Patient Controlled Analgesia, or PCA as it is referred to, is increasingly being used in UK hospitals and hospice environments.

What is Patient Controlled Analgesia?

Patient controlled analgesia (PCA) is a method of giving pain relief to a patient that involves the patient’s participation. It is typically administered intravenously although it can be given subcutaneously or by epidural. In addition to self-administration there is a continuous background infusion of opioids which may be delivered independently of the patient. This is to allow the patient to sleep without being constantly woken to re-establish their pain control.

How Does the Pump Work?

The PCA system is a battery-operated pump that has a syringe and a timing device. The system is programmed in advance, then activated each time the patient presses a button. Alexander explains that the system is set with a safety device which ensures that the patient cannot receive too much analgesia over a certain period of time.

What are the Advantages of Patient Controlled Analgesia?

• PCA machines administer a continuous dose of analgesic which replaces the need for painful intramuscular injections.
• According to Thomas, intramuscular injections also cause narcotic blood levels to rise and then fall sharply. This results in the patient experiencing peaks and troughs of pain which is not desirable.
• Pain relief is delivered instantly through a PCA and it is not necessary to wait for two nurses to be available to check controlled drugs.
• The continuous dose delivered by a PCA machine ensures that the patient’s pain is never out of control and that their pain can be monitored effectively.
• This method allows the patient to be in control and not feel awkward by constantly needing to summon a nurse.
• According to Nendick, use of PCA ensures that patients are able to move around quicker after surgery, reducing post-operative complications such as Deep Vein Thrombosis.

What are the Disadvantages of Patient Controlled Analgesia?

• For PCA to be effective a patient must be mentally and physically able to press a button. This may be difficult for an individual that suffers with arthritis, for example, or a patient with confusion.
• Hauer cautions that patients with Chronic Obstructive Pulmonary Disease or those that have suffered a head injury should not use the PCA system, as respiratory depression may be more likely to occur.
• Some patients may also find the PCA machinery overwhelming and would prefer traditional methods of pain relief.
• Nausea and vomiting are common side effects when using a PCA device containing opioids. If this occurs then additional anti-emetics will be required.
• To avoid risk of malfunction, nurses need to ensure that the equipment is charged frequently and checked and maintained according to local policies and procedures.
• A patient attached to a PCA pump will need assistance when changing their clothes, as the wire will need to be disconnected, threaded through clothing and re-connected to the machine.

Which Drugs are Used in Patient Controlled Analgesia?

The most common medications administered through a PCA device are Morphine, Fentanyl and Hydromorphone. These drugs are prescribed by a doctor and require checking and administering by two nurses, at least one of whom needs to be a qualified nurse, according to the controlled drugs policy for that particular area.

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What About Adverse Incidents or Near-Misses?

As with any drug use, it is essential that any adverse safety incidents or near-misses are made known to the nurse in charge of the ward. The National Patient Safety Agency defines safety incidents as “any unintended or unexpected incident which could have, or did, lead to harm for one or more patients receiving NHS-funded healthcare” and operates an incident reporting system. In the event of such an episode happening nurses are encouraged to learn from mistakes and highlight the problems which occurred.

Furthermore, when caring for a patient who is controlling their own pain relief, nurses must still monitor the patient regularly – observing vital signs such as pulse, blood pressure, respirations and oxygen saturation. It is also important for the nurse to regularly assess the patient’s pain in order to determine whether adequate pain control is actually being achieved.

Sources

• Alexander, M. Fawcett, J. and Runciman, P (2000) Nursing Practice: Hospital and Home. Second Edition. London: Harcourt Publishers Ltd.
• Hauer, M. (1995) Intravenous patient controlled analgesia in critically ill postoperative patients. Dimensions of Critical Care Nursing. Vol. 14 (3)
• National Reporting and Learning Service. National Patient Safety Agency. Information retrieved 6th April 2011
• Nendick, M. (2000) Patient satisfaction with post-operative analgesia. Nursing Standard. Vol.14, (22)
• Thomas, N. (1996) Patient – controlled analgesia. Nursing Standard. Vol 10 (14)

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