What is the greatest concern with patient controlled analgesia PCA by proxy?
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Verghese ST, Hannallah RS. Postoperative pain management in children. Anesthesiol Clin North Am 2005; 23:163-184. Show Berde CB, Sethna NF. Analgesics for the treatment of pain in children. N Engl J Med 2002; 347:1094-1103. Joint Commission on Accreditation on Healthcare Organizations (JCAHO). Sentinel event alert on patient controlled analgesia by proxy (2004); December 20, issue 33. Hudcova J, McNicol E, Quah C, et al. Patient controlled opioid analgesia versus conventional opioid analgesia for postoperative pain. Cochrane Database Syst Rev 2006; 18:CD003348. Cashman JN, Dolin SJ. Respiratory and haemodynamic effects of acute postoperative pain management: evidence from published data. Br J Anaesth 2004; 93:212-223. Cohen LL, Lemanek K, Blocent RL. Evidence-based assessment of pediatric pain. J Pediatr Psychol 2008;33(9):939-955. Jonas D. Parent's management of their child's pain in the home following day surgery. J Child Health Care 2003; 7:150-162. Malviya S, Voepel-Lewis T, Tait AR. A comparison of observational and objective measures to differentiate depth of sedation in children from birth to 18 years of age. Anesth Analg 2006; 102:389-394. Nelson KL, Yaster M, Kost-Byerly S, et al. Patient controlled analgesia by proxy: results from a national survey. Anesthesiology 2007; 107:A685. Voepel-Lewis T, Marinkovic A, Kostrzewa A, et al. The prevalence of and risk factors for adverse events in children receiving patient-controlled analgesia by proxy or patient-controlled analgesia after surgery. Anesth Analg 2008; 107:70-75. Overdyk FJ, Carter R, Maddox RR, et al. Continuous oximetry/capnometry monitoring reveals frequent desaturation and bradypnea during patientcontrolled analgesia. Anesth Analg 2007; 105:412-418. Babl FE, Crellin D, Cheng J. The use of the faces, legs, activity, cry and consolability scale to assess procedural pain and distress in young children. Pediatr Emerg Care. 2012; 28:1281-1296. Tomlinson D, von Baeyer CL, Stinson JN, et al. A systematic review of faces scales for the self-report of pain intensity in children. Pediatrics 2010; 126(5):e1168-98. R Srouji, S Ratnapalan, S Schneeweiss. Pain in children: assessment and nonpharmacological management. Int J Pediatr 2010;2010:474838. Malviya S, Voepel-Lewis T, Tait AR, et al. Effect of age and sedative agent on the accuracy of bispectral index in detecting depth of sedation in children. Pediatrics 2007; 120:461-470. Viscusi ER. Patient-controlled drug delivery for acute postoperative pain management: a review of current and emerging technologies. Reg Anesth Pain Med 2008; 33:146-158. Hicks RW, Sikirica V, Nelson W, et al. Medication errors involving patientcontrolled analgesia. Am J Health System Pharm 2008; 65:429-440. ST Verghese, Hannallah RS. Acute pain management in children. J Pain Res 2010; 3:105-123. Gureno MA, Reisinger CL. Patient controlled analgesia for the young pediatric patient. Pediatr Nurs 1991; 17:251-254. Monitto CL, Greenberg RS, Kost-Byerly S, et al. The safety and efficacy of parent/nurse-controlled analgesia in patients less than six years of age. Anesth Analg 2000; 91:573-579. Institute for Safe Medication Practices (ISMP). Safety issues with patient-controlled analgesia. Part I-how errors occur. ISMP Medication Safety Alert! 10 July 2003. Wuhrman E, Cooney MF, Dunwoody CJ, et al. Authorized and unauthorized 'PCA by proxy' dosing of analgesic infusion pumps: position statement with clinical practice recommendations. Pain Manag Nurs 2007; 8:4-11. Cohen MR, Smetzer J. Patient-controlled analgesia safety issues. J Pain Palliat Care Pharmacother 2005; 19:45-50. Cooney MF, Czarnecki M, Dunwoody C, et al. American Society for Pain Management Nursing position statement with clinical practice guidelines: authorized agent controlled analgesia. Pain Manag Nurs 2013; 14:176-181. Howard RF, Lloyd-Thomas A, Thomas M, et al. Nurse-controlled analgesia (NCA) following major surgery in 10,000 patients in a children's hospital. Paediatr Anaesth 2010; 20:126-134. Duedahl TH, Hansen EHA. Qualitative systematic review of morphine treatment in children with postoperative pain. Pediatr Anaesth 2007; 17:756-774. What side effects of patientThe most observed adverse effects of opioid-based PCA are nausea and vomiting, pruritus, respiratory depression, sedation, confusion and urinary retention.
What are the complications of PCA?Risks of PCA. Allergic reaction.. Nausea or vomiting.. Low blood pressure.. Sleepiness.. Constipation.. Trouble breathing (respiratory depression): This is the biggest danger.. What should you monitor when caring for a patient with a PCA who is at risk for respiratory depression?Continuous capnography and/or pulse oximetry should be used in all patients receiving PCA opioids for early detection of opioid-induced respiratory depression.
What should the nurse assess in a patient who is receiving patientMonitoring the Effects of PCA
Monitoring requirements should be developed for patients who are receiving PCA. At a minimum, the patient's level of pain, alertness, vital signs, and rate and quality of respirations should be evaluated every four hours.
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