Pdf the benefits and drawbacks of syringe drivers in. Guidelines for syringe driver management in palliative care developed by. Morphine, diamorphine and oxycodone combinations in. Subcutaneous levetiracetam keppra in palliative and. Consult a medical practitioner or palliative care specialist for support and advice regarding doses and the compatibility of medications. If compatibility is an issue, the use of two syringe driver devices3 or. The syringe driver is a simple and costeffective method of delivering a continuous subcutaneous infusion csci. Palliative care matters pang guidelines, paediatric guidelines, journal articles, events, news and books m. If difficulties are experienced drawing up a syringe, contact your palliative care team. Syringe driver drug compatibilities guide to palliative care. Guidelines for syringe driver management in palliative care. Its use stimulated research into the effectiveness, safety, and compatibility of.
After loading a syringe, the driver depresses the plunger at a set rate for continuous, steady delivery. At the time the database was locked, 1,945 combinations had been recorded 2,2 samples were collected, but 186 were excluded due to erroneous entry, with 278 discrete combinations of drugs being identified. Guidelines for clinical management and symptom control 2014 pages 150. Palliative care matters welcome to palliative care matters. It is not something that is used by every patient in palliative care, but it can be very useful. Specialist palliative care involvement is essential. If you are on a public computer, please uncheck this box. The use of alfentanil in a syringe driver in palliative. In palliative care it is hugely important to be open to, and to consider, future health problems and. 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.
What we know syringe drivers are small portable usually batteryoperated devices used to administer medication in palliative care. The use of a subcutaneous or intravenous infusion using a syringe driver to deliver medications has certain advantages. 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. Limited evidence of compatibilitydiscuss with palliative care team. Preparations keppra 100 mgml concentrate for solution for infusion. Eastern metropolitan region palliative care consortium syringe driver drug. When combining medications for syringe driver use, be aware there is data available from compatibility studies for only a few combinations.
Caution should be used when combining drugs in syringe. The site contains a link to the palliative care formulary on the medicinescomplete platform. In palliative care, when a patient can tolerate neither oral nor parenteral administration of medicationsparticularly while on. Continuous subcutaneous infusions in palliative care. Initiating use of a syringe driver in a patient during palliative care may represent a significant and unwelcome milestone for the patient and their familywhanau, because syringe drivers are often required when a patient is close to death. The compatibility tables contain information for a subcutaneous infusion using a cme t34 syringe pump or a nonambulatory pump containing. Compatibility of medicines for syringe driver infusions commonly prescribed in general practice adapted from palliative care handbook 2012. The syringe driver and the subcutaneous route in palliative. Nov 15, 2016 the syringe driver is a simple and costeffective method of delivering a continuous subcutaneous infusion csci. A syringe pump also referred to as a syringe driver is used to deliver a. The use of alfentanil in a syringe driver in palliative medicine. Syringe driver compatibility chart hospital palliative care. A syringe driver is useful when the oral route of administration is not possible and repeated subcutaneous doses are.
Syringe driver drug compatibilities guide to palliative care practice 2016 sodium chloride 0. Some acute areas will use nonambulatory pumps, for example alaris pump. 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 benefits and drawbacks of syringe drivers in palliative care. However, there is wide experience of their use in palliative care. The syringe driver and the subcutaneous route in palliative care. Syringe driver drug compatibilities the eastern metropolitan palliative care consortium has produced a guide to practice on syringe driver compatibilities.
Syringe drivers and drug compatibility chart 29 key resources twycross r, wilcock a, howard p eds 2014 palliative care formulary. Syringe driver drug compatibilities practice guidelines 2011. This is particularly important for patients receiving palliative care, for whom a continuous infusion of medication can improve symptom control. The syringe driver is normally used to deliver medications over a 24. A compatibility study heather kean1,3, diane rigge1, phil weir1, andrew dickman2, andrew evans3, elsie gaskell3 background the issue of patient safety alert 20. Continuous subcutaneous infusions in palliative care 4 ed. Promoting safer use of injectable medicines by the national patient safety agency in march 2007 includes the. If the patient is in pain, vomiting or very agitated, give a stat sc injection of appropriate medication while setting up the syringe driver. Quality control north west morphine, diamorphine and oxycodone combinations in palliative care. If the patient is in pain, vomiting or very agitated, give a stat sc injection of. At present, current practice is to limit syringe driver infusion time to a. The syringe driver describes how syringe drivers allow for a single or mixture of compatible medications to be delivered by syringe rather than by infusion bag. The eastern metropolitan palliative care consortium has produced a guide to practice on syringe driver compatibilities.
Remove the empty syringe from the driver by loosening the rubber strip and sliding back the mechanism. These guidelines reflect current australianvictorian palliative care practice, and published evidence. Syringe drivers are indicated when other routes become inappropriate or difficult. Only access to the palliative care formulary is moving over to the medicinescomplete platform. The current evidence base for the feasibility of 48hour continuous. Terms and conditions cookie and privacy policy subscription terms cookie and privacy. Many drugs used in palliative care especially drug combinations in syringe driver are used outside of the product licence or datasheet recommendations. A total of 57 individuals representing 33 separate palliative care services completed the national survey. Guidelines for subcutaneous infusion device management in. Do not leave drugs in a syringe driverpump for more than 24 hours. Mixing of medications in this manner is unlicensed but is supported by practice. The syringe driver drug compatibility charts, available in the palliative care formulary, summarize both the compatibility data submitted to the sdsd and that from published compatibility references. 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.
