A client is receiving patient-controlled analgesia (PCA). The client complains to a nurse that the button has been pushed several times but there is no pain relief. On examination of the PCA pump, it appears no analgesic has been delivered for 3 hours. Which is the safest action for the nurse to take? 1. Replace the old pump with a new one. Place the old pump in soiled receiving. 2. Check the programming on the pump to ensure it is programmed correctly. 3. Replace the old pump with a new one. Sequester the old pump. 4. Report the pump malfunction to the supervisor
The Correct Answer and Explanation is :
The correct action for the nurse to take is Option 2: Check the programming on the pump to ensure it is programmed correctly.
Explanation:
In this situation, the primary concern is ensuring the patient receives adequate pain relief through the patient-controlled analgesia (PCA) pump. The fact that no analgesic has been delivered for 3 hours suggests a potential malfunction or issue with the pump’s programming.
- Checking the pump’s programming (Option 2) is the most appropriate and safest first step because PCA pumps can be subject to programming errors. It’s possible that the pump may have been inadvertently set with incorrect parameters, such as a locked-out period that was too long, a low dose, or a failure to activate the medication delivery after the button was pressed. By checking the programming, the nurse can quickly verify if this is the case and make any necessary adjustments, ensuring the patient receives the pain relief they need. This action also prevents unnecessary replacement of the pump or incorrect handling of the situation.
- Option 1 (Replace the old pump with a new one) is premature. Before replacing the pump, the nurse should verify if the issue is with the settings or programming. Replacing the pump without ensuring the problem lies there may waste valuable time and resources and could delay pain relief for the patient. Additionally, placing the old pump in soiled receiving may create confusion and disrupt proper documentation.
- Option 3 (Replace the pump and sequester the old one) is also an overreaction. The nurse should first assess the pump’s functionality before deciding to replace it. If a malfunction is identified, the pump should indeed be sequestered for further evaluation or troubleshooting.
- Option 4 (Report the pump malfunction to the supervisor) is a critical step if the issue is identified as a malfunction, but it is premature to report it without first verifying that the problem is not related to simple programming errors or minor troubleshooting issues. Reporting can occur after ensuring the immediate needs of the patient are addressed.
In summary, checking the pump’s programming allows the nurse to potentially correct a simple issue and resume pain relief quickly, ensuring patient safety and comfort.