The syringe driver is a simple and costeffective method of delivering a continuous subcutaneous infusion csci. Jan 18, 2017 cumbria syringe driver training equipment needed. When and how to use a syringe driver in palliative care. Procedure for the use of mckinley t34 syringe driver to. You might have a syringe driver for medicines to help manage pain, sickness, fits, agitation or breathing problems. The mckinley t34 is calibrated in mlhour a 30ml luer lock syringe is recommended the maximum volume of fluid in a 30ml syringe is 22ml. The recent gosport war memorial hospital inquiry1 has increased uk patient, public and clinician awareness about syringe drivers for continuous. For those patients who are on opioids other than morphine, such as methadone, oxycodone or. A syringe driver is a small battery operated pump designed to deliver medication sub cutaneously just under the skin over a 24 hour period. Clinical policy and procedure for the subcutaneous.
Example a syringe driver dose converting from oral morphine to syringe driver e. Always indicate on the regular prescription chart that a 4 hourly care test syringe driver working syringe driver is in use. If symptoms are acute a concurrent rescue dose should be given. A survey performed in 1992 reported that at least 28 drugs were used in combination with others in a single syringe driver. A syringe driver is a small, batterypowered pump that delivers medication at a constant rate throughout the day and night.
Give 115 of the 24 hour dose po morphine to sc alfentanil. When first set up or after dose changes of the drugs delivered by a syringe driver subcutaneously the effect will take at least 4 8 hours to reach the intended level. When the oral route is no longer appropriate, a syringe driver can be used to ensure continued symptom control. April 2017 introduction palliative care patients often exhibit multiple symptoms that require the use of numerous drugs. Conversion of oral opioids to parenteral opioids is overleaf. Syringe driver drug compatibilities guide to palliative care practice 2016 sodium chloride 0. A syringe pump also referred to as a syringe driver is used to deliver a csci, which is considered fundamental for continued symptom. Guidelines for syringe driver management in palliative. Drugs for subcutaneous administration in syringe drivers.
It is usually inappropriate to anticipate syringe driver doses routinely. Syringe drivers are often required to provide medicines for symptom management in patients who are. Three of the commonest syringe drivers in the west midlands region are 1,2. Starting setting up a syringe driver mckinley t34 if symptomatic give stat dose as syringe driver takes 2 4 hours from setting up to achieve effect. Subcutaneous drug infusion compatibility guidelines. A syringe driver is a small, portable, powerdriven device used to administer a continuous 24hour dose of medication. The device and the prescriptions for the driver can pose many problems. The syringe driver describes how syringe drivers allow for a single or mixture of compatible medications to be delivered by syringe rather than by infusion bag.
Symptoms tend to increase during the last days and weeks of life and pharmacological interventions are essential for adequate alleviation. Guidelines for syringe driver management in palliative care. Cyclizine dosage in syringe driver this article is for information only and should not be used for the diagnosis or treatment of medical conditions. This is because the niki t34 syringe driver simplifies administration by detecting the syringe size and volume of medicine, and sets the rate to deliver the infusion over the required time period, e. If the patient is in pain, vomiting or very agitated, give a stat sc injection of appropriate medication while setting up the syringe driver. The use of a subcutaneous or intravenous infusion using a syringe driver to deliver medications has certain advantages. A person with palliative care needs who has difficulties ingesting or digesting medications may receive them subcutaneously under the skin using a syringe driver.
Your medicines are put in a syringe, and the syringe driver pushes the medicines through a soft plastic tube and into your body. If compatibility is an issue, the use of two syringe driver devices3 or. Chapter 1 continuous subcutaneous infusions and syringe drivers. A syringe driver takes 3 4 hours to establish a steady state drug level in plasma. Authors andrew dickman and jennifer schneider produced a wellwritten, wellreferenced, and efficient treatment of the modern syringe driver for subcutaneous infusions as used in palliative care. Slide 1 sc administration of medications using a syringe. Guidelines for syringe driver management in palliative care in new zealand. Generally all of the drugs included in the section.
Syringe drivers are routinely used in palliative care for the subcutaneous infusion of drugs for pain and symptom control. Aug 07, 2019 cyclizine dosage in syringe driver this article is for information only and should not be used for the diagnosis or treatment of medical conditions. Over time, drug combinations used in a syringe driver are likely to change and the aim of this survey was to obtain a more recent snapshot of practice. The use of a syringe driver to administer drugs by continuous subcutaneous infusion is common practice in the uk. A syringe driver takes 34 hours to establish a steady state drug level in plasma. Common medicines are compatible with morphine and diamorphine, however cyclizine compatibility is concentration dependent. They can be used in hospital, in hospices and at home. A csci provides a safe and effective way of drug administration and can be used to maintain symptom control in patients who are no longer able to take oral medication.
You might be offered a syringe driver if you cannot take medicine by mouth for example, if youre being sick or have difficulty swallowing. Click here to view the syringe driver drug compatibility charts on the medicinescomplete platform. Syringe driver drug compatibilities guide to palliative. Page 4 of 24 84 administration of drugs via a syringe driver. Single drugs used in a subcutaneous infusion over 24 hours in palliative care tables 1a to 1f diluent. There is, however, little documented information regarding clinical practice. Continuous subcutaneous administration of medicines via. There have been several developments in this field since the third edition of this highly. Medicines are drawn up into a syringe that is then attached to the driver, which is set to move the plunger of the syringe forward at an accurately controlled rate. These include reactions at the infusion site, incompatibly of drugs and lack of understanding of the syringe driver. Points on mixing medications adapted from palliative care matters website. Incidence and causes for syringe driver site reactions in palliative.
