Maybe 1,2,3 Isn't A Expert Password.
Wednesday, October 8, 2003
The pumps tin sack also live laid to deliver a "basal rate," a constant infusion of narcotic hurting medication, inwards add-on to the dose the patient gets when he or she pushes the button. No affair how sleepy the patient is, the heart volition operate on infusing narcotics. Normally, without a basal rate, patients using a PCA tin sack alone have medication when they are awake plenty to force the button, which serves every bit a safeguard against receiving an overdose.
As I convey noted, PCA pumps necessitate to live carefully employed as well as tin sack live unsafe without appropriate monitoring:
The Happy Hospitalist explains:
Why is PCA morphine dangerous? Too much medication tin sack drive patients to halt breathing. Opiates, oftentimes inappropriately referred to every bit narcotics past times doctors as well as nurses, suppress the cardinal nervous system's respiratory drive as well as increases the peril of life threatening apnea. This is the drive of boot the bucket inwards a heroin overdose. This is the drive of boot the bucket inwards the epidemic of prescription opiate drug overdoses heard nearly on the news. Many PCA morphine lodge sets require continuous oxygen saturation monitoring as well as frequent documentation of respiratory charge per unit of measurement every bit security mechanisms. This is to protect the patient from experiencing prolonged hypoxemia every bit a effect of also much sedation when no identify unit of measurement is available at the bedside.
The Joint Commission published a sentry trial alarm on the affair inwards August 2012.
In many parts of many hospitals, the basal charge per unit of measurement is non used, just because of how unsafe it is. There are other options for those patients alongside high narcotic needs, such every bit having a nurse give the patient a scheduled dose of narcotic every few hours afterward making certain it is rubber for the patient to have it.
All this background is to fix a recent trial at an academic medical center:
A drug addicted patient "hacked" his PCA heart as well as gave himself a basal charge per unit of measurement of 2mg dilaudid per hr alongside a 1mg self-administered PCA dose every v minutes. This would convey resulted inwards respiratory arrest if the nursing staff had non rapidly realized what was going on. (I'm advised that most people halt breathing at nearly 2-4mg per hour. Since this somebody was tolerant, he in all likelihood could convey lasted a few hours just inevitably would convey overdosed overnight). The staff took the PCA away.
What are to a greater extent than or less possible lessons from this nigh miss? At a minimum, it mightiness live worth thinking nearly changing the PCA heart passcode from "1,2,3" to something to a greater extent than hard to guess. Maybe it would also pay to eliminate the basal charge per unit of measurement pick all together on the machines inwards parts of the infirmary where constant monitoring is non available.