Guidelines&Protocols
CompareComparing...

PCA

Now Reading
PCA

Contents

This protocol is not intended for clinical application. Users are fully responsible for any use of this document.

Standard Hospital Formula

Morphine 2 mg/kg in 50 ml Dextrose 5% or Saline
1 ml = 40 mcg/kg
Max concentration: 100mg/50ml (prefilled adult cartridge >50kg)

Pump Parameters

Parameter Setting Notes
Loading Dose 80–120 mcg/kg By anaesthetist
PCA Bolus 0.5 ml (20–40 mcg/kg) 1 mg if >50kg
Lockout 6 minutes Range: 5–12 min
Continuous Infusion 0.5 ml/hr (not in use currently) Range: 0–1 ml/hr (not in use currently)
Max Dose Limit 400 mcg/kg/4 hr (<50kg) 20 mg/4hr (>50kg)

IV Opioid Safety

  1. No supplementary opioids unless prescribed by Anaesthetist
  2. Use anti-siphon valve with all IV opioid infusions
  3. Line should be exclusive or anti-reflux valve used
  4. Maintain IV access throughout

Monitoring

  • Observe hourly for 4h, then 4-hourly
  • Record RR, HR, BP, Temp, Pain/Nausea/Sedation
  • If zero scores twice → shift to 6-hourly

Regular Analgesics

  • NSAIDs: Difene 1mg/kg PR 12h Ibuprofen 7.5mg/kg TID PO
  • Paracetamol: 15mg/kg PO/PR/IV

Troubleshooting


Inadequate analgesia: Call Anaesthetist (bleep 097)

Nausea: Ondansetron 0.1mg/kg (max 4mg) IV

Itching: Piriton 0.2mg/kg (max 10mg) IV

Over-sedation: Stop PCA, call Anaesthetist. Consider Naloxone.

RR < 8/min: Administer O2, give Naloxone:

  • Initial dose: 100 mcg/kg IV/IM (max 400 mcg)
  • Repeat every 1 min if no response (max 2mg)
  • Infusion: If repeated doses needed, start infusion at 60% of dose that maintained ventilation for >15 min

Note: Naloxone has a short duration—monitor for rebound sedation. Doctor administration only. Avoid in tramadol overdose (↑seizure risk).

Patient-Review

Every child must be reviewed next day and on PCA stop by anaesthetist (bleep 097).
Log sedation, pain, nausea scores, drug usage & satisfaction in PCA audit book.

PCA Terms Explained

Loading Dose Given prior to PCA start to relieve pain
Bolus Dose Given when handset is pressed
Lockout Time before next allowed bolus
Background Infusion Continuous infusion if prescribed
Total Drug Given All bolus + background doses recorded 
Baseline: 100mg/50ml prefilled

Target: 40 µg/kg/ml
Bolus: 0.5ml = 20 µg/kg

e.g. 30kg patient → need 60mg in 50ml
100mg in 50ml → remove 20ml (40mg), replace with 20ml saline

CADD-Prizm™ PCS II Official Manual

Last updated on 05/08/2024

Posted In
Guidelines&Protocols
Tags