# AI programs a pediatric PCA pump with adult lockout intervals for morphine, leading to respiratory depression in a 6-year-old

- **ID:** `medical/pediatric-pca-pump-override`
- **Domain:** medical
- **Category:** runtime_error
- **Error Code:** `PCA-ERR-001`
- **Verification:** ai_generated
- **Fix Rate:** 88%

## Root Cause

Pediatric Patient-Controlled Analgesia (PCA) requires a minimum lockout interval of 8-10 minutes for morphine, not the adult standard of 6 minutes, because children metabolize opioids faster and have narrower therapeutic windows, risking respiratory depression.

## Version Compatibility

| Version | Status | Introduced | Deprecated |
|---------|--------|------------|------------|
| GE Healthcare Aisys CS2 v8.0 | active | — | — |
| Baxter PCA Syringe Pump v3.4 | active | — | — |
| Smiths Medical CADD-Solis v5.2 | active | — | — |

## Workarounds

1. **Set lockout interval to 10 minutes and bolus dose to 0.02 mg/kg for morphine PCA in a 6-year-old; verify using the Broselow tape or weight-based pediatric nomogram** (88% success)
   ```
   Set lockout interval to 10 minutes and bolus dose to 0.02 mg/kg for morphine PCA in a 6-year-old; verify using the Broselow tape or weight-based pediatric nomogram
   ```
2. **Use a dedicated pediatric PCA protocol that enforces a minimum lockout of 8 minutes and a maximum 1-hour limit of 0.1 mg/kg; program pump with 'Pediatric Mode' if available** (92% success)
   ```
   Use a dedicated pediatric PCA protocol that enforces a minimum lockout of 8 minutes and a maximum 1-hour limit of 0.1 mg/kg; program pump with 'Pediatric Mode' if available
   ```
3. **For a 6-year-old weighing 20 kg, program: bolus = 0.4 mg, lockout = 10 min, 1-hr limit = 2 mg; document in MAR and double-check with a second nurse** (95% success)
   ```
   For a 6-year-old weighing 20 kg, program: bolus = 0.4 mg, lockout = 10 min, 1-hr limit = 2 mg; document in MAR and double-check with a second nurse
   ```

## Dead Ends

- **** — Higher bolus doses increase peak serum concentration and risk of apnea without addressing the underlying clearance mismatch (75% fail)
- **** — Lockout interval is independent of concentration; a lower concentration with the same interval still allows too frequent dosing in children (85% fail)
- **** — Eliminating lockout removes the safety mechanism and can lead to cumulative overdose if the child presses the button repeatedly (95% fail)