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Introducing the accufuser: a new solution for ambulatory continuous epidural infusion

Introduction Epidural analgesia is useful for some patients with refractory cancer pain. However delivering a continuous epidural infusion can raise some challenges regarding safety and practicality. We present our experience of using the Accufuser Elastomeric Vacuum pump. Aims ▶ To identify a delivery method for continuous epidural infusion for ambulatory patients in the Hospice and Community setting. ▶ To develop policies and procedures and facilitate staff training. ▶ To facilitate discharge of ambulatory patients with continuous epidural infusions. Methods The Integrated Pain service performs joint consultations and has monthly meetings to develop Policies and Procedures and discuss complex cases. In response to patient need we performed a literature review to select a device that was portable, light, easy to fill, has long duration of action and was safe. We met with the manufacturer to evaluate it fully prior to use. Result The Accufuser is an elastomeric device delivering a near linear infusion with a patented piston preventing under or over dosing. It has variable infusion rates and volumes. It is filled aseptically in the hospital pharmacy in the aseptic unit and we used a device which lasts 5.7 days. It was used for a patient with severe perineal pain despite maximal tolerated oral therapy who had benefitted from bolus epidural analgesia. Following titration of diamorphine, clonidine and levobupivacaine the patient was discharged and returned to the hospice for renewal. Discussion Introduction of the accufuser required an integrated approach from the Pain team, Pharmacy and the Specialist Palliative Care Team. Development of a policy and patient leaflets alongside intensive staff training was required. We feel this is innovative practice and opens up the choices for Units and Pain teams dealing with Epidural infusions. This device is unique in its mechanism and patented technology and offers a better patient experience.