Anaesthetists Handbook - MEDICAL EDUCATION at University ...

Pain management and postoperative care5. Child understands that the nurse is still there to help them,especially if the PCA ‘doesn’t work’.6. Child should understand that the PCA should help their pain butit should not make them very, very sleepy (sedated) althoughthey can obviously go to sleep.7. Child can explain to the nurse about how PCA works to showthey have grasped the essentials.8. Child understands that they are the only ones to press thebutton (not family members) unless they ask the nurse to pushthe button for them.9. Parents should be given a clear explanation of how the pumpworks.10. Parents should be discouraged from pressing the PCA button.Setting up PCAPCAs are usually commenced in theatre by the anaesthetist. If a PCAneeds to be set up on the ward the anaesthetist or pain team willcome to the ward to assess the child and assist ward staff. The PCApumps and giving sets will be kept on ward 16.Drug concentrationMake up 1 x body weight in milligrams of morphine to 50 mL withsodium chloride 0.9%.e.g. 35 kg child = 35 mg morphinemaximum dose = 50 mg in 50 mLFor children > 50 kg set 1 mL bolus, (1 mg) background 0.2 mL h -1 .PCA Programme using the Hospira Blue PCA Pump onlyBolus dose 1 ml = 20 µg kg -1Lockout time5 minutesBackground infusion 0.2 mL h -1 = 4 µg kg -1 h -1Anaesthetists Handbook January 2010 109