Syringe driver in palliative care

The recent gosport war memorial hospital inquiry1 has increased uk patient, public and clinician awareness about syringe drivers for continuous subcutaneous delivery of opioids and other medications at the end of life. Graham f, clark d 2005 the syringe driver and the subcutaneous route in palliative care. When and how to use a syringe driver in palliative care. State the rationale for use of a syringe driver in palliative care. Andrew dickman and jennifer schneider have produced a wellwritten, wellreferenced, and efficient treatment of the modern syringe driver for subcutaneous infusions as used in palliative care.

A single drug, or more often a combination of drugs is given via a slow subcutaneous infusion to help control symptoms when other routes of administration are no longer viable, feasible or preferred. The bulletin board, document library, news, surveys and the syringe driver survey database sdsd will continue to be available at the site contains a link to the palliative care formulary on the medicinescomplete platform. This revised edition of the the guidelines for subcutaneous infusion device management in palliative care takes account of the october 2007 withdrawal from sale in australia of the graseby syringe driver, a subcutaneous infusion device that was the major focus of the first edition. The syringe driver and the subcutaneous route in palliative care. Much of the material from the old palliative medicine handbook is still available on this site, with the main guidelines section updated with. Use the current local protocols for setting up and monitoring the syringe pump you are using. Prescribing in palliative care overview palliative care is an approach that improves the quality of life of patients and their families facing lifethreatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial, and. 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. See also syringe driver compatibility chart if commencing a subcutaneous infusion intravenous or subcutaneous fentanyl may occasionally be used under supervision of the. Guidelines for syringe driver management in palliative.

My dad had a syringe driver put in because we couldnt keep his pain under control and he was starting to struggle taking all the tablets he was on. Syringe drivers caresearch, palliative care knowledge. When and how to use a syringe driver in palliative care bpac. The general principle that injections should be given into separate sites and should not be mixed does not apply to the use of syringe drivers in palliative care. In community palliative care, a syringe driver is usually managed by a palliative care or nursing service. The syringe driver is a simple and costeffective method of delivering a continuous subcutaneous infusion csci. Importantly and distinctively, the authors combined laboratory data with clinical observations to produce both a useable and practical text. A syringe driver takes 34 hours to establish a steady state drug level in plasma. Users need to register on first use, but the registration process is kept very simple. Registration allows users to save bookmarks and favourites, and to keep.

Syringe drivers continuous subcutaneous infusion marie curie. The syringe driver pump is able to deliver a combination of medications and does so. Guidelines for syringe driver management in palliative care in new. Kain project officer, centre for palliative care research and education professor patsy yates acting director, centre for palliative care research and education. Document listing medication combinations available for prescription via syringe driver for patients receiving palliative care in southern derbyshire if you are working outside this area you may refer to other guidance regarding drug compatibilities in syringe drivers. Incidence and causes for syringe driver site reactions in palliative.

Two syringe pumps may be required for doses above 2gday or the use of a 50ml syringe. The patient has new severe pain or pain that has persisted after 24 hours on a syringe driver. The display resizes so it is usable on a small screen i. You might have been given a syringe driver, to help control pain, sickness, agitation or fits. Although the device itself has not been adopted universally, it has stimulated interest in the use of csci in palliative care and played a significant role in the modern history of this approach. Since the early 1980s, the syringe driver has become a commonly used technology in british palliative care, used to administer continuous subcutaneous infusions csci for symptom management. Specialist palliative care inpatient facility in the uk. Guidelines for subcutaneous infusion device management in. Safe practice in syringe pump management nursing times. District health boards of new zealand dhbnz has recommended the ad ambulatory syringe.

A syringe driver is a small portable battery operated pump that administers drugs subcutaneously by continuous infusion. Syringe driver recording forms were retrieved from case notes of consecutive patients who received medication via a. Subcutaneous infusion devices syringe drivers are commonly used to give comfort in palliative care to treat distressing symptoms when other. Since the early 1980s, the syringe driver has become a commonly used technology in british palliative care, used to administer continuous subcutaneous. 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. 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. If the patient is in pain, vomiting or very agitated, give a stat sc injection of. Incidence and causes for syringe driver site reactions in. I think its very hard to say what will happen, but i had been warned by a friend that once her mum had a syringe driver she.

