Specialized Infusion Safety (PCA and Epidural)
Key Points
- PCA and epidural infusions are high-risk therapies that require strict order verification and continuous monitoring.
- For PCA demand dosing, only the patient presses the demand button to reduce oversedation risk.
- Epidural block progression above T4 or respiratory decline requires immediate escalation and infusion reassessment.
Equipment
- Programmed PCA or epidural pump with locked settings per policy
- Dedicated tubing/connectors to prevent wrong-route medication administration
- Continuous monitoring tools (pulse oximetry, end-tidal CO2 when ordered, and frequent vital-sign workflow)
Procedure Steps
- Verify complete provider order and perform independent double-check (drug, concentration, dose settings, lockout interval, and maximum limits) before initiation.
- Confirm patient appropriateness for PCA self-dosing and teach that only the patient activates demand dosing.
- Start infusion with policy-based setup, secure dedicated line routing, and avoid incompatible bolus administration through dedicated lines.
- Monitor pain response, sedation level, respiratory status, oxygenation, hemodynamics, and demand-versus-delivered dose trends.
- For epidural care, track motor/sensory status and block level progression from documented baseline.
- Trigger emergency actions immediately for deterioration: stop infusion when indicated, provide oxygen/airway support, and notify anesthesia/provider per protocol.
Common Errors
- Family-activated PCA dosing or incorrect programming → high risk for opioid oversedation and respiratory depression
- Reconnecting disconnected epidural tubing or delayed response to rising block/respiratory change → severe neurologic or cardiopulmonary harm
Related
- iv-insertion-and-iv-removal - Foundational infusion line safety and sterile handling principles.
- peripheral-iv-therapy-complications - Complication surveillance logic applies to high-risk infusion therapy.