Question

Place the following steps in the correct order for administration of patient- controlled analgesia: A. Insert drug cartridge into infusion device and prime tubing. B. Wipe injection port of maintenance IV line vigorously with antiseptic swab for 15 seconds and allow to dry. C. Demonstrate to patient how to push medication demand button. D. Secure connection and anchor PCA tubing with tape. E. Instruct patient to notify a nurse for possible side effects or changes in the severity or location of pain. F. Insert needleless adapter into injection port nearest patient. G. Apply clean gloves. Check infuser and patient-control module for accurate labeling or evidence of leaking. H. Program computerized PCA pump as ordered to deliver prescribed medication dose and lockout interval. I. Attach needleless adapter to tubing adapter of patientcontrolled module.

Short answer

The correct order is: Perform hand hygiene, apply clean gloves, check equipment, prepare medication, disinfect injection port, connect PCA pump, secure the connection, program PCA pump, instruct the patient, and educate about side effects.

Step-by-step solution

Hand Hygiene

Before any procedure, ensure to perform hand hygiene to prevent the spread of infection.

Apply Clean Gloves

After hand hygiene, put on clean gloves for the procedure. This is to maintain aseptic technique throughout the procedure.

Check Equipment

Examine the infuser and patient-control module to make sure they are correctly labeled and are not leaking.

Prepare Medication

Insert the drug cartridge into the infusion device and prime the tubing to ensure the medication is ready for administration.

Disinfect Injection Port

Wipe the injection port of the maintenance IV line with an antiseptic swab for 15 seconds and then allow it to dry to maintain sterility.

Connect PCA Pump

Insert the needleless adapter into the injection port nearest the patient and attach this adapter to the tubing adapter of the patient-controlled module to connect the PCA pump to the patient's IV line.

Secure the Connection

After making sure the connection is established, secure it and anchor the PCA tubing with tape to prevent accidental dislodgment.

Program the PCA Pump

Program the PCA pump according to the physician's orders to deliver the correct dose of medication at the appropriate lockout interval.

Instruct the Patient

Demonstrate to the patient how to use the medication demand button and explain how the PCA device works.

Educate About Side Effects

Advise the patient on possible side effects and instruct them to notify a nurse if they experience changes in pain severity or if the pain relocates.

Key concepts

PCA Pump Programming

Programming a patient-controlled analgesia (PCA) pump is a step that requires precision and an understanding of the physician's orders. The PCA pump allows patients to manage their pain by pressing a button to deliver a set dosage of pain medication through an intravenous (IV) line. To ensure the safety and efficacy of PCA, the pump must be programmed with the correct medication dose and lockout interval, which is the minimum amount of time between doses to prevent overdose.

When programming the pump, it's essential to adhere to the physician's instructions meticulously. The dose must match the order, and the lockout interval must be accurately set to allow the patient to receive medication when needed while preventing too frequent administration. Nurses must also confirm the medication concentration and total volume to be infused, ensuring that the settings on the PCA pump reflect the patient's current needs and prescription. Proper programming of the pump also involves setting up an alarm system to alert the healthcare team of potential issues, such as a low medication reservoir or a malfunction of the device.

In practice, this process can be enhanced by using barcode medication administration (BCMA) to validate the medication cartridge. This helps to minimize errors and ensure that the correct drug is being administered. Verification by a second nurse can also be implemented as a double-check system for programming accuracy and patient safety. Training on the specific PCA device model used within the facility is crucial for all administering medical staff to prevent programming errors and ensure effective patient pain management.

Nursing Aseptic Technique

Nursing aseptic technique is a critical component in preventing infection during medical procedures, including the administration of PCA. It encompasses practices used to maintain sterility and minimize the risk of introducing pathogens to the patient. When setting up a PCA infusion, nurses must perform hand hygiene before the procedure, which removes transient microorganisms acquired by direct contact with patients or contaminated surfaces.

Upon ensuring clean hands, nurses should don clean gloves before handling any part of the PCA system or the patient's IV line. Gloves act as a barrier protection, reducing the risk of contaminating the sterile fields. Before connecting the PCA pump, cleaning the injection port with an antiseptic swab for at least 15 seconds and allowing it to dry creates a sterile environment for the needleless adapter to be inserted.

Throughout the connection process, it is paramount that nurses do not touch the ends of the PCA tubing or needleless adapter with their hands or any non-sterile surfaces. If contact occurs, the equipment should be considered contaminated and replaced. Aseptic technique further requires careful and secure taping of connections to prevent dislodgement, which could potentially expose the insertion site to infection. Training on aseptic techniques is fundamental for all nursing staff and must be adhered to rigorously to ensure patient safety and prevent healthcare-associated infections (HAIs).

PCA Patient Education

Proper patient education is a foundational aspect of successful PCA therapy. Educating patients on the use of the PCA device empowers them to take control of their pain management, thereby improving their comfort and satisfaction with care. The nurse must explain the function of the PCA pump, including how to use the demand button to self-administer medication safely. This education should encompass the concept of the lockout interval, to clarify why the pump may not deliver medication with every button press and to prevent any confusion or anxiety the patient may have regarding the efficacy of their pain control.

Additionally, it is imperative to discuss the potential side effects of the pain medication provided through PCA, such as drowsiness, nausea, itching, or respiratory depression. Patients should be aware of signs to look out for and be encouraged to report any adverse reactions immediately to the nursing staff. Instructing patients on the importance of communicating changes in the severity, location, or characteristics of pain allows for timely adjustments to their pain management plan. Regular reassessment of pain levels and analgesic needs is essential for optimizing PCA therapy.

Effective patient education on PCA should be provided using clear, easily understood language and reinforced with written materials that can be referred to as needed. Involving the patient's family members or caretakers in the education process can also aid in monitoring the patient's response to the PCA therapy and ensure that concerns are reported quickly to the healthcare team.