Subcutaneous delivery of drugs using a syringe driver is common practice within specialist palliative care units. The syringe driver only regulates the delivery of the drugs and saves having multiple injections per day with a hypodermic needle it doesnt affect the effectiveness of the morphine. Syringe drivers continuous subcutaneous infusion marie curie. Clinical protocol for the use of syringe drivers in palliative care patients. When combining medications for syringe driver use, be aware there is data available from compatibility studies for only a few combinations.
The patient may require a dose of immediate release medication prior to commencement of the syringe driver, as medication from a syringe driver may take up to four hours to reach the desired blood level. The syringe driver and the subcutaneous route in palliative care. They designed this book as a valuable reference source, providing a. It is important to remember that a syringe driver is an alternative route for drug. A syringe driver, or pump, represents a simple and costeffective method of delivering a continuous subcutaneous infusion csci. Talk to your dads care team especially his gp if that is who is prescribing his drugs and talk about your concerns. Call the advice line if advice is needed at any time. The syringe driver pump is able to deliver a combination of medications and does so.
Symptom control with the syringe driver oxford medicine. Sometimes a small batteryoperated pump called a syringe driver is used to give medicine continuously under the skin for a period of time, such as 24 hours. The oral route should be used where possible, but as the patients condition deteriorates, it. There are many uses of syringe drivers, with the most common use being in palliative care for symptom control. Syringe driver drug compatibilities guide to palliative care. The use of syringe drivers or pumps to administer medication had been under general consideration within medicine for many years. Common symptoms experienced by patients at the end of life include pain, respiratory tract secretions, agitation, delirium, restlessness, nausea, and vomiting. Syringe drivers are recommended for use when it has been determined that the continuous. Whilst the preferred route of medication administration in paediatric palliative care is the oral one, there may be occasions when this is impractical or undesirable.
Registration with permits access to latest additions, news, bulletin board for both drug and nondrug issues, syringe driver survey drug compatibility database sdsd and document library. The syringe driver continuous subcutaneous infusions in palliative care 3rd ed. Some drugs can have side effects, such as making you feel drowsy or sick. Syringe pumps also known as syringe drivers are commonly used for people living with a terminal illness. The guidance above are well accepted drugs and doses used at the endoflife.
Guidelines for setting up and changing the mckinley t34 syringe driver for children receiving palliative care. Examples of good practice resource guide gold standards. Provide a range of doses, this will allow dose adjustment as required. The syringe driver is a small, portable batterydriver infusion pump, used to give medication subcutaneously via a syringe usually over 24 hours. When and how to use a syringe driver in palliative. Cyclizine is not compatible with hyoscine butylbromide or oxycodone in a syringe driver.
Dec 02, 2016 a syringe driver takes 3 4 hours to establish a steady state drug level in plasma. Drug compatibility in subcutaneous infusions chart in. Ensure breakthrough dose remains at 16th of syringe driver dose. Suitable drugs to prescribe for a syringe driver would be based on his current needs. Identification of drug combinations administered by continuous.
September 2018 page 4 of 31 palliative care department 2. The more drugs that are mixed together, the greater the risk of precipitation and reduced efficacy9. Commonly used drugs drug usual dose range indication clonazepam 16 mg24 hours agitation, confusion, seizures cyclizine 75150 mg24 hours. He obviously has trouble swallowing his morphine tablet and anti sickness tablet so as of 4 days ago he had a syringe driver fitted. Syringe drivers have been the mainstay of delivery and administration of drugs in palliative care for many years. A syringe driver is a small, portable, battery operated device that administers medicines subcutaneously over a selected time period, usually 24 hours. The pump holds a syringe containing medication and this is connected to the patient via a small needle and a line. A syringe driver or syringe pump is a small infusion pump some include infuse and withdraw capability, used to gradually administer small amounts of fluid with or without medication to a patient or for use in chemical and biomedical research applications. Continuous subcutaneous administration of medicines via the t34 syringe driver for adult palliative care patients. The syringe driver is a small, portable battery driver infusion pump, used to give medication subcutaneously via a syringe usually over 24 hours. Adverse effects the adverse effects of medicines are often used as a therapeutic goal or are a symptom of the. Syringe driver drug compatibilities practice guidelines 2011. Diazepam, chlorpromazine and prochlorperazine are too. My dad was diagnosed with terminal oesophageal cancer with secondary mets in his lungs and liver on 23rd december.
The syringe driver drug compatibility charts, available in the palliative care formulary, summarize both the compatibility data submitted to the sdsd and that from published compatibility references. Welcome to the syringe driver survey database sdsd the sdsd is a database of the visual appearance of drug combinations reported in prospective international multicentre surveys and also from individual reporting. Definitions drugs which can be administered subcutaneously. Any patient receiving medication via a syringe driver check volume of fluid remaining.
Continuous subcutaneous administration of medicines via the. Provide enough for at least 3 4 prn as needed doses per day as well as for csci syringe driver prescribe on fp10 to obtain medicines and on syringe driver and prn as needed charts. They are a safe and effective way to give medicines for symptoms such as pain, nausea and vomiting, seizures, agitation and. Guidelines for clinical management and symptom control 2014 pages 150151 4.
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