VAN WERT COUNTY HOSPITAL Policy/Procedure: Interdepartmental No.: N 7-14 Issue Date: 6-90 By: Nursing No. of Pages: 9 Reviewed: 6-14, 12-13, 5-11 Revised: 6-14 Distribution List: All Nursing Departments, Pharmacy Concurrence: Subject: PCA II Pump Policy: Patients with PCA analgesis will have vital sign including oxygen saturation and level of consciousness evaluated every 4 hours. Purpose: To provide controlled analgesia by patient or nurse through IV infusion pump by delivery of a predetermined dose of medication within set limits To allow patient or nurse to effectively titrate analgesia dose by balancing analgesia against sedation and other side effects To control pain with continuous analgesia in severe cases, such as terminal cancer NOTE: For labor patients receiving epidurals see policy N 36A re:epidurals May be performed by: RN Equipment: 1. Primary IV 2. PCA II Pump (obtain from PACU or OB for epidurals 3. Anti-siphon PCA tubing Combination Set (Materials Management item # 21452) 4. Needleless System Injection Site (MM item # 21434) 5. Needleless System Thread Lock Cannula (MM item # 21437) 6. Alcohol pledget 7. Saline lock adaptor at IV site 8. Narcotic medication in 100 ml. viaflex bag for PCA use as ordered (obtain from Narcotic cabinet or Pharmacy) 9. Key to access pump (on narcotic medication key ring) 10. (4) size D batteries required for pump operation (from MM) Procedure: A. Basic Preparation 1. Check physician order for: a. drug name b. dosage c. delay/lock-out interval d. hour limit e. basal rate f. boluses
PCA Pump Page 2 2. Obtain appropriate narcotic and equipment a. obtain narcotic from stock supply or pharmacy b. obtain pump and tubing c. place pateint use only sticker on PCA button 3. Patient/family/SO teaching with written instructions a. regarding purpose and use of PCA through daily Logicare teaching b. a beep will sound each time the button is correctly depressed c. pain medicine will only be administered as often as programmed 4. Determine previous allergy history regarding narcotics 5. Evaluate patient s: a. mental status b. age c. level of consciousness d. psychological stability e. intellectual capacity 6. Attach saline lock cap to IV if not already present (See Nursing P&P N 9-06) 7. Place thread lock cannula on end of PCA tubing 8. Attach ordered drug to PCA tubing with needle centered over injection port 9. Attach PCA pump to IV pole above volumetric pump; tighten pole mounting clamp 10. Using key, unlock PCA pump door & open. 11. Press on-off button to power on the pump. Wait until you see the power up screen before you install the syringe. The pump will automatically perform self-diagnostics. It will beep three times when it is ready and then prompt each step in programming the process. Note: If you need to adjust display screen contrast or brightness for better visualization, push preference button and adjust as needed. You may also adjust volume of machine. Note: As you go through the screens, on many of them you can press back key to go to previous screen or clear key if the data you entered is incorrect. 12. The first screen prompts to confirm that date and time are correct. After verifying the date and time, you will be prompted to close and lock the syringe cover to verify user authorization. Then you will be prompted to unlock and open the cover again to complete authorization. Syringe Installation 13. To install the syringe, push the pusher block lever as far to the right as it will go. While you have the lever squeezed, push the pusher block to the top of the syringe compartment.
PCA Pump Page 3 14. Load syringe so that the graduation lines are facing you and align the syringe flange with the groves on the compartment marked slide flange. 15. Slide the barrel of the syringe under the syringe clamp. The syringe clamp will move to accommodate the syringe as you slide it under the clamp, so do not pull on the clamp. 16. Push the pusher block lever to the right andf slide it down toward the syringe until it comes in contact with the syringe plunger then release the pusher block lever and the syringe will be secured in place by the plunger retainers or flippers on the pusher block. 17. Close and lock the compartment door. Note: If the syringe hasn t been correctly installed, you will see a diagram on the display showing how it has been misloaded. Correct the problem. Press okay and continue. 18. Confirm that the installed syringe type is correct by pressing yes. If it isn t, press no and choose the correctsyringe type. 19. Press enter. 20. Confirm your selection by pressing yes. 21. The screen will ask if you want to prime through the pump. If you primed manually, press no. To prime through the pump, press yes and make sure the pump is disconnected from the patient, then press start. The pump will begin priming in half milliliter increments up to 5 milliliters. You don t have to hold the start button during priming and if you need to interrupt priming, push the stop button. After each 0.5 millileter volume has been primed, you will be asked if priming is complete. Press no if you want to continue priming. Press yes when the priming volume is complete. 22. Connect IV tubing to the back of the PCA tubing. 23. Place thread lock cannula on the end of the PCA tubing. 24. Connect PCA tubing to saline lock. Programming On Infusion Note: There are 3 modes of selection, PCA only, Basal & PCA or continuously only. This procedure explains Basal & PCA. The others are similar, just fewer stops. 25. Select drug units (usually mg). 26. Confirm drug units selected. 27. Set the drug concentration (program number of lml). 28. Press enter. 29. Confirm the drug concentration you selected by pressing yes. 30. Set PCA dose Note: If you select a dose outside of the given range, the screen will prompt you to select a value within the appropriate range. 31. When you ve chosen the correct amount, press enter. 32. Set the time between injections or lockout. Using the number keypad, press the lockout time.
