A syringe driver is a small, portable, battery operated device that administers medicines subcutaneously over a selected time period, usually 24 hours. Choice of diluent The choice of diluent for the infusion solution varies according to local guidelines as there is evidence for and against the two most commonly used diluents – sterile water water for injection and normal saline NaCl 0. Lung cancer in New Zealand News and updates: Specialist palliative care is available in most areas as day hospice care, home-care teams often known as Macmillan teams , in-patient hospice care, and hospital teams. Gastric distension pain due to pressure on the stomach may be helped by a preparation incorporating an antacid with an antiflatulent and a prokinetic such as domperidone before meals. Make the solution as dilute as possible – use a larger syringe When possible, select a solution that is close to physiological tonicity – sterile water is hypotonic, normal saline is isotonic, and solutions with high concentrations of some medicines become hypertonic Use plastic cannulae as they cause less site irritation than metal cannulae In a patient who has been prone to site problems, consider rotation of the site of infusion before any localised reactions develop Avoid oedematous areas when selecting the site for infusion Use 0.
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It should be prevented if possible by the regular administration of laxatives; syrknge faecal softener with a peristaltic stimulant e. Conversion ratios vary and these figures are a guide only. Ceftriaxone; Prostate cancer; Glandular fever. Gastro-intestinal pain The pain of bowel colic may be reduced by loperamide hydrochloride.
Formulations of fentanyl that are administered nasally, buccally or sublingually are also licensed for breakthrough pain.
Pain control Diamorphine hydrochloride is the preferred opioid since its high solubility permits a large dose to be given in a small volume see under Mixing and Compatibility, below. Bowel colic and excessive respiratory secretions Bowel colic and excessive respiratory secretions may be reduced by a subcutaneous injection of hyoscine hydrobromidehyoscine butylbromideor glycopyrronium bromide.
Similar documentation is recommended for patients who are receiving care at home. Methadone hydrochloride linctus should be avoided because it has a long duration of action and tends to accumulate.
Prescribing in palliative care | Medicines guidance | BNF content published by NICE
In a palliative care setting, subcutaneous administration of medicines given via a syringe driver is useful for managing symptoms such as pain, nausea, anxiety and restlessness. If the patient’s symptoms remain uncontrolled despite an increase in dose, consider an alternative medicine e.
If more than two medicines are to be mixed in an infusion, refer to The Palliative Care Handbook or contact your local hospice for commonly used combinations and additional compatibility information. Convulsions Patients with cerebral tumours or uraemia may be susceptible to convulsions. Pain management with opioids Oral route Treatment with morphine is given by mouth as immediate-release or modified-release preparations. Levomepromazine has a sedative effect.
An additional dose should also be given 30 minutes before an activity that causes pain, such as wound dressing. Login to my bpac. These antimuscarinics are generally given every 4 hours when required, but hourly use is occasionally necessary, particularly in excessive respiratory secretions. Dexamethasone by mouth can be used as an adjunct. Check the compatibilities of the medicines in the syringe using the chart in The Palliative Care Handbook or Table 2 and decide on the volume to infuse, stating the diluents.
Medicine requirements must be anticipated for a 24 hour period and can result in a loss of flexibility in dosing Medicines given by other routes including “as needed” subcutaneous injections may be required to manage the patients symptoms for the initial four hours of the syringe driver infusion while the medicines reach a plasma concentration that provides effective symptom control An increase in the patients symptoms may require additional injections for relief Local reactions such as pain, inflammation or infection can cause discomfort and interfere with the delivery and absorption of the medicines Patients may see the use of a syringe driver as a final step before death and find its use disconcerting and obtrusive The patients symptoms and effectiveness of the infusion must still be reassessed regularly.
Patients with cerebral tumours or uraemia may be susceptible to convulsions. Bowel colic and excessive respiratory secretions may be reduced by a subcutaneous injection of hyoscine hydrobromidehyoscine butylbromideor glycopyrronium bromide. If these preparations do not control the pain then morphine is the most useful opioid analgesic. Patients with advanced cancer may not sleep because of discomfort, cramps, night sweats, joint stiffness, or fear. Follow us on facebook.
Physical incompatibility usually results in changes in the solution that can be observed such as discolouration, clouding or precipitation of crystals or particles. Ideally, the cause should be determined before treatment with an antiemetic is started. Nausea and vomiting are common in patients with advanced cancer. Hyoscine butylbromide is used for bowel colic and for excessive respiratory secretions, and is less sedative than hyoscine hydrobromide.
The patient should ideally be reviewed every day so that medicine doses can be adjusted according to their needs. Headache due to raised intracranial pressure often responds to a high dose of a corticosteroid, such as dexamethasone and should be given before 6 p.
Home Medicines guidance Prescribing in palliative care.
When and how to use a syringe driver in palliative care
When oral medication is no longer possible, diazepam given rectally, or phenobarbital by injection is continued as prophylaxis. These include the site selected, the type of cannulae used and the medicine being given.
An antiemetic is usually necessary only for the first 4 or 5 days and therefore combined preparations containing an opioid with an antiemetic are not recommended because they lead to unnecessary antiemetic therapy and associated side-effects when used long-term.
Restlessness and confusion Restlessness and confusion may require treatment with an antipsychotic, e.