Caregiver - Assisted Analgesia by PCA

PCA (Patient Controlled Analgesia) is a way to receive pain medications that allow the patient to control when they receive their pain medicine. A family member may help the patient receive their pain medicine. The family member who pushes the PCA button for the patient is providing Caregiver-Assisted Analgesia.

How does the PCA Infusion Pump work?
The pain medicine is given into the vein (IV) by a pump called a PCA pump. The PCA pump has a cord with a button. When the button is pushed, the PCA pump will give a pre-set dose of pain medicine ordered by the doctor. After the pump gives the pain medicine, it will lock for a few minutes and no more can be given. This protects the patient from receiving too much medicine. The pain medicine is a prescription that may only be changed by a doctor's order.

Who should push the PCA button?
Doctor approved family members and the patient's nurse are the only persons to press the PCA button. There is a chance of harming the patient if the button is pushed by anyone who does not have permission and education.

Caution:

* More than one family member/loved one may provide Caregiver-Assisted Analgesia for the same patient; however, the control of the PCA button is given to one family member at a time.
* Family members who provide Caregiver-Assisted Analgesia may not pass on this privilege to other untrained family members in their absence.
* Family members who provide Caregiver-Assisted Analgesia for the patient should inform the patient's nurse when they can no longer press the PCA button for the patient.

When should I push the PCA button?
Push the button when the patient is awake and tells or shows you, he or she has pain. Push the button before any activity that could increase pain such as a dressing change or movement.

When not to push the PCA button?

* If the patient is sleeping
* If you cannot awaken the patient normally or
* If the patient's breathing is too slow, shallow or noisy
* When you are instructed by the nurse or doctor not to push the button
* For any other complaints such as anxiety or for sleep

If the patient cannot talk, decide with the nurses which behaviors mean the patient needs more pain medicine. Children as well as some adults are often unwilling or unable to tell us about the pain they are feeling. Watch for other signs of pain such as frowning, moaning, poor appetite, not moving around and trouble resting or sleeping.

When to alert the staff
Sometimes you may not be certain if you should push the button (give more pain medicine) for the patient. When in doubt, please call the nurse and ask for help in deciding whether you should push the button/give more pain medicine.

How does pain affect the body?
Pain is a normal response after surgery or injury. Pain relief helps the healing process and allows the patient to live more comfortably. Pain medicine is not habit-forming when the medicine is taken for pain and stopped when the pain is gone. Please tell the nurse or doctor if the patient does not have enough pain relief.

What is the pain medicine in the PCA pump?
The pain medicine used in the PCA pump is an opioid. Opioids are the strongest type of pain medicine. The opioid pain medicine starts to work in five to 15 minutes from the time the button is pushed. The pain medicine continues to work for the next 30 to 60 minutes, with the strongest effect in 15 to 30 minutes. One of the following pain medicines (options) will be placed in the PCA pump:

* Morphine
* Fentanyl
* Hydromorphone

What are the possible side effects of the pain medicine?
The pain medicine may cause side effects that can be treated. Tell the nurse or doctor if you think the patient is having any of the following:

* Itching
* Nausea/Vomiting
* Constipation
* Difficulty urinating
* Drowsiness

Most side effects will respond to giving less pain medicine or another type of pain medicine. Other medications may also be used to treat the side effect, such as a medication for vomiting or a laxative for constipation.

The last part of your education is to sign an agreement, "Caregiver Acceptance of Responsibility" (Form M861). Bryan Medical Center staff wants you to feel secure and knowledgeable in your role as a caregiver who is assisting your loved one to receive pain medicine by PCA.