State the rationale for use of a syringe driver in palliative care. Syringe driver drug compatibilities guide to palliative care practice 2016 sodium chloride 0. Graseby may be used during the covid19 response, however nonsyringe driver alternatives may be preferable to using unfamiliar equipment. Syringe pumps are used as part of palliative care to administer medicines subcutaneously to patients who are unable to manage or tolerate oral. Syringe driver check list and community subcutaneous medications record sheet community or syringe driver observation chart hospicehospital practice points t34 syringe drivers are calibrated in mls per hour the standard delivery period for a continuous subcutaneous infusion in palliative care is 24 hours. Health care professionals should consider a syringe driver as a means of providing symptom control via subcutaneous infusion of drugs to treat unrelieved pain.
Syringe drivers also known as pumps care and support. 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. Procedure for the use of mckinley t34 syringe driver to deliver a continuous subcutaneous infusion in palliative care for adults page 4 of 41 contents page section title page number 1. The patient has new severe pain or pain that has persisted after 24 hours on a syringe driver. 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. If the patient is in pain, vomiting or very agitated, give a stat sc injection of. Palliative care patients often exhibit multiple symptoms that require the use of numerous drugs. If the patient is in pain, vomiting or very agitated, give a stat sc injection of appropriate medication while setting up the syringe driver. A syringe driver takes 34 hours to establish a steady state drug level in plasma. The subcutaneous route, in particular, continuous subcutaneous infusion csci, is a commonly used symptom management technique in.
Educate the patient and family about the use of a syringe driver. Guidelines for subcutaneous infusion device management in. Graham f, clark d 2005 the syringe driver and the subcutaneous route in palliative care. Obtaining the drugs for the palliative care patientseamless care at the hospitalhospicecommunity interface. 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 pump holds a syringe containing medication and this is connected to the patient via a small needle and a line. Sonia chand, mrpharms, is a palliative care pharmacist and teacher practitioner at walsall healthcare nhs trust and the university of. You might have been given a syringe driver, to help control pain. This was later extended to patients requiring palliative care. The use of medicinal products offlabel or unlicensed medication is widely accepted practice within palliative care.
Analgesics can be divided into three broad classes. The guidelines are intended for health care practitioners in hospitals, hospices, aged care settings and the community. Continuous subcutaneous infusion in palliative care. You might have been given a syringe driver, to help control pain, sickness, agitation or fits. Its sometimes called a continuous subcutaneous infusion. The syringe driver and the subcutaneous route in palliative care. Developing guidelines for syringe driver management. The use of a subcutaneous or intravenous infusion using a syringe driver to deliver medications has certain advantages. This is the case regardless of whether they are going home, to a residential care facility to a rural hospital or to hospice. A syringe driver is useful when the oral route of administration is not possible and repeated subcutaneous doses are inappropriate, ineffective or impractical. 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.
Anticipatory prescribing in palliative care just in case prescribing when to prescribe a jic 1. It does not replace adequate assessment and individual. The syringe driver pump is able to deliver a combination of medications and does so. Syringe drivers are small portable usually battery operated devices used in palliative care. This guideline refers to the use of drugs in syringe drivers for palliative care only. Continuous subcutaneous administration of medicines using a syringe driver often becomes necessary for the control of symptoms during palliative care. The syringe driver in palliative care is a small, portable, battery powered. The subcutaneous administration of medications using a syringe driver is a common and accepted practice in palliative care for assisting with the management of. This website hosts the pang palliative care guidelines developed by a collaboration of uk health organisations. Use of the syringe driver for continuous infusion in palliative care.