PCA Pump Page 4 Note: The lockout interval begins when the PCA bolus is completed. The loading dose is completed or the pump restarted if the lockout time has been modified. 33. Press enter. 34. Set the Basal rate or continuous infusion rate. 35. Press enter. 36. Set the limit of the amount of medication that can be administered to the patient over a pre-determined time limit of 1 or 4 hours. Set the amount. 37. Press enter. 38. Review and verify the prescription. 39. If the prescription displayed on the screen is correct, press okay. 40. Second nurse verifies that prescription is correct. Second nurse presses okay. If incorrect, you may edit the prescription from the screen. If second nurse is not available at time of setup, place pump in standby until second nurse is available to verify that prescription is correct. Note: If no loading dose ordered, skip to 44. Loading Dose 41. Key in value for loading dose. 42. Press enter. 43. Confirm loading dose by pressing okay. 44. The pump is now programmed and ready. Press start. The screen will show amount being infused and the green infusion light will begin flashing. Note: You can press the stop button to stop or interrupt the loading dose at any time. Administering A Clinical Bolus 1. Press the stop button to stop the infusion. 2. Press the Bolus key. 3. Enter security code. 4. Press enter. 5. Set the value for the Bolus amount. 6. Press enter. 7. Confirm the Bolus you set and press okay. 8. Press the start button to start Bolus. Note: To stop the Bolus at any time, press the stop button. 9. The pump will beep when Bolus is complete, then press the start button to resume previous settings.
PCA Pump Page 5 Editing Prescription 1. Press stop button. 2. Press edit RX key. 3. Enter security code. 4. Press enter. 5. Select values that need to be changed. Note: Once infusion has been started you cannot change modes of therapy, units or concentration. To change these values you must reprogram the pump. 6. Use the up and down arrows to highlight values you want to edit. 7. Press enter. 8. Select new value. 9. Press enter. 10. When you edit any of these values, the hour limit will also have to be reset. Press the new value. 11. Press enter. 12. When done editing the prescription, press okay. 13. Have secon clinician confirm edited prescription by pressing okay. 14. Press start to begin infusing the edited prescription. Standby-to be used if preprogramming a pump for future use or to pause an infusion. 1. When prompted for verification of prescription by second clinician, press standby key. 2. Confirm by pressing yes. 3. To bring out of standby mode, touch screen. 4. Press wake key. 5. Key in security code. 6. Press enter. 7. Confirm prescription. 8. Press start button to restart the prescription. History Reports 1. Press history button. 2. View current prescription as well as how long before patient s next PCA dose is available. 3. To view chart history, hourly history or event history, press up or down arrows to highlight desired item, then press enter. Note: Chart history shows: a. PCA injection. b. PCA attempts. c. Amount delivered. d. Date and time last cleared.
PCA PUMP PAGE 6 4. After viewing chart history, record amount delivered on Mar., then press the clear key to clear the information. 5. Press yes to confirm. Alarms And Alerts A. When an alarm occurs, the pump stops infusing, an alarm tone sounds, red light flashes and a message on the screen tells you the nature of the alarm and what you must do. 1.Press mute for a 2 minute silence. 2. Follow instructions on the screen. 3. Press okay. 4. Press start to restart the infusion. B. When an alert occurs, the pump does not stop infusing. An alert is indicated by a flashing yellow light, an alert tone, a message on the screen and how you should respond. 1. Press mute for a 2 minute silence. 2. Follow instructions on screen. 3. Press okay. Changing Batteries Note: Battery life is 8-12 days. A battery life icon shows in corner of display. An alert will appear when 60 minutes of battery life remains and again at 45, 30 and 15 minutes. A battery depleted alarm will sound when there are only 3 minutes of battery life remaining. You can continue with the same prescription and patient history. If you replace batteries within 1 hour of powering off the pump. 1. Press stop. 2. Open syringe compartment door. 3. Press and hold on-off button. 4. Press and hold the block release bar on the battery compartment. 5. Carefully slide compartment toward the pump handle. The battery compartment is heavy, so use 2 hands to hold it. 6. Turn black knob counter-clockwise and remove the battery cover. 7. Remove old batteries. 8. To insert new batteries, follow diagram on inside of battery compartment. 9. Place first 2 batteries in the compartment with middle ends up in a tent shape.
