PCA Question

[uclalee]

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I want to order a Dilaudid PCA for a patient with a continuous rate of 2mg/hr with a 2mg q15 demand dose (max 4 per hour - 8 mg).

Does this mean my 1 hour lockout I set on the unit is 8mg, or 10mg? In other words, does the PCA count the continous infusion toward the 1 hour lockout?

 

[Frank Rizzo]

yes

 

[Licoricestick]

I want to order a Dilaudid PCA for a patient with a continuous rate of 2mg/hr with a 2mg q15 demand dose (max 4 per hour - 8 mg).

Does this mean my 1 hour lockout I set on the unit is 8mg, or 10mg? In other words, does the PCA count the continous infusion toward the 1 hour lockout?

15min demand doses - is this what most people's normal order is?

And why do you need a 1hr lockout dose😕 - if your machine is an appropriate PCA machine shouldn't it not allow this patient to receive any more than 10mg in 60min regardless?

I ask cause our standard PCA orders are 5min lockouts on the bolus dose, no set max dose per hour (although obviously the maximum number of doses they can deliver in an hour is 12).

 

[rsgillmd]

15min demand doses - is this what most people's normal order is?

And why do you need a 1hr lockout dose😕 - if your machine is an appropriate PCA machine shouldn't it not allow this patient to receive any more than 10mg in 60min regardless?

I ask cause our standard PCA orders are 5min lockouts on the bolus dose, no set max dose per hour (although obviously the maximum number of doses they can deliver in an hour is 12).

Machines will vary. UCLALee's regimen is strange -- I'm assuming it's for someone opioid tolerant because we don't do basal rates on opiate naive patients. Also I have rarely had to program for more than 0.5 mg of Dilaudid q7 minutes (typical lockout when I was a resident) -- usually it was 0.2 mg q7 minutes. This is nowhere near the 2 mg q15 minutes.

 

[Planktonmd]

First: Why would you give a basal rate of 2 mg/hr? this is a huge dose and the only reason why you might want to do that is if the patient is a heavy narcotic user and you expect him to be really tolerant, but I wouldn't start at such a high basal rate even in that population.
Second: 2 mg every 15 minutes is also too high, are you sure of these numbers?
Third: a lockout of 15 minutes is too long.
Dilaudid comes in 0.2mg/cc solution are you sure that you are not talking cc not mg?

I want to order a Dilaudid PCA for a patient with a continuous rate of 2mg/hr with a 2mg q15 demand dose (max 4 per hour - 8 mg).

Does this mean my 1 hour lockout I set on the unit is 8mg, or 10mg? In other words, does the PCA count the continous infusion toward the 1 hour lockout?

 

[pgg]

First: Why would you give a basal rate of 2 mg/hr? this is a huge dose and the only reason why you might want to do that is if the patient is a heavy narcotic user and you expect him to be really tolerant, but I wouldn't start at such a high basal rate even in that population.
Second: 2 mg every 15 minutes is also too high, are you sure of these numbers?
Third: a lockout of 15 minutes is too long.
Dilaudid comes in 0.2mg/cc solution are you sure that you are not talking cc not mg?

I agree that this regimen is probably not appropriate for opioid naive patients.

As for the q15 lockout, I will occasionally make use of less frequent higher dose settings in opioid tolerant chronic pain patients. These patients sometimes seem more satisfied with less frequent bigger hits. Their pain control isn't any better but, I don't know how exactly to put it, they feel more empowered and in control of their pain if an infrequent button hit gives them a bigger dose.

 

[Noyac]

I agree with Plank and pgg. Your doses are way too high. I think you may be confusing dilaudid and MS.

 

[SleepIsGood]

I agree with Plank and pgg. Your doses are way too high. I think you may be confusing dilaudid and MS.

my thoughts exactly.