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| Author | Comment |
Kirsteen
 Feb 16, 08 - 3:25 PM |
PCA & Maintenance IV Fluids
Hi Does anyone have any data for or against the use of running maintenance IV fluids with a PCA (using anti-syphon reflux valve tubing). Am used to not running maintenance fluids with a PCA but my Director of Nursing has a different idea (not evidence based but because that is what she has always done) 
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Glenn
Feb 18th, 2008 - 11:28 AM |
Re: PCA & Maintenance IV Fluids
Evidenced based - can't help with that, but from more years experience than I care to admit to I know that PCA's without fluids are bad news, more occlusion alarms, and a higher venflon failure rate (probably due to localised histamine release from morphine pooling at the venflon site, rather than being flushed into the system) Glenn |
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Simon
Feb 18th, 2008 - 11:29 AM |
Re: PCA & Maintenance IV Fluids
Hi Kirsten, like Glen says PCA + no fluids = problems |
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Simon Higgs
Feb 18th, 2008 - 1:15 PM |
Re: PCA & Maintenance IV Fluids
It is not policy and we haven't had any problems when they don't have maintanance fluid, we actually recommend that a PCA is on a dedicated line with no other secondary infusion. Unfortunately we had to take this stance as despite education we often found antibiotics etc on the same line as the PCA. Maybe our infusion device has a higher occlusion alarm setting or the patients use it more frequently??? |
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Wendy Turner
Feb 18th, 2008 - 5:04 PM |
Re: PCA & Maintenance IV Fluids
We have a running battle with our surgeons: They discontinue the fluids, and then have a go at us because the PCA/canula plays up!!! PCA's work MUCH better with piggy backed fluids. If you have the chance to make it your norm GO FOR IT! 
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Maggie P
Feb 18th, 2008 - 9:17 PM |
Re: PCA & Maintenance IV Fluids
We encourage the use of fluids - those pcas that do get left without have a habit of failing MP |
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sharon
Feb 19th, 2008 - 3:06 PM |
Re: PCA & Maintenance IV Fluids
I have to agree with simon higgs. We insist that a separate cannula is used and do not have any problems with alarms or failing. Having said that when we changed to new and different make of machine the alarms were going but that was because we had the occlusion alarm set at wrong level. No problems since. |
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Susan Collins
Feb 20th, 2008 - 8:08 AM |
Re: PCA & Maintenance IV Fluids
Most of the PCAS I've worked with contain morphine, at either 1mg/ml (with a 1ml bolus) or 2mg/ml (with a half ml bolus) Would you give a straight IV injection of this solution without flushing the venflon? I really can't see how a pca, without fluids can be acceptable. SC |
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Simon Higgs
Feb 20th, 2008 - 10:59 AM |
Re: PCA & Maintenance IV Fluids
I have checked with my Acute Pain Lead colleagues in Northern Ireland and none of us use a maintenance infusion along with the PCA. Medical and surgical staff want to avoid the use of unnecessary IV fluids of which we feel this would be. Also our PCA's are ambulatory and self contained, add to this another infusion and the portability is reduced even further affecting the patient's mobility. If staff on the ward maintain IV cannulas correctly we feel there should not be a problem and have not been alerted to any instances of phlebitis caused by non-flushing raised by Susan. Again in an ICU environment this solution is used to give a continual infusion of 1-5mls/hr again causing no problems. We all discontinue PCA once opioid use is reduced to a level were oral is more appropriate. If due to an inability to ensure a dedicated line for PCA due to venous access problems we may use a secondary line which must have an anti-reflux valve fitted to the secondary infusion. However we still have safety alerts were staff 'forget' to use anti-reflux valves or 'didn't know' that antibiotics, IV paracetamol can't be infused aong with PCA, despite this covered at length in our PCA training package and policies. |
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