Comparison of Continuous Epidural Infusions with PCEA infusions- A Plymouth Perspective

1. Comparison of Continuous Epidural Infusions with PCEA infusions- A Plymouth Perspective David Portch Paul Youngs J Coghill Plymouth

2. Change in Epidural administration May 2009 change from continuous epidural infusion (CEA) to patient controlled epidural infusion (PCEA) CEA using infusion pumps with 50ml prefilled syringes containing 0.1% bupivacaine and 2mcg/ml fentanyl Continuous infusion at 9.9mls/hr Top ups of 0.25% levobupivacaine administered by midwife if required

3. PCEA protocol PCEA- Background infusion 8mls/hr with patient controlled bolus of 8mls (20 min lockout) Using new equipment Mckinley bodyguard 545 pump 250ml epidural infusion bag (0.1% bupivacaine with 2mcg/ml fentanyl) Giving set Top ups of 0.25% levobupivacaine administered by midwife if required

4. Number of top ups and infusion changes required 2 x 62 day periods 1st Jan 2009-3rd March 2009 and 1st July-31st Aug 201 CEAs vs 245 PCEAs Identified number of �non-operative� epidural top ups and number of infusion syringes/infusion bags required

5. Epidural rate 2009

6. Equipment Issues

7. Epidural CEA vs PCEA

8. Cost of setting up and running CEA

9. Cost of setting up and running PCEA

10. Midwife time saving Each top up/ syringe change requires 2 midwives. One looking after patient and another senior midwife to check drugs out/ administered. Approx time 10mins of senior midwife time to help with a top up �Time� per PCEA = 4.1 mins �Time� per CEA = 17.6 mins

11. Connections Each top up or change of syringe represents both an infection risk and an opportunity for IV connection to occur. Average number of connections with PCEA = 2.8 Average number of connections with CEA = 5.9

12. Cumulative differences

13. Conclusions More expensive Time saving Potentially safer