It contains an extensive, referenced list of compatibility and stability data. Syringe driver drug compatibilities guide to palliative. What is palliative care guidelines plus this website hosts the pang palliative care guidelines developed by a collaboration of uk health organisations. If compatibility is an issue, the use of two syringe driver devices3 or regular or prn subcutaneous injection should be considered. 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. The risk of incompatibility generally increases with the number of drugs, and compatibility information should always be consulted before medicines are mixed in a syringe driver see information sources, below. This requires the completion of a separate registration process. To mix or not to mix compatibilities of parenteral drug. Before mixing any drugs together in a subcutaneous infusion, check. Two syringe pumps may be required for doses above 2gday or the use of a 50ml syringe. The use of alfentanil in a syringe driver in palliative medicine warning. Metropolitan region palliative care consortium victoriaclinical working party 3. Medications commonly used in a syringe driver consult a medical practitioner or palliative care specialist for support and advice regarding doses and the compatibility of medications.
Additional services are provided for free to members of. Syringe driver drug compatibilities practice guidelines 2011. Authority for administration of prescribed medication. The display resizes so it is usable on a small screen i. Drug compatibility in subcutaneous infusions chart in. When the oral route is no longer appropriate, a syringe driver can be used to ensure continued symptom control.
However it is common practice in a palliative care setting, and sometimes up to 5 medicines may be given using a single device. Incidence and causes for syringe driver site reactions in. Much of the material from the old palliative medicine handbook is still available on this site, with. It is important to ascertain whether the compatibility data displayed are relevant to the situation of intended use. This website hosts the pang palliative care guidelines developed by a collaboration of uk health organisations. There is a clear need to identify compatibility and stability of drug. 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. For advice and support, contact nurse maude hospice palliative care service, phone 03 3754274.
Many hospices have a helpline staffed by medical professionals. Thus, north american palliative care practitioners considered drug compatibility issues under the heading of csci, whereas uk practitioners considered these under the title of syringe driver use. Use this drug compatibilities resource 704kb pdf to formulate a list of medications that are commonly used for symptoms in the terminal phase and those which are suitable for syringe drivers. 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. Identification of drug combinations administered by continuous. The syringe driver is normally used to deliver medications over a 24. Given over 24 hours via a syringe pump csci using water for injection as diluent. When and how to use a syringe driver in palliative. Syringe drivers are routinely used in palliative care for the subcutaneous infusion of drugs for pain and symptom control. There have been several developments in this field since the third edition of this highly. See also syringe driver compatibility chart if commencing a subcutaneous infusion intravenous or subcutaneous fentanyl may occasionally be used under supervision of the. A total of 57 individuals representing 33 separate palliative care services entered. It can be diluted with water for injection or normal saline. Do not exceed 2g due to volume capacity in the 30ml syringe driver and monitor for site reaction and seizure activity.
The syringe driver is a small, portable batterydriver infusion pump, used to give medication subcutaneously via a syringe usually over 24 hours. Palliative and end of life care guidelines fourth edition 2016 careful initial assessment is very important and should include clear documentation of findings. The compatibility and stability of 28 combinations of diamorphine hydrochloride 5100 mgml with cyclizine lactate 550 mgml, eight combinations of diamorphine 10100 mgml with haloperidol 24 mgml and eight combinations of all three drugs was assessed after storage in 1 ml polypropylene syringes. It does not replace adequate assessment and individual. Morgan s, evans n 2004 a small observational study of. Syringe driver drug compatibilities palliative care victoria. Registration allows users to save bookmarks and favourites, and to keep.
Subcutaneous drug infusion compatibility guidelines. Subcutaneous drug infusion compatibility guidelines gippsland. If the patient is in pain, vomiting or very agitated, give a stat sc injection of appropriate medication while setting up the syringe driver. Conclusion there is a lack of laboratory data supporting the compatibility and stability of drug combinations currently used in syringe drivers in paediatric palliative care. Dec 02, 2016 local palliative care guidelines should always be followed when mixing drugs in a syringe driver. Compatibility information compatibility information is limited. Subcutaneous drug administration in palliative care and drug compatibility in syringe drivers for palliative care from therapeutic guidelines subscription required. Syringe driver compatibility chart hospital palliative 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. Syringe driver drug compatibilities guide to palliative care.
Syringe driver drug compatibilities the eastern metropolitan palliative care consortium has produced a guide to practice on syringe driver compatibilities. There have been several developments in this field since the third edition of this highly successful book. Maximal dilution with wfi is recommended in order to preserve the infusion site. A syringe pump also referred to as a syringe driver is used to deliver a csci, which is considered fundamental for continued symptom management in palliative care. Several classes of drugs, such as opioids, antiemetics, anticholinergics, antipsychotics and benzodiazepines are routinely administered by csci alone or in combinations 2. Combinations of two, three or more of these drugs occasionally need to be coadministered via. Eastern metropolitan region palliative care consortium victoria. Users need to register on first use, but the registration process is kept very simple.
If compatibility is an issue, the use of two syringe driver devices3 or. Syringe driver compatibility chart hospital palliative care service. During office hours contact pharmacy or the palliative care team for advice. Monitoring of the combined drugs in the syringe driver throughout the infusion period is advised. A person with palliative care needs who has difficulties ingesting or digesting medications may receive them subcutaneously under the skin using a syringe driver. Subcutaneous levetiracetam keppra in palliative and. When and how to use a syringe driver in palliative care. The needle, or soft plastic cannula, is usually placed in the upper arm, leg or abdomen. Develop a policy and procedures for managing palliative care medication including the use of syringe drivers. A syringe driver, or pump, represents a simple and costeffective method of delivering a continuous subcutaneous infusion csci. If compatibility is an issue, the use of two infusion devices3 or regular or prn. Compatibility of syringe driver admixtures for continuous subcutaneous infusion, pharmacy department auckland hospital. The concept of total pain is commonly used in palliative care to prompt health professionals to consider all possible influences on the pain experience.