There have been several developments in this field since the third edition of this highly successful book. Its sometimes called a continuous subcutaneous infusion. A syringe driver, or pump, represents a simple and costeffective method of delivering a continuous subcutaneous infusion csci. Managing pain and other symptoms end of life care nhs. Maximal dilution with wfi is recommended in order to preserve the infusion site. If you have symptoms of cancer you should still contact your doctor and go to any appointments you have. A syringe driver helps reduce symptoms by delivering a steady flow of injected medication continuously under the skin. Provided that there is evidence of compatibility, selected injections can be mixed in syringe drivers. The needle, or soft plastic cannula, is usually placed in the upper arm, leg or abdomen. Association for palliative medicine position on the double effect, 2009. A syringe driver is useful when the oral route of administration is not possible and repeated subcutaneous doses are inappropriate, ineffective or impractical. Morgan s, evans n 2004 a small observational study of.

Clinical protocol for the use of syringe drivers in palliative care patients. In situations where the patient has not previously received levetiracetam there is limited. Syringe drivers are indicated when other routes become inappropriate or difficult. On completion of this syringe driver competency package and workshop participants will be able to. A syringe driver is useful when the oral route of administration is not possible and repeated subcutaneous doses are. The syringe driver in palliative care is a small, portable, battery powered infusion device that is suitable for patient use in the hospital and at home. Also check local guidelines as to the appropriate use of syringe drivers. Syringe driver drug compatibilities guide to palliative care practice 2016 sodium chloride 0. This was later extended to patients requiring palliative care. 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. Guidelines for syringe driver management in palliative care. Except in the case of poor absorption, pain which is. For advice and support, contact nurse maude hospice palliative care service, phone 03 3754274. Syringe drivers also known as pumps care and support.

Syringe pumps for palliative care are programmed to deliver the medicines over a 24hour period, so a new syringe of medicines is usually set up once per day. 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. Continuous subcutaneous administration of medicines using a syringe driver often becomes necessary for the control of symptoms during palliative care. This guide is intended for use by healthcare professionals and the expectation is that they will use clinical judgement, medical, and nursing knowledge in applying the general principles and recommendations contained within. Queensland health management of subcutaneous infusions in palliative care learning package the aim of this learning package is to assist the clinician to develop knowledge and skills of the basic principles of care for people with subcutaneous infusion devices in palliative care settings. Syringe pumps will be set up by a specialist nurse, district nurse or gp. Prescribing in palliative care medicines guidance bnfc. This website hosts the pang palliative care guidelines developed by a collaboration of uk health organisations. There have been several developments in this field since the third edition of this highly. It is not something that is used by every patient in palliative care, but it can be very useful. Its been developed for patients and their families, but may also be useful for health and social care professionals. A syringe driver can be used at home and maintained over extended periods.

The use of syringe drivers, particularly in the last days of life, has made a significant contribution to ensuring patient comfort in palliative care mitten 2001. Pdf the benefits and drawbacks of syringe drivers in. Note that it is important to seek expert advice before initiating a syringe driver. They are not meant to replace the many available texts on the subject of palliative care. Compatibility of syringe driver admixtures for continuous subcutaneous infusion, pharmacy department auckland hospital. Only access to the palliative care formulary is moving over to the medicinescomplete platform. 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 syringe driver advisory group was set up by the new zealand palliative care working party in december 2007 to facilitate a smooth and safe transition to an approved alternative device. Commencing a syringe driver marks a more significant change in patient care. The use of a subcutaneous or intravenous infusion using a syringe driver to deliver medications has certain advantages.

Syringe driver drug compatibilities guide to palliative. Local palliative care guidelines should always be followed when mixing drugs in a syringe driver. Prescribing in palliative care medicines guidance bnf. Explain management and safety principles when caring for patients with these devices. Educate the patient and family about the use of a syringe driver. Syringe drivers are routinely used in palliative care for the subcutaneous infusion of drugs for. Prospective quantitative data collection of syringe driver use for 170 hospice inpatients. The pump holds a syringe containing medication and this is connected to the patient via a small needle and a line. Guidelines for syringe driver management in palliative care developed by. Syringe drivers are often required to provide medicines for symptom management in patients who are terminally ill. Suitable patients may be identified at regular palliative care meetings in the gp practice, or by the specialist palliative care teams. Talk to your dads care team especially his gp if that is who is prescribing his drugs. A syringe driver is a small battery operated pump designed to deliver medication sub cutaneously just under the skin over a 24 hour period.