PCEA- What is it? Nursing Management of Patient Controlled Epidural Analgesia

Nursing Management of
Patient Controlled Epidural Analgesia
Adam Cooper, RN, MSN
Adult Nurse Educator
PCEA- What is it?
A method for administering epidural
analgesia continuously and intermittently.
Continuous infusions of analgesics and/or
local anesthetics can be provided through a
catheter placed in the epidural space.
PCEA Pump- medications are infused
continuously through a pump into the
epidural catheter.
PCEA Basics
Spinal level of catheter
insertion guides the
RN in assessing what
pain will be controlled
and what pain will not
be alleviated
Most common btwn: L2-L4
(33 vertebrae)
PCEA- RN Responsibilities
Assessing patient pain
Notifying the physician of pain
Planning pain management with team
Monitoring the patient and the patient’s
response to interventions
PCEA Orders
The epidural infusion is ordered by the
MD on the pre-printed order sheet
– Standard Mix (Ropivicaine w/ Fentanyl)
– Delivery Settings
– Titration Orders
– Additional Meds
– Monitoring Orders
Delivery Settings
Continuous Rate (basal rate)- mL/hr
Demand Dose (pt controlled injection)mL/inj
Demand Dose Lockout (interval of how
often pt can use)- min
One hour limit- mL
Titration Orders
Continuous (basal) rate may be:
– Increased by __mL/hr every 1 hour for
severe pain. 1 hour limit is max.
– Decreased by __mL/hr every 1 hour for
excessive sedation, arm/leg/chest
numbness, or hypotension.
Other Important Issues
No opioids, sedatives, or anticoagulants
(except Aspirin or SC Heparin)
Only MD/NPs or Adult ICU/PACU RNs may
attach epidural catheters to tubing
IV & Foley Catheter must be in during the
infusion and must be in place for 12 hours
after d/c.
RN Monitoring
Assess & Document Q 2 x 12hrs then Q4hrs:
RR (call if <10)
O2 (call if <90%)
Sedation (watch for somulence)
Other Vital Signs (n/v/, hypotn)
Abnl absorption: numb mouth/metallic taste, tinnitus
Total dose infused Q 24hrs
– Clear Pump/Document: CC- 0700
AC- 0000
RN Monitoring
If RR < 8 or O2< 85%, unresponsive,
or severe hypotension (SBP<80):
– Stop infusion
– Check vitals now
– Give Naloxone (Narcan)
– Notify Pain Svc and primary MD
– Place O2 bag/mask on high
– Check vitals q 1hr x 12 hours
– Call rapid response or even code blue!
Naloxone (Narcan)
Opioid antagonist
IV acts within 2 minutes
Must monitor as Narcan can wear off before opioids
Expect pain, tachy, diaphoresis afterwards
Comes in a 0.4mg/ml vial
Dilute in NS to a total volume of 10 mL = 0.04 mg/ml
0.1 mg IV q 1 min PRN respiratory depression or
0.1mg = 2.5ml
Push SLOWLY. Using the 10ml syringe of diluted
naloxone push 1 ml every 1-2 minutes until sedation
and respiratory depression improves.
Directions at bottom of
2 RN Check
Green light- GO!
Use arrows to adjust
CADD Pump (con.)
Must be unlocked to make changes
CADD Pump (con.)
There is NO on/off
Pump is turned on
when battery is
Pump is turned off
when battery is
CADD Pump (con.)
More Info
Pain ServiceParnassus: 719-2398
Mt. Zion:
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