For all of their clinical benefits, pain pumps present several challenges related to sending unsupervised patients home with an invasive piece of equipment. If you're thinking about adding the devices to your post-op pain control protocols, review the following tips for success.

Understand the basics
Before you begin using pain pumps, your staff needs to know how they work, recognize the functioning issues that can arise and identify potential complications such as failed blocks, local anesthesia toxicity or infection at the puncture site.

• Conduct hands-on training. Organize in-service training that includes hands-on practice sessions that let staff members attach and operate the pumps. If you haven't standardized the pumps you buy, your staff should understand how the various models in your facility operate, know how to ensure they're properly filled and verify that they're correctly programmed.
• Recognize signs of trouble. Staff must identify pain-pump-related complications while the patient is in the facility as well as during follow-up phone conversations when the patient is at home. For example, if the catheter misses the area next to the nerve and enters a blood vessel, the patient is at risk for local anesthesia toxicity. Symptoms include perioral numbness, a metallic taste in the mouth, dizziness, blurred vision and ringing in the ears. Other more severe complications include seizures and cardiovascular collapse.

Staff should also be able to identify common side effects of nerve blocks placed in the upper extremities, such as a scratchy voice, facial drooping on the side of surgery, eye redness with a sagging eyelid and shortness of breath. These symptoms are not serious and typically subside in the first 24 hours post-op. A well-trained staff member will be able to tell the difference between non-serious conditions and physical reactions that demand immediate attention.

Infections are more common when the catheter has been inserted in the groin or axillary areas. If an infection develops, symptoms include redness, swelling and tenderness near the puncture site. In rare cases, the patient may see pus drainage or experience fever or chills. Signs of infection will usually show after 24 hours post-op. If any signs of infection occur, patients should contact the anesthesia provider. In most cases, the patient will be instructed to discontinue the catheter.

Set expectations
Patient education is key to pain pump success. If patients understand how the pump works and how to change the infusion rate — if the pump allows it — they're more likely to operate the pump properly and therefore experience less pain. Thorough patient education will also help patients identify complications that could become aggravated as time passes.

Ideally, the surgeon should introduce the patient to the concept and provide instructions on how the pump works during a pre-op office visit. Otherwise, the patient should receive written and oral instructions before and after surgery. Some facilities also provide instructions and videos on their webpages that explain how to operate the pump and what to expect during the post-op recovery.

You can also include family members in these discussions, but it's important to emphasize that if the pump lets the patient change flow rates or begin a bolus, only the patient can operate the pump. A family member can't change a pump's settings because the pumps are indicated only for "patient-controlled anesthesia."

Finally, patients need to know how to tell when the pump is empty, how to remove the catheter and how to dispose of the pump. (In some states, patients can't put pumps directly in the trash; they instead need to return the pumps to their physicians' offices for disposal.) Once they're finished with the pump, patients should understand that continuing their oral pain medications is paramount to a successful recovery.

Communication is key
Patients sent home with pain pumps should have 24-hour access to an expert in your facility or the local hospital who has a clear understanding of how pain pumps work, how to identify and fix problems related to the pump's function and what to do in case of a clinical emergency. (Some pump manufacturers provide 24-hour hotlines staffed by specialists who can answer questions from patients and providers.) As with all patient care, the more access patients have to their healthcare providers, the better they'll feel about the procedure and recovery process.