Syringe driver drug compatibilities guide to palliative care practice 2016 sodium chloride 0. Hence, as the syringe driver was little adopted in north america, some potentially useful sources of information could be neglected. 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 added to a syringe driver the recommended diluent is water for injection. This guideline refers to the use of drugs in syringe drivers for palliative care only. Use of alfentanil in renal failure in palliative care in. Guidelines for the handling of palliative care medicines in community services 1. Syringe pumps will be set up by a specialist nurse, district nurse or gp.
Registration with permits access to latest additions, news, bulletin board for both drug and nondrug issues, syringe driver survey drug compatibility database sdsd and document library. Do not exceed 2g due to volume capacity in the 30ml syringe driver and. In a syringe driver, alfentanil is compatible with other commonly prescribed symptom control medications of midazolam, levomepromazine and hyoscine butylbromide. Click here to view the syringe driver drug compatibility charts on the medicinescomplete platform. About this canterbury dhb document 4162 document owner. T34 compatibility information scottish palliative care guidelines website guidelines for the use of the t34 ambulatory syringe pump by cme medical for adults in palliative care pdf 2. Guidelines for syringe driver management in palliative care. Palliative care there are a number of drugs that are commonly delivered via syringe driver to patients having palliative care in the community see box. Mixing of medications in this manner is unlicensed but is supported by practice. Once printed, this is no longer a controlled document. Authority for administration of prescribed medication via continuous subcutaneous infusion document no.
The syringe driver is a small, portable battery driver infusion pump, used to give medication subcutaneously via a syringe usually over 24 hours. Drugs for subcutaneous administration in syringe drivers. Syringe driver survey database sdsd palliative drugs. Some acute areas will use nonambulatory pumps, for example alaris pump. Graham f, clark d 2005 the syringe driver and the subcutaneous route in palliative care. 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. The syringe driver advisory group was set up by the new zealand palliative care working party in december 2007 to facilitate a smooth and safe transition to an approved alternative device. Alfentanil, at higher concentrations, may be incompatible with cyclizine.
Three of the commonest syringe drivers in the west midlands region are 1,2. A syringe pump also referred to as a syringe driver is used to deliver a. When combining medications for syringe driver use, be aware there is data available from compatibility studies for only a few combinations. 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.
Subcutaneous levetiracetam keppra in palliative and end. Palliative care patients often exhibit multiple symptoms that require the use of numerous drugs. Consultant in palliative medicine february 2019 midazolam, morphine sulphate, oxycodone and ranitidine using sodium chloride 0. Jan 10, 2018 medications commonly used in a syringe driver consult a medical practitioner or palliative care specialist for support and advice regarding doses and the compatibility of medications. The use of a subcutaneous or intravenous infusion using a syringe driver to deliver medications has certain advantages. 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. The compatibility tables contain information for a subcutaneous infusion using a cme t34 syringe pump or a nonambulatory pump containing. The syringe driver is a simple and costeffective method of delivering a continuous subcutaneous infusion csci. Sh cp 18 syringe driver policy for adult supportive and palliative care version 7 november 2018 if a syringe driver is discontinued whilst the infusion is in progress and morphine or other controlled drugs remain in the syringe these should be denatured before disposal using a denaturing kit as instructed in the medicines policy sh cp 1. Safe practice in syringe pump management nursing times. If you are on a public computer, please uncheck this box. Guidelines for clinical management and symptom control 2014 pages 150. The general principle that injections should be given into separate sites and should not be mixed does not apply to the use of syringe drivers in palliative care.
Guidelines for syringe driver management in palliative. District health boards of new zealand dhbnz has recommended the ad ambulatory syringe. The use of alfentanil in a syringe driver in palliative. Syringe driver drug compatibilities practice guidelines. Prescribing in palliative care medicines guidance bnf. The reader is presented with an overview of syringe drivers and continuous subcutaneous infusions followed by referenced information about drugs that are likely to be encountered, compatibility tables and information about symptom control in the last few days of life, concentrating specifically on the use of the syringe driver. Local palliative care guidelines should always be followed when mixing drugs in a syringe driver. Compatibility of medicines for syringe driver infusions commonly prescribed in general practice adapted from palliative care handbook 2012. Provided that there is evidence of compatibility, selected injections can be mixed in syringe drivers. It contains an extensive, referenced list of compatibility and stability data relating to drug combinations administered by csci. Portable infusion pumps are used in palliative care to deliver a continuous subcutaneous infusion of medication over 24 hours. If the patient is in pain, vomiting or very agitated, give a stat sc injection of. In situations where the patient has not previously received levetiracetam there is limited. In order to ensure consistent and better quality information, more detailed instructions on syringe driver preparation should be included in the smps.
Only access to the palliative care formulary is moving over to the medicinescomplete platform. Mar 23, 2017 a syringe pump also referred to as a syringe driver is used to deliver a csci, which is considered fundamental for continued symptom management in palliative care. Guidelines for clinical management and symptom control 2014 pages 150151 4. Guidelines for syringe driver management in palliative care developed by. Much of the material from the old palliative medicine handbook is still available on this site, with the main guidelines section updated with. 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. A syringe driver takes 34 hours to establish a steady state drug level in plasma. Your choice will be saved in a cookie on this computer. Northern england clinical networks palliative and end of. The syringe driver and the subcutaneous route in palliative.
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