PCEA- What is it? Nursing Management of Patient Controlled Epidural Analgesia

Nursing Management of
Patient Controlled Epidural Analgesia
Adam Cooper, RN, MSN
Adult Nurse Educator
PCEA- What is it?
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A method for administering epidural
analgesia continuously and intermittently.
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Continuous infusions of analgesics and/or
local anesthetics can be provided through a
catheter placed in the epidural space.
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PCEA Pump- medications are infused
continuously through a pump into the
epidural catheter.
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PCEA Basics
Spinal level of catheter
insertion guides the
RN in assessing what
pain will be controlled
and what pain will not
be alleviated
Most common btwn: L2-L4
(33 vertebrae)
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PCEA- RN Responsibilities
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Assessing patient pain
Notifying the physician of pain
assessment
Planning pain management with team
Monitoring the patient and the patient’s
response to interventions
Documenting
PCEA Orders
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The epidural infusion is ordered by the
MD on the pre-printed order sheet
Includes:
– Standard Mix (Ropivicaine w/ Fentanyl)
– Delivery Settings
– Titration Orders
– Additional Meds
– Monitoring Orders
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Delivery Settings
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Continuous Rate (basal rate)- mL/hr
Demand Dose (pt controlled injection)mL/inj
Demand Dose Lockout (interval of how
often pt can use)- min
One hour limit- mL
Titration Orders

Continuous (basal) rate may be:
– Increased by __mL/hr every 1 hour for
severe pain. 1 hour limit is max.
– Decreased by __mL/hr every 1 hour for
excessive sedation, arm/leg/chest
numbness, or hypotension.
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Other Important Issues

No opioids, sedatives, or anticoagulants
(except Aspirin or SC Heparin)
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Only MD/NPs or Adult ICU/PACU RNs may
attach epidural catheters to tubing

IV & Foley Catheter must be in during the
infusion and must be in place for 12 hours
after d/c.
RN Monitoring
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Assess & Document Q 2 x 12hrs then Q4hrs:
–
–
–
–
–
–
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RR (call if <10)
O2 (call if <90%)
Pain
Sedation (watch for somulence)
Other Vital Signs (n/v/, hypotn)
Abnl absorption: numb mouth/metallic taste, tinnitus
Total dose infused Q 24hrs
– Clear Pump/Document: CC- 0700
AC- 0000
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RN Monitoring

If RR < 8 or O2< 85%, unresponsive,
or severe hypotension (SBP<80):
– Stop infusion
– Check vitals now
– Give Naloxone (Narcan)
– Notify Pain Svc and primary MD
– Place O2 bag/mask on high
– Check vitals q 1hr x 12 hours
– Call rapid response or even code blue!
Naloxone (Narcan)
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Opioid antagonist
IV acts within 2 minutes
Must monitor as Narcan can wear off before opioids
Expect pain, tachy, diaphoresis afterwards
Comes in a 0.4mg/ml vial
Dilute in NS to a total volume of 10 mL = 0.04 mg/ml
0.1 mg IV q 1 min PRN respiratory depression or
unresponsiveness
0.1mg = 2.5ml
Push SLOWLY. Using the 10ml syringe of diluted
naloxone push 1 ml every 1-2 minutes until sedation
and respiratory depression improves.
IR
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CADD Pump

Directions at bottom of
screen
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2 RN Check
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Green light- GO!
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Use arrows to adjust
settings
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Slow…..
CADD Pump (con.)
Must be unlocked to make changes
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CADD Pump (con.)
There is NO on/off
button!
Pump is turned on
when battery is
inserted
Pump is turned off
when battery is
removed
CADD Pump (con.)
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More Info
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Pain ServiceParnassus: 719-2398
Mt. Zion:
443-2676
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Quick Reference Cards
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Video in nursing education
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Nursing P&P
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