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For more detail on adverse effects due to the opioid administered, equipment used,
or operator and patient‐related factors, see Sections 7.1.2, 7.1.6 and 7.1.7 respectively.
7.1.6 Equipment

Both programmable PCA pumps and disposable PCA devices are available.
Programmable PCA pumps
These types of pumps allow significant flexibility of use. Adjustments can be made to the dose
delivered and lockout intervals, background infusions can be added, and accurate assessments
can be made of the total dose of drug delivered. In addition, access to the syringe (or other
drug reservoir) and the microprocessor program is only possible using a key or access code.
All require disposable items, eg generic or dedicated syringes or cartridges, antisiphon valves
to prevent siphoning of drug from the drug reservoir, and antireflux valves to prevent
backflow of drug into the IV infusion line (see later).
Disposable PCA devices
There is a variety of disposable PCA devices.
Parenteral PCA devices
Disposable PCA devices are often based on the same physical principle; the volume of
pressurised fluid delivered (dependent upon spring or elastomer technology) is determined by
mechanical restrictions within the flow path and the speed of filling of the bolus dose reservoir
determines the ‘lockout’ interval (Skryabina & Dunn, 2006). Advantages include small size and
weight, freedom from an external power source, elimination of programming errors, and
simplicity of use. Disadvantages include an inability to alter the volume of the bolus dose
delivered or add a background infusion, difficulties determining the amount of drug the
patient has received accurately, the possibility of inaccurate flow rates, and long‐term costs
CHAPTER 7 (Skryabina & Dunn, 2006). There may also be security issues as the drug reservoirs for these
devices are more readily accessible.
Transmucosal PCA devices
Metered‐dose PCINA devices are available. The drugs must be administered in small volumes
to avoid significant run‐off into the pharynx.
Initial PCINA devices delivered sprays of a reasonable dose but large volume (eg 25 mcg
fentanyl/0.5 mL (Striebel, Pommerening et al, 1993) or smaller volume but with smaller doses
than commonly used with IV PCA (eg 9 mcg fentanyl/0.18 mL (O'Neil et al, 1997). A specially
formulated solution of 300 mcg/mL fentanyl has been used in a device that enables fentanyl
doses of 54 mcg to be delivered in just 0.18 mL (Paech et al, 2003).
Transdermal PCA devices
The fentanyl PCTS uses a low‐intensity electric current to drive the drug from the reservoir
through the skin and into the systemic circulation (Banga, 2005). The IONSYS™ device, which is
applied to the chest or upper outer arm, delivers a fixed dose of 40 mcg fentanyl over a
10‐minute period following a patient demand and allows delivery of up to 6 doses each hour,
up to a maximum of 80 doses in 24 hours (Banga, 2005; Koo, 2005). This device must be replaced
every 24 hours, was not available in all countries, and was designed for in‐hospital use only.
Despite the potential advantages noted under Section 7.1.4, the marketing authority for the
fentanyl PCTS was suspended by the European Medicines Agency in November 2008, after
corrosion of a component of the system in one batch was detected (European Medicines Agency,
2008). This fault carries the risk of triggering the self‐activation of the system, which could lead

178 Acute Pain Management: Scientific Evidence