or nurse has told you to push the button for your child. Before you are allowed to push the boost button, you will need to be taught how to use it. The doctor or nurse will tell you when you should and should not push the boost button.
How a PCA pump works
Your child’s care team (doctor, nurse, and pharmacist) will decide which pain medicine will be put in a cassette or bag and attached to the PCA pump. The tubing from the PCA pump will be attached to your child’s IV line. The pain medicine is usually morphine, hydromorphone (Dilaudid®), or fentanyl. These medicines are all opioids (narcotics) that are also used in other forms, such as pills, for managing pain. The amount of pain medicine your child receives (dosages) will be based on body size, age, overall medical condition, the type of pain, and how much pain. The care team will decide these dosages for the PCA pump, which are called “pump settings.”
When your child has pain and presses the button, the pump will give a set amount of medicine, called a “bolus dose” or “boost” through the IV line. By pushing the button, your child can have smaller, more frequent doses of pain medicine to control pain with less risk of becoming too sleepy and slowing the breathing rate.
The computer program in the pump has a timer, called a “lock out” to prevent your child from giving the boosts more often than prescribed. Even if your child pushes the button before this time period ends, the pump will not give the boost. The boost will only be given if your child pushes the button after enough time has gone by since the last dose.
The pump will store information about how much pain medicine your child receives as well as how many times the button is pushed, even if the lock out time prevents the pump from giving a boost. Therefore, it is important for your child to push the button only if pain medicine is needed. Your child should not test the button to see if it works or otherwise play with the pump. Do not change the pump settings or give any dose other than the programmed boost dose at any time. Only health care providers may change the pump settings.
Full-time pain relief
The pump can be programmed to give a continuous amount of the pain medicine even if your child does not push the button. This is called the “continuous,” “basal,” or “background” infusion.
At least one time a day, the care team will review the number of times your child pushes the button and the pain scores. By looking at the information saved by the pump, they can decide if the medicine doses are the best settings to lessen your child’s pain. The amount of medicine may be increased or decreased, or a different medicine may be used if your child still has pain. The team will also check the program of the pump often to make sure the pump settings are correct.
If needed, the care team may order “clinician boluses.” These are boluses of the medicine that the nurse can give using the pump. Family members are not permitted to give clinician boluses.
If you think your child is not getting enough pain relief with the PCA or if you have questions about a PCA pump, talk to the care team.
A PCA pump can:
- Provide safe, steady control of your child’s pain;
- Decrease some of the side effects that pain medicine can cause such as being too sleepy;
- Increase your child’s ability to be active by preventing pain from movement; and
- Give your child more control over pain.
How do I know the pump is working?
The pump is infusing when the green light on the left side of the screen is flashing and the bar at the top of the screen is green and reads RUNNING. The infusion is not running if an orange light is flashing to the left of the screen and the bar at the top of the screen is red with the word STOPPED.
How do I start and stop the pump?
To start or stop the pump:
- Press the STOP/START button.
- When you see the message “Stop Pump?” press YES or NO.
How do I know if a blockage is keeping the pump from giving the medicine?
The pump will alarm to tell you if the tubing is kinked or clamped. The screen will say “downstream occlusion. Clear occlusion between pump and patient.” If you unkink or unclamp the tubing, the alarm sound will stop and the pump will automatically start running as it had before. Until you can find the problem and correct it, the alarm sound will continue and your child will not receive medicine from the pump. To stop the alarm, turn off the pump and remove the batteries. If you cannot find the problem causing the alarm, you will need to call the pain doctor as soon as you can for further directions.
How do I care for my child while on the pump?
If your child is having increased pain and is an inpatient, a doctor or nurse will make any needed changes to the pump during daily rounds. If your child is an outpatient, you should call C clinic during regular business hours at 901-595-5372 or 901-595-3300 after hours and ask to speak to the pain doctor on call.
How do I know when to change the batteries?
If a message on the screen says “Battery low, replace battery,” you will need to replace the batteries as soon as you can.
How do I change the batteries?
To change the batteries, follow these steps:
- Press the STOP/START button.
- When you see the message “Stop Pump?” press YES.
- Remove the 4 used batteries.
- Insert 4 new AA batteries. Do not use rechargeable NiCAD or carbon zinc (“heavy duty”) batteries because the pump will not work properly with those kinds of batteries.
- Press the power switch to turn on the pump.
- The screen displays “Do you want to start a new patient?” Press NO.
- Press STOP/START to start the pump.
- When you see the message “Start Pump?” press YES.
- If you do not change the batteries while they are low, the alarm will sound and the orange light will no longer flash. Change the batteries as described above.
What will happen if the pump runs low on medicine in the cassette or bag?
The care team will try to keep the medicine from running low in the pump by ordering more before the cassette or bag is empty. If outpatient, your child must return to the clinic at the appointed time to make sure the cassette or bag can be changed before it is empty. A clinician must make all cassette and bag changes. These can be done in the hospital (inpatient or clinic) or at home by a home health or hospice nurse.
If you see the message “Reservoir Volume Low” on the pump screen, alert your child’s team that a new bag or cassette will be needed soon.
