CADD Pump for Pain and/or Dyspnea

A Continuous Ambulatory Delivery Device (CADD) pump enables individuals to receive medications for symptom management through intravenous or subcutaneous routes delivered via continuous infusion and/or bolus doses. One of many benefits of CADD pumps is that they can be utilized in almost any care setting including the home.

When to Consider Using a Medication Pump for Symptom Management of Pain and/or Dyspnea

Individual or situational characteristics may include: ^1,2,3

• Symptom issues with pain or dyspnea
• Not opioid naive
• Dysphagia limiting use of PO medications
• GI absorption concerns
• Increasing frequency of administration, including PRN doses
• Family administration constraints

Nursing Care When Using a Pump ^1,2,3

Screen

• Think Total Pain or Dyspnea. Could there be a combination of physical, social, psychological, and spiritual or existential elements that we also need to address?
• Screen for these and common symptoms and side effects of opioids using validated tools such as the ESAS-r.

Assess

• Assess for efficacy
• Re-assess after giving PRN doses to ensure effectiveness and follow up after schedule doses

Monitor

Opioid Side Effects ^1,2,3

• Common: constipation, dry mouth, nausea and vomiting, sedation
• Less common: confusion, restlessness, delirium, hallucinations, myoclonus, seizures, itch, hives, urinary retention, dizziness, syncope
• Rare: respiratory depression (RR <8 breaths per min)

Opioid-Induced Neurotoxicity^2,3

• Signs and symptoms: sedation, drowsiness, lethargy, confusion, hallucinations, agitation, myoclonus, seizures, hyperalgesia, allodynia, decreased resp. rate
• Potential Causes: Conversion errors, dose changed too frequently, decreased pain, sepsis
• Increased risk factors: Renal impairment, long-term opioid therapy at high doses, increased age, dehydration, concurrent treatment with medications such as TCAs or benzodiazepines, delirium

Tools:

• OPQRSTUV Fraser Health Assessment Tool
• Observational Pain Tools for non-verbal or cognitive impairment: PAINAD, Abbey Pain Scale, PACSLAC
• Tools to assess for sedation:
  • RASS-PAL The Richmond Agitation-Sedation Scale modified for palliative care
  • POSS The Pasero Opioid-induced Sedation Scale

Resources

1. https://www.sciencedirect.com/science/article/pii/S1524904224000237
2. https://www.hamiltonhealthsciences.ca/wpcontent/uploads/2019/08/CADDPainPump-th.pdf
3. https://meds.queensu.ca/source/CADD%20Pump%20PC%20Medicine%20Skills%2010-10-21.pdf
4. The Pallium Palliative Pocketbook(E-book): A peer-reviewed, referenced resource. 2nd Cdn ed. Ottawa, Canada. Pallium Canada, 2020.

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