Patients who received medications via a syringe driver at least once during end of life care, between drug compatibility in syringe and dec were included. There is no direction of exact amounts because that will depend on what drugs the resident is already on. Controlled drugs that are no longer required for a patient can be returned to the. Part one our educational video, looking at the best way of setting up a syringe driver in the community. The use of a subcutaneous or intravenous infusion using a syringe driver to deliver medications has certain advantages. Some drugs can have side effects, such as making you feel drowsy or sick. Dont confuse palliative sedation with euthanasia, which implies the purposeful ending of a patients life. Syringe pumps also known as syringe drivers are commonly used for people living with a terminal illness. Use the current local protocols for setting up and monitoring the syringe pump you are using. Administering anticipatory medications in endoflife care. Managing pain and other symptoms end of life care nhs. Only access to the palliative care formulary is moving over to the medicinescomplete platform. The lockable, battery operated, niki t34 syringe driver is the current device available in new zealand for the continuous subcutaneous administration of medicines in a community setting.
This identified relevant websites relating to syringe driver management. Guidance on prescribing anticipatory drugs and syringe drivers in the community prescribing anticipatory drugs anticipatory drugs in a palliative setting are those drugs that are prescribed for use on an as required basis to manage common symptoms that can occur at the end of life. This video is designed to be used by medical professionals only. 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. Safe practice in syringe pump management nursing times. 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. The recent gosport war memorial hospital inquiry 1 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. Patients at the end of life often experience new or. April 2017 introduction palliative care patients often exhibit multiple symptoms that require the use of numerous drugs. Cyclizine is not compatible with hyoscine butylbromide or oxycodone in a syringe driver. Please be aware that mckinley t34 syringe drivers will be used within these sessions. To family at the bedside, it may seem like the drug caused or contributed to the death, especially if death occurs within a few minutes. The guidance above are well accepted drugs and doses used at the endoflife.
You might be offered a syringe driver if you cannot take medicine by mouth. They deliver continuous medication over extended periods of time. They are used primarily when patients are no longer able to take medicines by mouth. Suitable drugs to prescribe for a syringe driver would be. Managing symptoms, including pain, is an important part of end of life care. Advice on end of life medication is available from the nursing and medical. T34 syringe driver instruction video for oxfordshire youtube. For carers, friends and families of people with a terminal diagnosis to discuss their emotions about the prospect of losing their loved ones, as well as practical issues about palliative care and end of life. When and how to use a syringe driver in palliative. Administer in separate syringe pump, incompatible with most drugs. In gosport, excessive doses of opioids, usually diamorphine, were given to.
Diazepam, chlorpromazine and prochlorperazine are too. The pump holds a syringe containing medication and this is connected to the patient via a small needle and a line. Fentanyl and alfentanil can be mixed with all the common drugs in a syringe driver, though care should be taken with alfentanil and cyclizine as it. Cyclizine is the drug which seems to precipitate most commonly in the syringe driver and causes problems with poor absorption and site reactions. A syringe driver takes 34 hours to establish a steady state drug level in plasma. Syringe drivers are often used at the end of life because they are the easiest way to give someone the medicines they need to feel comfortable at that time. Update end of life register, out of hours gp and district nurse service about present clinical situation, medications prescribed and possible problems that may occur. Anticipatory endoflife care medication for the symptoms. 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. The syringe driver pump is able to deliver a combination of medications and does so.
The syringe driver is used to administer a continuous subcutaneous sc infusion of drugs from a syringe e. As it is likely that he will need a syringe driver in the near future, and you can anticipate his likely needs, you should consider prescribing drugs needed for a syringe driver, as well as prn drugs for endoflife care targeted anticipatory prescribing. The graseby syringe driver has been gradually phased out of use as it was not tamperproof. If the patient is in pain, vomiting or very agitated, give a stat sc injection of appropriate medication while setting up the syringe driver. They are written by uk doctors and based on research evidence, uk and european guidelines. Conversion of oral opioids to parenteral opioids is overleaf. 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. Pdf the benefits and drawbacks of syringe drivers in. Guidelines for syringe driver management in palliative care. The process of dying in the frail older population is not thought to be painful worcester, 1940. These guidelines are written for the use of health care professionals in the oxford radcliffe nhs trust and. Syringe driver guidelines are available on the trust website. 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. 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.