If you see the message “Reservoir Volume is zero” on the screen, the cassette or bag may be empty.
- Press the ACKNOWLEDGE key to stop the alarm.
- Then alert your child’s team that you need a new cassette or bag right away.
How will the pump dosages be changed if my child is an outpatient?
If a dosage change is needed when your child is an outpatient, you will come to the clinic. It will not be possible for you to change the settings yourself. However, the care team still needs you to tell them how well your child’s pain is being controlled on the current settings.
You may need to give reminders about pushing the button if your child complains of pain or right before an activity that may cause pain.
- After your child pushes the button, wait a few minutes for the pain medicine to work.
- Do not be worried about how much time has gone by since your child has last pushed the button. Do not encourage your child to push it for any reason other than pain.
- Do not have your child wait until the pain is severe before pushing the button.
Using a boost dose before your child expects to feel pain from certain activities may be helpful. It may help to have a boost dose before the following:
- Getting out of bed
- Coughing or breathing deeply to keep the lungs clear
- Having a dressing change
- Using medicines for mouth care
You can remind your child of other ways to lessen pain such as massaging the painful area or focusing on something other than the pain.
Sometimes the medicines in the PCA pump can cause side effects. Usually these symptoms will go away over time or by reducing the dose of pain medicine. Do not stop the pump. Report the following side effects to your child’s care team as soon as possible:
- Feeling itchy
- Constipation (trouble having bowel movements)
- Problems urinating
More serious side effects need attention right away. If your child has the following symptoms and is using a PCA pump as an outpatient, stop the PCA pump and call 901-595-3300.
- The pain medicine may cause changes in your child’s ability to think, confusion, or hallucinations (seeing things that are not there).
- If your child is very drowsy it could be a warning sign that the amount of pain medicine is too much and could soon cause slow breathing. To reduce this risk, the boost button usually should be pushed only by the child. If such a problem is detected early, the sleepiness and slower breathing can be corrected by stopping the pump for a short time and arousing your child to be sure breathing is normal.
If your child stops breathing or is breathing less than _________ per minute:
- Call 911 for emergency medical services;
- Stop the PCA pump;
- Gently shake your child; and
- Provide CPR if breathing does not start again.
Many family members wonder if their child could receive too much medicine. The amount of pain that a child has from one day to the next may differ, so the amount of pain medicines needed will change, as well. Your child may need to push the button more during certain times of day when there is more pain. That is the purpose of the PCA pump. It allows the child to match the level of pain to the pain medicine received by pushing the button only when needed. The PCA pump may not take all the pain away, but the dosage can be adjusted to the amount of pain your child is feeling at the time.
Some people worry about becoming addicted to the pain medicines. The chance of becoming addicted is very rare. If your child is using these medicines only for pain, this will not become a problem. In fact, your child will need this pain relief to remain active and rest well.
Check with your child’s care team before giving other medicines that may cause sleepiness, such as diphenhydramine (Benadryl®), lorazepam (Ativan®), promethazine (Phenergan®) or other anti-nausea medicines.
Do not take the pump into the shower or put it in water. Although the pump is water-resistant, it is not waterproof. If you accidentally drop the pump in water, retrieve it quickly, dry it off with a towel, and call your child’s care team.
If you drop the pump or hit it against a hard surface:
- Check the latch on the side of the pump and make sure the dot on the latch lines up with the solid dot on the pump;
- Gently twist and pull on the cassette or tubing in the pump to make sure it is still firmly attached;
- Check the battery door to make sure it is still firmly attached; and
- If the cassette or battery door is loose or damaged, do not use the pump. Close the tubing clamp, stop the pump, and contact your child’s care team.
Warning: If the cassette or tubing connected to the pump becomes detached, an uncontrolled flow of medicine from the reservoir or a backflow of blood may result. This could cause serious health problems.
If the battery door becomes detached or loose:
- The battery will not be properly secured, which may result in loss of power, and
- The drug will not flow into your child, so pain will increase.
When should I push the boost button for my child?
Usually, only your child will be allowed to push the boost button. If you are told you can push the button for your child, please follow these safety guidelines:
- Never push the boost button:
- While your child is sleeping;
- If you cannot wake your child normally; or
- If your child is having abnormal breathing (too slow or too shallow).
- The boost button should not be used to make your child sleep or to make your child feel less anxious. If your child is anxious or has trouble sleeping, talk to the care team about help with these problems.
- Push the boost button only if your child is awake and behavior or words tell you your child is hurting but cannot push the button.
When the PCA pump is no longer needed, the team will change the pain medicine to another form such as pills. The dose of pain medicine will be reduced gradually until the pump is no longer needed and your child is able to take pain medicine a different way.
If you have questions about PCA pumps, please talk to your child’s doctor, nurse, or pharmacist. The local St. Jude number is 901-595-3300. If you are outside the Memphis area, dial toll-free 1-866-2STJUDE (1-866-278-5833).
This document is not intended to take the place of the care and attention of your personal physician or other professional medical services. Our aim is to promote active participation in your care and treatment by providing information and education. Questions about individual health concerns or specific treatment options should be discussed with your physician.
St. Jude complies with health care-related federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
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