dilaudid pca

[Jimmy LaRoux]

what do you think is a good starting point for a dilaudid pca in a patient NOT on chronic opoids who has just had a colon resection?

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[usnavdoc]

what do you think is a good starting point for a dilaudid pca in a patient NOT on chronic opoids who has just had a colon resection?

1/10/6 or 1/8/8 is a common starting point with a .2 mg/ml concentration

 

[DireWolf]

0 mg basal/0.25 mg bolus/10 minute lockout

titrate from there.

 

[jetproppilot]

what do you think is a good starting point for a dilaudid pca in a patient NOT on chronic opoids who has just had a colon resection?

Do it every day. Many times.

Young people 2/10/0/12.

Old people 1/10/0/6.

 

[bubalus]

0 mg basal/0.25 mg bolus/10 minute lockout

titrate from there.

I basically do the same, but with a 0.2 mg bolus. I like to think in rounder numbers.

 

[sdn1977]

Whatever you decide - find out what the pharmacy purchases or compounds.

Then, make it easy for nursing to program the pump rate.

It will either be 0.5mg/ml, 0.1mg/ml or 0.2mg/ml (the commercially available product).

There will be fewer errors that way.

For the basal, depends on your nursing - if you have good nursing ratio, a basal rate is good - the pt can be monitored for respiratory depression, pain is controlled, particularly in first 24hr.

Our standard protocol is 1mg basal x 24hr/8/10. Basal is stopped after 24 hr on surgeons recommendation. There is always the option to change bolus or time out depending on pt status. If >3 attempts in fewer than 10 min, can increase bolus &/or time out.

More options = fewer calls to you!

 

[coprolalia]

More options = fewer calls to you!

There are two schools of thought here, re: basal vs. no basal.

First school of thought = basal. The argument is that the patient usually waits until they're in pain before they push the button, and with the lock-out they are forever playing "catch up". So, if you put a low basal rate on, they'll reach a steady state and actually push the button only for moderate to severe breakthough. Good idea when, like sdn1977 says, you have a low patient to nursing ratio.

Second school of thought (my school of thought too) = no basal. The reason why I like this better is that it is true to the spirit of PCA. You are truly allowing the patient to manage their pain, and if you have someone who is reasonably intelligent you can tell them to push the button enough to stay ahead of their pain. Likewise, there is far less room for error. With a basal, it is much easier to have someone over-narcotized (i.e. you should never run a basal on the floor). I've seen this happen. Too much room for error.

So, those are my thoughts. Feel free to discuss.

-copro

 

[Jimmy LaRoux]

1/10/6 or 1/8/8 is a common starting point with a .2 mg/ml concentration

Let me get this straight: That's (1mg/hour and 10mg q 6 minutes?) or (1mg/hour and 8mg q 8 minutes?)

 

[Jimmy LaRoux]

Whatever you decide - find out what the pharmacy purchases or compounds.

Then, make it easy for nursing to program the pump rate.

It will either be 0.5mg/ml, 0.1mg/ml or 0.2mg/ml (the commercially available product).

There will be fewer errors that way.

For the basal, depends on your nursing - if you have good nursing ratio, a basal rate is good - the pt can be monitored for respiratory depression, pain is controlled, particularly in first 24hr.

Our standard protocol is 1mg basal x 24hr/8/10. Basal is stopped after 24 hr on surgeons recommendation. There is always the option to change bolus or time out depending on pt status. If >3 attempts in fewer than 10 min, can increase bolus &/or time out.

More options = fewer calls to you!

That's 1mg/hour and 8mg q 10 minutes?

 

[Jimmy LaRoux]

Do it every day. Many times.

Young people 2/10/0/12.

Old people 1/10/0/6.

I don't understand the terminology. Are you saying for young people you give 2mg/hour as basal and 10mg every 12 minutes? What is the zero for?

 

[VentdependenT]

I don't understand the terminology. Are you saying for young people you give 2mg/hour as basal and 10mg every 12 minutes? What is the zero for?

those are lethal doses my friend

10ucg fentanyl = 1mg morphine = .2mg dilauded

so the doses would be .2mg/every 10 minutes/0 continuous/0 4hr lockout


I would choose 0.3mg/every 8 minutes/0 continuous/0 4hr lockout for a starting dose in a narcotic naive non elderly NON OBESE patient.

Pain medications kill patients, not pain.

 

[usnavdoc]

Let me get this straight: That's (1mg/hour and 10mg q 6 minutes?) or (1mg/hour and 8mg q 8 minutes?)

No...

1/10/6 1ml incremental dose/10 min lockout/6 ml hourly total

1/8/8 1ml incremental dose/8 min lockout/8 ml hourly total (doesnt completely add up but its easy on the RNs)

Generally I start out like this and go up from there depending on the PT. Of course things are different for chronic pain pts...I dont use a basal rate the risk benefit isnt worth it.

 

[jetproppilot]

I don't understand the terminology. Are you saying for young people you give 2mg/hour as basal and 10mg every 12 minutes? What is the zero for?

Sorry.

Parameters are for a .2mg/mL hydromorphone (Dilaudid) pca. The numbers represent number of mL ordered.

2/10/0/12...............2mL (.4mg).......lockout interval 10 minutes (patient can push the pca button a hundred times but the max they'll get is .4mg every ten minutes...........basal rate of zero............one hour limit 12 mL .

With rare exception, I don't write basal rates.

 

[Intubate]

ordering any medication in ml is a bad idea. i always write for the mg or mcg. the pharmacist can sort out the rest based on their formulations.

 

[jetproppilot]

ordering any medication in ml is a bad idea. i always write for the mg or mcg. the pharmacist can sort out the rest based on their formulations.

We have a standardized, premade pca sheet where all you do is fill in the blanks.

For writing in physicians orders I agree.

 

[lobelsteve]

Pain medications kill patients, not pain.

Ouchie.

How about poor policy regarding pain medicine killing patients?
Taking your statement out of context can get you arrested in California.
(2 separate cases)
But I know what you mean...

 

[Tenesma]

those 2 cases were in hospice patients (terminal)

and i agree with no basal - unless it is a chronic narc/junkie kinda patient who you couldn't kill with opioids even if you tried

basal is a set-up for respiratory arrest in my opinion