Based on my mums end of life care and my wifes experience after a major operation, that sounds like the morphine kicking in more than anything. Syringe drivers are medical devices that are critical for end of life care. Setting up a syringe driver in the community part 1 youtube. When a patient is receiving regular pain medication such as morphine in the final hours or days of life, there is always a last dose. Prescribing for end of life care dr andrew williams associate specialist in palliative medicine 3rd october 2012. 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. Call the advice line if advice is needed at any time. Its common to feel nervous about having a syringe driver but most people find that they are very helpful for managing symptoms and give a feeling of reassurance. End of life journal, 20, vol 3, no 3 page 2 of 6 2010.
Administration of endoflife drugs by family caregivers. Claire britton, specialist nurse practitioner from sobell houses community team, demonstrates how to set up the t34 syringe driver. When the oral route is no longer appropriate, a syringe driver can be used to ensure continued symptom control. Syringe drivers continuous subcutaneous infusion marie curie. Management of pain in the elderly at the end of life. Advice on end of life medication is available from the nursing and medical team at st nicholas hospice care telephone 01284 7663. Many drugs used in palliative care especially drug combinations in syringe driver. This article explains how to administer drugs safely using these devices. You might have a syringe driver for medicines to help manage pain, sickness, fits, agitation or breathing problems.
There are several opioid drugs that palliative care physicians most commonly prescribe for moderate to severe pain in the context of a serious, lifethreatening illness. To this end, he designed his syringe driver to run in millimeters over time, not milliliters, as did the large devices. A syringe driver is set up to manage symptoms and can be used at any. If more than 3 drugs are needed in a syringe driver, discuss the situation with your palliative care team. This meant that it could be used to dispense the contents of any syringe that fitted on to it. A syringe driver is a small battery operated pump designed to deliver medication sub cutaneously just under the skin over a 24 hour period. Prescribing for end of life care oxleas nhs foundation trust. Leave syringes and needles in the house for prn injections and store these with drugs in just in case boxsyringe driver box. Subcutaneous sc drug infusion by portable syringe driver has had a significant.
The syringe driver is a simple and costeffective method of delivering a continuous subcutaneous infusion csci. Prescriptions may need to include drug formulations that family caregivers can administer buccally, sublingually, or rectally, in addition to the subcutaneous injection route, as these are easier for nonprofessionals. Wright wanted his device to be as simple and easy to use as possible, with a high degree of flexibility. Pages 25 are for syringe driver, transdermal and oral medications. Only use drugs that are known to be effective via the sc route. Drugs for subcutaneous administration in syringe drivers. Patients who received medications via a syringe driver at least once during end of life care, between jan 2011 and dec 20 were included. You might have been given a syringe driver, to help control pain. They are a safe and effective way to give medicines for symptoms such as pain, nausea and vomiting, seizures, agitation and respiratory secretions. The doctors decided to open his just in case box and start. Many drugs used in palliative care especially drug combinations in syringe driver are used outside of the product licence or datasheet recommendations. The drugs prescribed for syringe driver need to be carefully chosen to be the right ones, in the right dose for the symptoms that the patient is experiencing, as already described.
Commonly used drugs drug usual dose range indication clonazepam 16 mg24 hours agitation, confusion, seizures cyclizine 75150 mg24 hours. Their design contributes to the quality of experience. 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. Mukoreka j, sisay i 2015 safe practice in syringe pump management. The person declines because of the illness with or without the morphine. The tables in this guideline contain information about preparations, dose ranges, diluents and indications for single drugs that can be given by subcutaneous infusion for symptom control in palliative and end of.
Painrelieving drugs are available at home and in hospitals, hospices and care homes. Clinical protocol for the use of syringe drivers in. 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 literature was rated for its level of evidence using the joanna briggs. Professional reference articles are designed for health professionals to use. This is particularly important for patients receiving palliative care, for whom a continuous infusion of medication can improve symptom control.
Many drugs used in palliative care especially drug combinations in syringe driver are used outside. Diamorphine was the main lifeshortening opioid drug given to patients, often in a syringedriver, which was attached to the patients back and ensured a constant dosage. A person may be unable to take medication orally because of dysphagia difficulty. Prescribing anticipatory drugs nhs north kirklees ccg. Diluents and volumes used were more difficult to ascertain and respective community nursing teams and hospices were contacted to retrieve this data. You may find the end of life care article more useful, or one of our other health articles. Syringe drivers are small portable usually battery operated devices used in palliative care. A syringe pump is a small, batterypowered pump that delivers medication subcutaneously. When and how to use a syringe driver in palliative care. They can be used in hospital, in hospices and at home. Syringe drivers are often required to provide medicines for symptom. For older people at endoflife, syringe drivers can be effective in managing common symptoms.