Authors:
Kathy Ruble, RN, MSN,
OCN
Carol Billet, RN, MS, CPNP
Johns Hopkins Hospital, Baltimore, MD
Pain management in the very young is a challenge in Pediatric Oncology. Key aspects to good pain management in this population include, keen observance of behaviors, involving the child at a appropriate developmental level, and caregiver involvement. Patient controlled analgesia (PGA) is often used in adults and older children and allows them to manage their own pain in a timely and efficient manner. Because technology in PCA pumps allows for safe and effective management, it's use can be applied to the toddler age group. Currently we are applying Parent/Nurse Controlled analgesic techniques to control pain in our Bone Marrow Transplant patients of toddler age. Application of this method of pain control in a small number of cases has allowed us to examine it's efficacy and safety. The primary source of pain in these patients has been related to mucosal and perianal breakdown. In using PCA technology we can administer a continuous infusion of opioids to control baseline pain and take advantage of the bolus mode to control intermittent intensified pain, as that with diaper change or mouth care. Parents are often expert at assessing cues from their children and in this case may make the best decisions for dosing with PCA. Thus, parents are instructed on the use of the PCA pump and are given the option of operating the bolus mode. Assessments are completed by the nursing staff, with parent input, every four hours. Pain scores are obtained utilizing a developmentally appropriate pain scale (Pain Behavior Scale or Faces Pain Scale). In addition, a sedation score and number of boluses attempted and given are calculated. These values are recorded on a PCA flowsheet and used to determine optimal individual dosing. Measures such as the lock out intervals on the pump and efforts to keep the pump unaccessible to the toddler, aid in making this a safe solution to a difficult pain problem. In addition, continuous pulse oximeter readings are obtained for the first 24 hours of therapy and with dosage increases. Advantages to this technique of pain management include: maintenance of a steady state concentration of medication, immediate pain relief, involvement of parents in their child's care, and decreased nursing time.
March 15, 2002
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