If possible, doses should be given through a side port in the syringe driver cannula line to minimise patient distress. Syringe drivers can be used either short-term or long-term, for patients who are ambulatory and those who are confined to bed. When more than one medicine is used in an infusion solution there is a risk that they may not be compatible, either chemically or physically. Infusions for administration via continuous subcutaneous infusion using a syringe driver should be prescribed to run over 24 hours, although medicines mixed together may be pharmaceutically compatible and stable for longer than this. Many patients will also be under the care of a palliative care physician.
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Some of the practical issues that may need to be addressed include: If problems arise with an infusion site the patient may have localised discomfort, or there may be reduced absorption of the medicine and a loss of symptom control. Overview Palliative care is an approach that improves the quality of life of patients and their families facing life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of converzion and other problems, physical, psychosocial, and spiritual.
If breakthrough pain occurs give a subcutaneous preferable or intramuscular injection equivalent to one-tenth to one-sixth of the total hour subcutaneous infusion dose. Benzodiazepines, such as temazepammay be useful.
Antiemetic therapy should be reviewed every 24 hours; it may be necessary to substitute the antiemetic or to add another one. Restlessness and confusion may require treatment with an antipsychotic, e.
BPJ When and how to use a syringe driver in palliative care
The infusion is discontinued when the first oral dose of morphine is given. Managing breakthrough symptoms First check that the medicines are being delivered effectively via the syringe driver. A prokinetic antiemetic may be a preferred choice for first-line therapy. Glycopyrronium bromide may also be used to treat bowel colic or excessive respiratory secretions. Register or Log in to take part in quizzes.
Review pain management if rescue analgesic is required frequently twice daily or more. Oxycodone hydrochloride immediate-release preparations can be given for breakthrough pain.
Nausea and vomiting Haloperidol and levomepromazine can both be given as a subcutaneous infusion but sedation can limit the dose of levomepromazine. Midazolam is a sedative and an antiepileptic that may be used in addition to an antipsychotic drug in syrnge very restless patient. Guidelines for health professionals in the community on the use of syringe drivers for adults in palliative care.
Although drugs can usually be administered by mouth syringge control the symptoms of advanced cancer, the parenteral route may sometimes be necessary. The general principle that injections should morphjne given into separate sites and should not be mixed does not apply to the use of syringe drivers in palliative care. Doses can be prescribed in a flexible manner to achieve good symptom control, e.
Formulations of transdermal patches are available as hourly, hourly and 7-day patches, for further information see buprenorphine. The equivalent subcutaneous dose of diamorphine hydrochloride is about one-third of the oral dose of morphine.
Prescribing in palliative care | Medicines guidance | BNF content published by NICE
Hiccup Hiccup due to gastric distension may be helped by a preparation incorporating an antacid with an antiflatulent. Analgesics can be divided into three broad classes: Also consider other methods to relieve a patient’s distress – sometimes taking the time to sit and listen can be as effective as administering a medicine. Usual starting doses for subcutaneous infusion for commonly used medicines are: The preferred sites for insertion of the cannula for a continuous subcutaneous infusion are:.
Not all types of medication can be used in a subcutaneous infusion. The palliative care handbook. Injectable forms of medicines to control symptoms can be given alone, or mixed together in a syringe depending on their physical and chemical compatibility and the diluents used see below.
When and how to use a syringe driver in palliative care
The risk of precipitation can be minimised by using sterile water as the diluent and by maximising the total converrsion of the solution in the syringe, i. A syringe driver simply provides an alternative route for the administration of medicines. Conversion ratios vary and these figures are a guide only.
Diamorphine hydrochloride is sometimes preferred, because being more soluble, it can be given in a smaller volume.
Increasing the number of medicines in the solution increases the risk of problems with the combinations.