Patient-Controlled Analgesia (PCA Pump)

Patient-controlled analgesia (PCA) is a safe way for your child to get pain medicine quickly. A small pump gives this medicine through an IV or central line when your child pushes a button. 

PCA helps keep pain under control. It can ease worry because patients can get medicine when they need it. 

Only the patient should push the button. Family and friends should never push it unless a doctor or nurse says it is OK. 

The right pain control can help your child rest, move, and heal during treatment. Follow all instructions from your care team. Do not give your child a different medicine or more medicine than was prescribed. 

How a PCA pump works

When your child feels pain, they press a button that connects to a PCA pump. The PCA pump gives pain medicine through an IV or a central line.

The pump is set so your child can’t get too much medicine, even if the button is pressed a lot. 

PCA for pain control

Your child’s care team chooses the pain medicine and the settings for PCA. Opioids like morphine, hydromorphone (Dilaudid®), fentanyl, or another medicine may be used for managing pain.

Sometimes the nurse may give an extra dose of pain medicine, called a boost dose or “bolus”. This helps with severe or breakthrough pain based on your child’s pain score. 

Overdose protection

The PCA pump is set to keep your child from getting too much medicine. Your child can press a button to get a dose of medicine when pain starts.  The pump will not allow another dose of medicine until it is time, even if the button is pressed.

Your care team sets the pump to give a safe dose of medicine. Caregivers and family members should not change the pump settings or try to give extra doses. 

Full-time pain relief

The care team may set the PCA pump to give a small, steady amount of pain medicine all the time. This is called a continuous, or basal infusion. Your child can press the button to get an extra dose if pain starts. 

The care team will check your child’s pain level and how often they push the button. They may change the dose or the medicine to give the best pain control with the fewest side effects. 

Talk to your care team if you have concerns about your child’s pain level or if you think your child is not getting enough pain relief. 

Side effects of PCA

Medicines in the PCA pump can cause side effects. Side effects often get better over time or after the dose is changed. Tell your care team if your child has:

• Itching
• Constipation 
• Trouble urinating (peeing)
• Nausea and vomiting

Check with your child’s care team before giving medicines that may cause drowsiness or fatigue. These include diphenhydramine (Benadryl®), lorazepam (Ativan®), promethazine (Phenergan®), or other anti-nausea or calming medicines.

Some parents worry about opioid addiction. The risk of addiction is low when these medicines are used for pain and given as prescribed. 

PCA pump safety

A PCA pump has safety features that help protect your child while they are using opioid pain medicine.

The pump has a lockout setting.

After your child presses the button, the pump will not give another dose until enough time has passed. This helps keep the dose at a safe level.

Only your child should press the PCA button.

Family and friends should not press the button for your child. This keeps your child from getting too much medicine.

Your child will be monitored often.

Opioid medicines can sometimes slow breathing. Nurses will check your child’s breathing, oxygen level, pain score, and alertness. Some children may need closer monitoring if they have sleep apnea, lung problems, or take other medicines that cause sleepiness.

The care team checks the pump settings.

The care team will regularly check the medicine, dose, timing, and line placement. 

Serious side effects

More serious side effects need attention right away. Call your care team if your child has:

• Hallucinations (seeing things that are not there)
• Trouble breathing or very slow breathing
• Extreme sleepiness or trouble staying awake
• Confusion or acting differently

What to do if your child stops breathing

Breathing that is very slow, very shallow, or stops is a medical emergency. Opioid medicines used in PCA can sometimes slow breathing. Quick action is important.

At home or in housing

If your child stops breathing:

• Call 911.
• Stop the PCA pump if you have been taught how to do this. This prevents more medicine from being delivered.
• Gently shake your child to see if they start breathing.
• If you are trained and certified, start CPR if your child does not start breathing.

In the hospital

• Press the nearest “Code Blue” button or call the hospital emergency number from the room phone.
• Follow any instructions your care team gives you.

Going home with a PCA pump

If your child will use a PCA pump at home or in patient housing, your care team will teach you how to use the pump correctly.  

Make sure you understand possible side effects and which signs or symptoms need medical attention right away.

Keep important phone numbers nearby, including your care team and emergency services. Follow all instructions from your care team to help keep your child safe.

Questions to ask your care team

• What is a PCA pump?
• Why does my child need a PCA pump and how long will they need it?
• How does it help manage my child’s pain?
• How does my child know when to press the PCA button?
• Why is it important that only my child presses the button?
• Which pain medicine will my child get through the PCA pump?
• What signs should I look for that mean the dose or medicine may need to change?
• What side effects might I expect from my child’s pain medicine?
• Which side effects should I report right away?
• Are there medicines I should avoid giving my child while they are on PCA?
• What symptoms are considered an emergency while my child is using a PCA pump?

Related content