Clinical experience with patient-controlled analgesia using continuous respiratory monitoring and a smart infusion system

Maddox, Ray R.; Williams, Carolyn K.; Oglesby, Harold; Butler, Betty; Colclasure, Bernie

doi:10.2146/ajhp050194

Cited by 40 publications

(31 citation statements)

References 10 publications

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“…This is important in light of the observation that parents who received information about the benefits, risks, and management of side-effects had significantly greater perceived understanding than those who did not. Additionally, since unauthorized PCA by proxy (i.e., dosing by a family member or caregiver) has been associated with over-sedation and adverse respiratory events,14 it is imperative that parents are fully informed about the risks when PCA or NCA are implemented. The observation that 25% of children deemed old enough were not given any information about PCA is disturbing since a lack of understanding may affect their ability to manage their pain control postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Parents' Understanding of Information Regarding Their Child's Postoperative Pain Management

Tait

Voepel‐Lewis

Snyder

et al. 2008

The Clinical Journal of Pain

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Objectives-Unlike information provided for research, information disclosed to patients for treatment or procedures is largely unregulated and, as such, there is likely considerable variability in the type and amount of disclosure. This study was designed to examine the nature of information provided to parents regarding options for postoperative pain control and their understanding thereof.Methods-187 parents of children scheduled to undergo a surgical procedure requiring inpatient postoperative pain control completed questionnaires that elicited information regarding their perceptions and understanding of, and satisfaction with, information regarding postoperative pain management.Results-Results showed that there was considerable variability in the content and amount of information provided to parents based on the method of postoperative pain control provided. Parents whose child received Patient Controlled Analgesia (PCA) were given significantly (P< 0.025) more information on the risks and benefits compared to those receiving Nurse Controlled or intravenous-prn (NCA or IV) analgesia. Approximately one third of parents had no understanding of the risks associated with postoperative pain management. Parents who received pain information preoperatively and who were given information regarding the risks and benefits had improved understanding compared to parents who received no or minimal information (P< 0.001). Furthermore, information that was deemed unclear or insufficient resulted in decreased parental understanding.Discussion-These results demonstrate the variability in the type and amount of information provided to parents regarding their child's postoperative pain control and reinforce the importance of clear and full disclosure of pain information, particularly with respect to the risks and benefits.

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Section: Discussionmentioning

confidence: 99%

Parents' Understanding of Information Regarding Their Child's Postoperative Pain Management

Tait

Voepel‐Lewis

Snyder

et al. 2008

The Clinical Journal of Pain

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“…A smart pump, a specialized type of infusion device with preprogrammed parameters, should be used. Also, it is now common to use respiratory monitoring equipment, such as a pulse oximeter and an end‐tidal carbon dioxide monitor, when PCA is in use 17 . Collectively, these devices increase the safety of PCA 8…”

Section: Pharmacology Of Opioid Analgesicsmentioning

confidence: 99%

“…Also, it is now common to use respiratory monitoring equipment, such as a pulse oximeter and an end-tidal carbon dioxide monitor, when PCA is in use. 17 Collectively, these devices increase the safety of PCA. 8 Given that all of the analgesic products have the ability to suppress the respiratory system, nurses should be well versed in assessing patients' respiratory status.…”

Section: Dispensingmentioning

confidence: 99%

Perioperative Pharmacology: Patient‐Controlled Analgesia

Hicks

Hernandez²,

Wanzer³

2012

AORN Journal

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Patient-controlled analgesia (PCA) is an effective treatment option for reducing pain, but PCA errors can be quite serious. Opioid analgesics are among the most effective pain relievers available, but all have contraindications and can have adverse effects, including respiratory depression and other effects on the central nervous system. Practitioners must weigh the potential benefits of PCA use against the risks. Errors associated with the PCA process have been documented in each phase of the medication-use process; therefore, practice improvements in prescribing, transcribing, dispensing, administering, and monitoring PCA may reduce the likelihood of errors. Perioperative nurses can make important contributions to safe PCA use by establishing standardized processes to help ensure positive patient outcomes in pain management.

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“…In fact, recent literature suggests ventilation assessment using capnography in nonintubated patients undergoing sedation may improve practice by providing an "early warning system" for impending respiratory compromise and hypoxemia (Cacho et al, 2010;Lightdale et al, 2006;Soto, Fu, Vila, & Miguel, 2004;Vargo, 2000;Vargo et al, 2002). Current practice generally has an increased emphasis on pulse oximetry for all patients receiving sedation, perhaps enabling a false sense of security while increased PetCO 2 levels go undetected (DeWitt, 2001;Fu, Downs, Schweiger, Miguel, & Smith, 2004;Hutchison & Rodriguez, 2008;Maddox, Williams, Oglesby, Butler, & Colclasure, 2006). However, pulse oximetry does not measure ventilation and decreased arterial saturation (SaO 2 ) is often a late sign of patient deterioration (American Academy of Pediatrics, Committee on Drugs, 2002; American Society of Anesthesiologists Task Force on Sedation and Analgesia by non- Anesthesiologists, 2002;Greensmith & Aker, 1998;Lightdale et al, 2006).…”

Section: Respiratory Ratementioning

confidence: 99%