Patient Controlled Analgesia (PCA) by Proxy
What Is Patient Controlled Analgesia?
Analgesia is the medical word for pain
relief. With PCA, you are able to give your
own dose of pain medicine.
How IV PCA Works
The PCA system consists of:
ξ A pump which is kept next to the bed
ξ A control button at the end of a cable
which you keep at your side
ξ Pain medicine in the pump that is
connected to your intravenous line.
Your nurse will set the pump to give the
amount of medicine that is safe for you.
To get pain medicine you push the control
ξ When you press the button the
medicine goes into your IV
ξ There is a lock out period (often 6-10
minutes) after you press the button.
This is for your safety. Time gives
the medicine a chance to work.
Once enough time has passed, the
control button will lite up and you
can give yourself more medicine if
ξ It is common to have to press the
button several times each hour to
keep pain under control
What is PCA by proxy?
PCA by proxy is a term used when a family
member or caregiver is allowed to act for the
patient. In this case the family is allowed to
push the button on the PCA pump when the
Patient looks to be in pain.
Is this safe?
Pain medicines are given by the PCA pump.
These medicines can give great pain relief.
The PCA pump is carefully set up by two
nurses. A nurse will check on the patient
often to make sure the patient is safe. This
medicine does have side effects. The side
effects from these medicines include
ξ decreased breathing
ξ if not monitored carefully, death.
If a patient becomes too sleepy or their
breathing slows too much, there are things
that can help. Examples include
ξ stopping the PCA and letting the
medication wear off
ξ give another medication to reverse
the affects of the PCA
Who can safely be the proxy?
PCA by proxy is safe when the team caring
for the patient is able to find a person who
can safely be the proxy. This person must
ξ Know the patient well
ξ Be able to tell when the patient is in
pain by listening to the patient
ξ Understand physical behaviors (like
jaw clenching, or grimacing) that tell
that the patient is in pain
The proxy is the person who is allowed to
push the PCA button for the patient. If the
person who is acting as the proxy does not
understand the signs of pain the patient
shows, they may give too little or too much
ξ If they give too little pain medicine,
the patient will keep having pain
ξ If they give too much pain medicine
the patient can become sleepy, may
not breath normally and, in rare
circumstances may die.
How will the proxy be chosen?
The medical team caring for the patient will
talk with the family. That family member or
caregiver would need to understand:
ξ The risks and benefits of the
medicine and PCA
ξ How does this patient shows their
ξ When it is safe to give a dose of
ξ When is it not safe to give a dose of
ξ To know they need to call for help if
a change in patient’s breathing is
ξ They need to be able to spend a lot of
time at the bedside so the patient can
get consistent pain relief
Staff members will check with the proxy
every shift to make sure they understand
how to act safely as the proxy.
What if the proxy needs to leave?
If at any time the proxy feels they need to
leave the patients bedside, they should talk
to the nurse who will help sort out the issue.
Becoming the Proxy is a lot of
responsibility. We want people to feel
comfortable with their decision. If you need
to leave for short periods of time, such as for
meals, talk to the nurse. The nurse caring for
the patient may be able to take over the PCA
for a short time. If you need to leave for the
night or several days, you need to
ξ Talk to the nurse as soon as possible
so the team can find way to control
the patient’s pain
ξ You may not give permission to
another person to push the pain
button – that is not safe
ξ If a new person becomes the proxy,
the team will need to discuss the
change. The new proxy will need to
learn how to safely use the PCA
The team may also decide to change what
pain medicine is used if
ξ The patient’s pain is not well
ξ The patient has too many bad side
ξ If the patient is able to use pain
medicine in another way
How will I know if it is safe to push the
Safe to push the button:
ξ Patient tells you they are in pain
ξ You see known signs of pain
ξ Patient is awake, breathing normally
ξ Patient is awake, breathing fast
What do I do if I think my family
member/friend is not safe?
If you see any of these changes, call out to a
staff member to come and check on the
ξ try to wake up the patient and have
them take a deep breath while you
are waiting for a staff member to
come to the room
ξ stop pushing the button until a staff
member checks the patient and tells
you it is ok to push the button again
ξ If a patient is sleeping, the button
should not be pushed until the patient
awakens and can indicate they need
Everyone’s first priority is to keep the
Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright ©11/2017. University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#7697
Not safe to push the button:
ξ Patient is sleeping
ξ Appears sleepy
ξ Difficult to wake up the patient
ξ Patient breathing pattern changes,
they have long pauses between
ξ Slower breathing
ξ Increased snoring