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. Patient is not currently requiring regular injectable management of symptoms. When and how to use a syringe driver in palliative care. 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. Patients must be using a niki t34 syringe driver when discharging from hospital. If you are on a public computer, please uncheck this box. A syringe driver is a small battery operated pump designed to deliver medication sub cutaneously just under the skin over a 24 hour period. Specific to the use of syringe drivers in palliative care, one set of australian guidelines 2010 was found with a related learning module 2014. Pain management in palliative care is focused on achieving control of pain by administering the right drug in the right dose at the right time. An appropriate medication authority is required see below. Syringe pumps will be set up by a specialist nurse, district nurse or gp. The guidelines cover the management of particular symptoms and situations which palliative care patients may experience, as well as end of life care for patients with an advanced. If a patient has a palliative diagnosis, but not yet entered the care decisions for the last days of life pathway. Incidence and causes for syringe driver site reactions in.
Scottish palliative care guidelines alternatives to. When the oral route is no longer appropriate, a syringe driver can be used to ensure continued symptom control. If using levomepromazine in a syringe driver, the syringe should be shielded from sunlight. Guidelines for syringe driver management in palliative care developed by. 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. Use of t34 syringe driver hospital palliative care service.
For older people at endoflife, syringe drivers can be effective in managing common symptoms such. Syringe driver recording forms were retrieved from case notes of consecutive patients who received medication via a. Your choice will be saved in a cookie on this computer. The use of syringe drivers in palliative care request pdf. Pdf the benefits and drawbacks of syringe drivers in. This study has provided insights about the use of a syringe driver to relieve symptoms in palliative care from direct conversations with 27 people 12 patientfamily caregiver couples and 3 caregivers experiencing palliative care as a patient or as a family caregivers. A syringe driver is useful when the oral route of administration is not possible and repeated subcutaneous doses are. Much of the material from the old palliative medicine handbook is. 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. A key team member use of drugs beyond licence medication compliance aids use of the syringe driver. Syringe drivers are often required to provide medicines for symptom management in patients who are terminally ill. Drugs for subcutaneous administration in syringe drivers. 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.
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. Incidence and causes for syringe driver site reactions in palliative. Syringe drivers continuous subcutaneous infusion marie curie. Prescribing in palliative care medicines guidance bnfc. Prospective quantitative data collection of syringe driver use for 170 hospice inpatients. Guidelines for syringe driver management in palliative care in new.
Syringe drivers caresearch, palliative care knowledge. Safe practice in syringe pump management nursing times. There have been several developments in this field since the third edition of this highly. Oliver dj the use of the syringe driver in terminal care. 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. The development of these practice guidelines provides an example of how palliative care practitioners can use a framework of contemporary evidence to enhance clinical practice. Local palliative care guidelines should always be followed when mixing drugs in a syringe driver. 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. During office hours contact pharmacy or the palliative care team for advice. Explain management and safety principles when caring for patients with these devices.
Palliative care are advised to consult the palliative care formulary 6th edition pcf6 and local specialist guidelines for more detailed symptom management information. On completion of this syringe driver competency package and workshop participants will be able to. These guidelines are intended to provide clinicians and palliative care services with guidelines to inform practice, the development of policy and procedures, and associated training and education programs in relation to portable subcutaneous infusion device syringe driver management. Guidelines for syringe driver management in palliative care. Specialist palliative care inpatient facility in the uk. Kain project officer, centre for palliative care research and education professor patsy yates acting director, centre for palliative care research and education. Morgan s, evans n 2004 a small observational study of the longevity of syringe driver sites in palliative care. Prescribing in palliative care medicines guidance bnf. Syringe driver drug compatibilities guide to palliative. The guidelines aim to standardise information about syringe driver management in palliative care, promote safe practice, avoid unnecessary duplication of information, and support both generalist and specialist providers of palliative care. A syringe driver, or pump, represents a simple and costeffective method of delivering a continuous subcutaneous infusion csci. The syringe driver and medicines management in palliative care.
When and how to use a syringe driver in palliative care bpac. Guidelines for syringe driver management in palliative. Syringe drivers are routinely used in palliative care for the subcutaneous infusion of drugs for pain and symptom control. Morgan s, evans n 2004 a small observational study of. A syringe driver helps reduce symptoms by delivering a steady flow of injected medication continuously under the skin. Clinical protocol for the use of syringe drivers in palliative care patients.