Like 3 Way TIVA Set then PCA administration can be made Safer!

1. Tampering/Kinking of IV (Intravenous)
Administration Lines
PCA is a technique whereby small doses of analgesic drugs, usually opioids, are administered (usually IV, although
can be subcutaneous) by patients themselves. It is mostly used for the control of postoperative pain. The PCA
system allows on-demand bolus injections with the option of a background infusion. Overdosage is avoided by
limiting the size of the bolus and the total dose administered within a set period of time. A lock-out interval is
also set. PCA has been shown to provide more consistent plasma drug levels when compared with standard
intramuscular techniques, and less sedation. Drugs with (relatively) short half lives are usually used.
Dose regimens for PCA
Drug Bolus dose (mg) Lock-out (minutes)
Morphine 0.5-2.0 5-15
Fentanyl 0.02-0.1 3-10
Diamorphine 0.5-1.5 3-5
Pethidine 5-20 5-15
Nausea and vomiting may be a problem if regular anti-emetics are not prescribed. PCA may also be used in conjunction
with epidural analgesia (using plain bupivacaine infusions to avoid opioid overdosage).
Safety aspects of PCA
A one-way valve should be incorporated into any system which is linked via a Y-connector to a fluid infusion.
Backflow can occur into the tubing of the fluid infusion, which may then deliver a large bolus. Alternatively, PCA
may be delivered by a separate IV line. The pumps should be lockable and contain alarms which warn of
excessive doses. Patients should be observed for their level of sedation and respiratory rate. Nursing staff should
be allowed to administer naloxone in cases of suspected overdosage.

2. Patients being administered PCA in Recovery, the Surgical Ward or in an ambulatory setting should have the full
protection against the accidental disconnection of the IV cannula.
This can be partially achieved by the wrapping around of surgical tape close to the cannula site (The cannula site
per se needs to be visable for the evidence of inflamation>infection)
The GCM type of PCA/ 3 Way TIVA sets/ICU & MRI-Scanner Sets overcome this problem by an adjustable LineLok
which prevents a sudden ‘tug’ on the cannula and hence the unexpected and most unpleasant return of pain. In
the hospital ward this can be quickly sorted but a patient in the home setting would have a much longer wait
and probably would be in a distressed condition and unable to stop the pain.
This type of accident is thankfully not that common but it does happen and impacts negatively on a patient with
a serious underlying condition.
Like with a typical 3 Way Tiva Set with full safety a PCA IV Set should have this essential safety as standard.
The other important safety feature that should be built in to a PCA set is non-kink device at the distal end. It is
simply not enough to have a ‘bridge’ to protect the ‘U-Form’ -the end section should be ‘tamperproof’. Cases
have been reported of children squeezing the end section of an IV line and creating a bolus of drug with the
unwanted sequela.
Another important feature that should be provided with all PCA sets is internationally colour-coded drug tags to
affix to the two lines involved (The main line for the opiate and the distal IV volumetric fluid line) As many PCA
sets are also used for say, propofol sedation then the same safety measures should also be applied. GCM type
sets whether used for TIVA-TCI, ICU or other procedures all have these drug tags incLuded with the set.

3. The world's FIRST full Safety PCA set. The clear need has been identified for a much safer PCA set that addresses
the safety concerns for especially the ambulatory and/or domicile patient, or critical patients in difficult and high
risk situations such as HEMS, Paramedical and Military.
How many times have you seen ambulatory patients walking around hospitals with a drip stand and NO
protection for their cannula? More and more NHS Trusts and international hospitals are adopting the GCM
Sedation/PCA Full Safety sets for all the right reasons.
All types of IV lines can be made safer, PCA is no different and solutions have been found!

4. Drug ID Tags to match syringe content