N7-14 PCA PUMP PAGE 7 10. Press down on the middle until batteries snap into place. 11. Repeat steps 9 and 10 with next 2 batteries. 12. Put compartment cover back into place. 13. Turn knob clockwise until cover is secured. Be carefull not to over tighten the knob. 14. Holding battery compartment with 2 hands slide back into place until you hear a click. 15. Turn power on. 16. Lock syringe compartment. 17. Confirm date and time. 18. Verify user authorization by unlocking and locking the compartment. 19. Resume same infusion by pressing yes and follow screen prompts until infusion begins again. Documentation: 1. Chart on computer documentation Pain assess/symptom mgt/downtime # 6630-018 and Vital sign adult/downtime form # 6630-017 a. initiation of treatment b. response to therapy 2. MAR a. dose, delay, basal rate, boluses as orser states b. confirmation of settings by 2 nurses initials & signatures at initiation of PCA and with any dosing changes (as In p. 3C, #6)of this policy c. total amount used per shift 3. Controlled Substance Adminstration Record (Narcotic sign-out sheet) (See Nursing P7P N 11-23) 4. All PCA pumps need to be cleared prior to leaving an area. (Ex. from PACU to 4 th or between any unit transfer of pt Reference: Syndeo PCA Pump Operator s Manual, Baxter 07/04 Rev., Manufacturer N7-14 PCA PUMP PAGE 8
ALERTS Alert Situation Action Approximately 60, 45, 30, or Turn off the pump and replace "Batteries Low" 15 minutes of battery life all four D-cell alkaline batteries. remain (see screen for time. The button has been contin- Release the button "(Button Name) Button Held" uosly pressed for more than If the button remains stuck, three minutes. contact authorized service personnel for assistance. This alert occurs after approx- "Call Back Alert" imately two minutes of inactivity To proceed, enter the if the pump is NOT infusing, and clinician security code. NOT in standby. The pump is loaded and the syringe is confirmed, but the Close and lock the syringe "Cover Open Alert" syringe compartment door has compartment door. been left unlocked for more than 60 seconds. 1. Modify the prescription. 2. The pump will automatically The pre-determined PCA dose clear the alert and restart the "Dosage Limit Alert" limit (either one-hour or four-hour infusion when, due to the passlimit) has been reached. age of time, the total basal and PCA amount given falls below the one-hour or four-hour limit. 1. Release the PCA button. Note: Advise the patient to briefly press and release the The PCA button has been PCA button when making a "PCA Button Held" continuously pressed for more PCA request. than three minutes. 2. If the button remains stuck, contact your authorized Baxter service center for a replacement PCA button. "PCA Button Disconnected" The PCA Button has been Connect the PCA button to disconnected been the pump. the pump. Something has been touching Remove the contact from the "Screen Held" the display screen for more than display screen. three minutes. "Syringe Volume Low" The volume remaining is less Prepare to change the syringe, than 5 ml. if prescribed. "Unauthorized Access Attempt" An incorrect password has Unlock, then lock the syringe been entered three times. compartment cover. N7-14 PCA PUMP PAGE 9 ALARMS
Alarm Situation Action Only three minutes of battery power remain to power the pump Turn off the pump and replace "Battery Depleted" Note: The user will not be able all four D-cell alkaline batteries. to mute the "Batteries Depleted" alarm. 1. Press the button. 2. Press OK to resume normal The button has been continuously operation. "(Button Name) Stuck" pressed for more than six 3. If the button remains stuck, minutes. return the pump to an authorized Baxter service center for repair. The syringe compartment door Close and lock the syringe "Cover Unlocked" is unlocked while the pump is compartment door. infusing. 1. Check the tubing set for The pump has detected an closed clamps or kinks. "Downstream Occlusion" occlusion or blockage that is 2. Check for an empty syringe. preventing fluid flow. 3. Assess patency of the vascular device. The sensor calibration is either Contact authorized service "Sensor Not Calibrated" invalid or corrupted. personnel immediately for assistance. "Syringe Empty" The syringe is empty. Replace the syringe, if prescribed. The syringe is misloaded, or it Properly load the syringe, follow- "Syringe Misloaded" has moved out of place while ing the procedure in "Setting Up priming or infusing. the Pump." The display screen calibration Contact authorized service "Touchscreen Not Calibrated" is invalid or corrupted. personnel immediately for assistance. 1. Remove the contact from the Something has been touching display screen. "Touchscreen Held" the display screen for more than 2. If the display screen remains six minutes. stuck, contact your baxter service center for repair. SERVICE CODES If a service code occurs, turn off the pump to silence the alarm, then turn on the pump and reprogram the infusion. If the service code occurs again, turn off the pump and contact authorized service personnel. For additional information about service codes, refer to the Syndeo Maintenance Manual.