Guidelines for Adult Patients

Intravenous PCA Orders

Initiation of pca requires a awake, mentally competent and alert patient

Etco2 monitoring is required

Loading Dose: PCA should be initiated after an initial bolus dose of morphine 5 – 20 mg (2-3 mg every 5 minutes up to 20 mg) to attain adequate plasma morphine concentrations.

Doses should be reduced by 25-30% in patients over 70 years, and in patients with severely compromised physical status.

PCA Dosing: Morphine is the drug of choice. Meperidine is the last drug of choice. Avoid Meperidine in elderly, renal insufficiency patients or concurrent use of MAO inhibitor therapy

Basal rate may not be required

PCA Orders
Drug Concentration Continous rate

Pca dose

Lockout 4 Hour limit
Morphine 5mg/cc 1-2 mg/hr 1-3 mg 8-15 minutes 30-70 mg
Fentanyl 50 mcg/cc 10-25 mcg/hr 10-25mcg 8-15 minutes 400-800 mcg
Dilaudid 0.2 mg/cc 0.1-0.3mg/hr 0.1-0.6 mg 8-15 minutes 2.4 mg-4.8 mg
Meperidine 10mg/cc 0.1-0.3 mg/hr 10-30 mg 8-15 minutes 80-300 mg