How To Set Up A PCA Pump

I was setting up a PCA (Patient Controlled Analgesia – a “pain pump”) for my new patient.

I didn’t really have time to be doing this. It was one of those busy days. Everyone was calling me. The pager in my pocket rang constantly: Pain meds! Anxiety meds! When will the doctor be here? I want to go home! Move my Kleenex box two inches to the right!

I would leave a room, and would get called right back in. I couldn’t make any forward progress.

My new patient had just had surgery, and was in pain. She called me every five minutes, telling me the pain medication wasn’t working. I was pouring morphine into her, and finally called the doctor for a PCA, so she could push a button and receive a dose of pain medication whenever she wanted.

Taking the time to set up a PCA would ultimately be better than being paged to her room every five minutes. I could get to my other patients, who were also calling constantly. And she’d have better pain control. Win-win! If I could just get it set up quickly!

Because I really didn’t have any time.

The pump already had batteries in it, located on its underside. As the pager rang in my pocket, I turned on the pump and programmed it with the settings given to me by the doctor. Hooked the tubing up to the patient. Explained that she could hit her button whenever she wanted, that the pump would prevent any overdoses. Stepped back to admire my handiwork, satisfied – Did it! Got it done! – ready to move on to the next room –

And pop went the battery door to the PCA.

The batteries came tumbling out, scattering, rolling across the floor. All of my settings were cleared. The pump was rendered useless.

I stared at it. “Oh! The batteries fell out!” I said, a little dumbfounded.

I had to get down on my hands and knees and crawl around under the hospital bed and behind the bedside stand, rooting around, to retrieve all the batteries.

My patient peered at me from over the bedrail, watching with interest. It’s not every day that a nurse is on her hands and knees, scrabbling around under their bed, making little grunting noises.

Locating all the batteries, I fed them back up into the PCA. Latched the door firmly. Redid all the settings.

“There!” I said, satisfied once more. “Push the button whenever you –  ”

And pop went the battery door to the PCA.

The batteries came tumbling out, scattering, rolling across the floor. All my settings were cleared. The pump was rendered useless.

I stared, mouth open.

No way.

“Well, look at that!” I said as cheerfully as possible. I really didn’t have time for this. “That’s weird!”

I got back down on my hands and knees, crawled around under the bed, rooted behind the bedside stand, scrabbled for the batteries.

My patient craned over the bedrail, enjoying this unexpected show.

“Got ’em!” I said in a breezy tone, feeling tense. I dusted off my knees, clutching the batteries. My patient watched happily. I stuffed the batteries roughly back into the PCA pump, trying not to scowl. Hold it together, Carol! The pager rang shrilly in my pocket as I redid the settings.

Disingenuously, I chuckled. “These things happen, don’t they?”

My patient raised her eyebrows, fascinated. Really? Batteries fall out of equipment, nurses crawl around rooms on their hands and knees? These things happen here?

“Oh, well, actually not,” I revised myself hastily. “We’ll just put a little tape on the door to hold it shut, how’s that?”

And I pulled out my tape and put a few long pieces across the battery door, fastening it securely. “There we are!” I said, backing up. “Gotta go! My pager’s ringing!”

And pop went the battery door to the PCA.

The batteries came tumbling out, scattering, rolling across the floor. All my settings were cleared. The pump was rendered useless.

The patient couldn’t help it. I watched her eyes widen, a little grin start to appear. Her nurse was about to crawl around on the floor again. She was sitting up in bed now, peering over the rails in anticipation, watching the fun.

Down I went onto my hands and knees while my patient watched avidly. I crawled around under her  bed and behind the bedside stand, grunting, grabbing batteries that had scattered far and wide.

One was missing.

“There it is!” my patient squealed excitedly, pointing to her neighbor’s bed. “There’s the battery, over there!”

She was loving this new game.

Tip to new nurses: Distraction can be an excellent technique for controlling pain.

Second tip to new nurses: This is not the way to do it.

On my hands and knees, I crawled quickly across the room. My patient craned her neck over the bedrails, riveted, directing me. “See it? Over there! A little more to the right!” she called eagerly, gesturing. I scrabbled behind her neighbor’s bed and retrieved the wayward battery. Sweating, I shoved them violently back into the PCA pump.

“We’ll just tape it a little better this time!” I chirped, fighting the urge to scream, and pulled the tape out of my pocket again.

My patient bobbed her head gamely, radiating enthusiasm. She was sitting straight up in bed, beaming, watching every move with delight. Awesome new game!

And I taped the hell out of the thing, crosswise, lengthwise, forward and back, around the entire machine like it had a toothache. I grimly taped it so it’d never be opened again in its lifetime. I used nearly an entire roll of tape on that door. It would not pop again on my shift, or the next, or the next.

I turned on the PCA to redo the settings for the fourth time –

But no.

It can’t be!

The pump wasn’t powering up correctly. It seems that … unbelievably, it appears that…

One of the batteries was in backwards.

One of the batteries, behind that battery door.

Behind the door, under all that tape.

All that tape ensuring the door would never, ever open again.

And that’s when I lost it. Completely and spectacularly lost it.

That pump wants to be rendered useless? I’ll render the damn thing useless!

And I wrenched the PCA off its pole and battered it wildly against the wall. I dashed it savagely to the ground and kicked it violently back and forth across the room. I stomped on it with my heel, putting my whole weight into it, grinding it down, crushing it, spittle spraying liberally from my lips. I seized it from the floor and hurled the entire thing out of the window in a ferocious explosion of shattered glass and plastic. I clambered out the window after it and –

Okay, not really.

Critically important tip to new nurses: Sometimes you have to hide your feelings.

In the end, of course it worked out. It always works out.

I am grinding my teeth and breathing heavily, but I take off all the tape, locate the errant battery, feed it in correctly, and wisely check that the PCA would turn on before reapplying the enormous wad of tape.

And then I wrap a whole roll of gauze around the machine and tie a big ole knot, just to be sure.

That door does not pop open again. Not on my shift, or the next, or the next.

For the rest of the day, I overhear my patient recounting the story to laughing family and friends. With great animation, she pantomimes crawling and scrabbling, making little grunting noises. She points to the bandaged PCA, makes a scattering motion with her hands, then resumes her crawling and grunting.

She throws her head back and roars with laughter, her pain completely forgotten.

4 Comments How To Set Up A PCA Pump

  1. mistey

    Awesome story!! Especially because knowing you I can see you doing some of these things…facial expressions and all!!!! Hahhahahha

    1. Carol

      You can see me melting down, spittle flying from my lips, throwing things around the room? Gnashing my teeth, eyes wild, cheeks flapping as I stomp around? Great… 😉

  2. Karen Gake

    I can totally see you in this situation, and your patient has a memory they will never forget! And it would have taken more time to turn that pump in and get a new one that actually had a functioning battery door…you did the right thing…keeps you young, you know! 🙂

    1. Carol

      I thought about that later. Why didn’t I just get a new PCA pump? Duh!! I hope it didn’t go back into circulation for someone else to struggle with… although the big wad of gauze and tape might have clued the next nurse in, that maybe the pump should be inspected by Engineering…


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