Authority for administration of prescribed medication document no. 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 compatibility is an issue, the use of two infusion devices3 or regular or prn. 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. What is palliative care guidelines plus this website hosts the pang palliative care guidelines developed by a collaboration of uk health organisations. Mar 30, 2015 this is particularly important for patients receiving palliative care, for whom a continuous infusion of medication can improve symptom control. The responsibility for prescribing is taken by the prescriber usually a doctor. Subcutaneous levetiracetam keppra in palliative and end. The size of the syringe required will depend upon the medications to be administered 10ml, 20ml, and 30ml syringes can be used in the niki t34 note. Subcutaneous drug infusion compatibility guidelines. Dec 02, 2016 local palliative care guidelines should always be followed when mixing drugs in a syringe driver. However, when the parenteral route is required, the subcutaneous route should be the first option.
Eastern metropolitan region palliative care consortium victoria clinical group syringe driver drug compatibilities guide to practice 20 july 20 these guidelines have been ed. Do not leave drugs in a syringe driver pump for more than 24 hours. Syringe driver drug compatibilities palliative care victoria. Do not exceed 2g due to volume capacity in the 30ml syringe driver and monitor for site reaction and seizure activity. Please contact a pharmacist, the palliative care team tel. The syringe driver drug compatibility charts, available in the palliative care formulary, summarize both the compatibility data submitted to the sdsd and that. The eastern metropolitan region palliative care consortium emrpcc grants permission to reproduce parts of this publication for clinical and. A total of 57 individuals representing 33 separate palliative care services entered. Therefore, it seems timely to consider their wider use. Authority for administration of prescribed medication via continuous subcutaneous infusion document no.
Once printed, this is no longer a controlled document. This must always be done to safeguard against errors even if the syringe has been made to the same volume. There is, however, little documented information regarding clinical practice. A syringe driver is useful when the oral route of administration is not possible and repeated subcutaneous doses are inappropriate, ineffective or impractical. The use of subcutaneous levetiracetam in palliative medicine indications for use the treatment of epileptic seizures and status epilepticus in palliative care patients who are unable to take their medications orally and when iv access is not possible or not desired. A syringe driver, or pump, represents a simple and costeffective method of delivering a continuous subcutaneous infusion csci. Kain project officer, centre for palliative care research and education professor patsy yates acting director, centre for palliative care research and education. Parenteral compatibilitystability sa pharmacy medicines. Seek advice from the specialist palliative care team if necessary. Drug compatibility in subcutaneous infusions chart in. In palliative care clinical practice, the oral route of administration is the preferred option. Continuous subcutaneous administration of medicines using a syringe driver often becomes necessary for the control of symptoms during palliative care. Syringe driver drug compatibilities practice guidelines. Syringe drivers are small portable usually battery operated devices used in palliative care.
Subcutaneous delivery of drugs using a syringe driver is common practice within specialist palliative care units. Check the infusion rate with the new syringe as before. When added to a syringe driver the recommended diluent is water for injection. Concentrations compatibility is often concentration dependent. When and how to use a syringe driver in palliative care.
Compatibility information from the palliative care handbook 9th edition 2019. Resource for health care professionals in palliative care. When and how to use a syringe driver in palliative care bpac. The palliative care handbook guidelines for clinical management and symptom control, featuring extensive. A maximum of 3 compatible drugs in any one syringe driver pump is recommended. The bulletin board, document library, news, surveys and the syringe driver survey database sdsd will continue to be available at. Syringe driver drug compatibilities guide to practice 20. Portable infusion pumps are used in palliative care to deliver a continuous subcutaneous infusion of medication over 24 hours. This requires the completion of a separate registration process. The goals of administering medicines via a syringe driver therefore need. Click here to view the syringe driver drug compatibility charts on the medicinescomplete platform.
A person with palliative care needs who has difficulties ingesting or digesting medications may receive them subcutaneously under the skin using a syringe driver. Your choice will be saved in a cookie on this computer. A survey performed in 1992 reported that at least 28 drugs were used in combination with others in a single syringe driver. Northern england clinical networks palliative and end of. Safe practice in syringe pump management nursing times. If administering clonazepam via a syringe pump over 24 hours csci, there is no need to use the diluent ampoule supplied in the box as the clonazepam will be administered diluted in the syringe pump. There will be copies of the virtual syringe driver available in the professional development unit to play with. The use of subcutaneous levetiracetam in palliative medicine.
A single drug or a combination of drugs is given via a slow continuous subcutaneous infusion to help control symptoms when other routes of administration are no longer viable, feasible or preferred. Identification of drug combinations administered by continuous. A syringe driver takes 34 hours to establish a steady state drug level in plasma. General principles for compatibility of medicines in a syringe pump. Points on mixing medications adapted from palliative care matters website. Compatibility of drugs for use in syringe drivers for 24 hours.
Local palliative care guidelines should always be followed when mixing drugs in a syringe driver. 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. Twycross et al 2017 the palliative care formulary 6th edition ashley et al 2014 the renal handbook 4th edition dickman et al 2016 the syringe driver 4th edition the electronic medicines compendium nice clinical guidelines relevant to each section further details available from the lead author. Compatibility information compatibility information is limited. Many hospices have a helpline staffed by medical professionals. The palliative care handbook guidelines for clinical management and symptom control, featuring extensive support for advanced dementia 9th edition 2019. There is a clear need to identify compatibility and stability of drug.
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. Jan 10, 2018 medications commonly used in a syringe driver. Mukoreka j, sisay i 2015 safe practice in syringe pump management. In palliative care, medicines may be administered by continuous subcutaneous infusion csci at various points along a patients disease. Mar 23, 2017 a total of 57 individuals representing 33 separate palliative care services completed the national survey. Nurse maude hospice palliative care service, 15 mansfield ave, christchurch. Importantly and distinctively, the authors combined laboratory data with clinical observations to produce both a useable and practical text. A maximum of 3 compatible drugs in any one syringe driverpump is recommended.
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