Seek specialist advice from a clinical pharmacist if the doses needed are greater than those stated in the tables. Combinations of two, three or more of these drugs occasionally need to be coadministered via syringe driver. Points on mixing medications adapted from palliative care matters website. Subcutaneous delivery of drugs using a syringe driver is common practice within. Morphine, diamorphine and oxycodone combinations in. When the oral route is no longer appropriate, a syringe driver can be used to ensure continued symptom control. Mechanical problems, reactions at the infusion site and difficulties with the mixing of drugs in the syringe are all widely recognized. Guidelines for syringe driver management in palliative care. 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. Prescribing in palliative care overview palliative care is the active and total approach to the care of children and young adults with lifelimiting and lifethreatening conditions, embracing physical, emotional, social, and spiritual elements of their care. Commission on human medicine advised mhra mixing must only be undertaken when clinically. Commonly used drugs drug usual dose range indication clonazepam 16 mg24 hours agitation, confusion, seizures cyclizine 75150 mg24 hours.
There are many uses of syringe drivers, with the most common use being in palliative care for symptom control. Generally all of the drugs included in the section. It is not something that is used by every patient in palliative care, but it can be very useful. 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. Setting up a syringe driver in the community part 1 youtube. Clinical protocol for the use of syringe drivers in palliative care patients. Syringe drivers have been the mainstay of delivery and administration of drugs in palliative care for many years. This effect is often not visible, and a clear, colourless fluid free of precipitation is not definitive proof of compatibility between two or.
Syringe driver drug compatibilities guide to palliative care. For clinical advice including advice on mixing drugs in a syringe driver please see the syringe driver mixing table or for more guidance on symptom control please visit our clinical guidelines page. Common medicines are compatible with morphine and diamorphine, however cyclizine compatibility is concentration dependent. Mixing drugs in syringe drivers the association for. 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. Drugs with a similar ph are more likely to be compatible.
Syringe driver drug compatibilities guide to palliative care practice 2016 sodium chloride 0. The maximum number of drugs that respondents were prepared to mix in a. T34 adult syringe driver guidelines nhs harrogate and rural. Prescribing in palliative care medicines guidance bnf. Specialist references dealing with their mutual compatibilities need to be consulted. Background drug administration via syringe driver is safe, simple, noninvasive and cost effective.
The palliative care formulary twycross et al 2002 suggests. Sep 01, 2008 mixing drugs in syringe drivers is breaking the law mixing drugs in syringe drivers is breaking the law pountney, david 20080901 00. Di016 development of a quick reference guide for syringe. Before mixing any drugs together in a subcutaneous infusion, check for stability.
Syringe driver drug compatibilities guide to practice 20. Local palliative care guidelines should always be followed when mixing drugs in a syringe driver. After loading a syringe, the driver depresses the plunger at a set rate for continuous, steady delivery. When combining medications for syringe driver use, be aware there is data available from compatibility studies for only a few combinations. The eastern metropolitan region palliative care consortium emrpcc grants permission to reproduce parts of this publication for clinical and educational use only, provided that the emrpcc is acknowledged. Jun 24, 2018 drug compatibility in syringe drivers for windows june 24, 2018 admin laboratory data is generally derived from microscopic examination of a drug mixture under polarised light at specified concentrations and several time points when kept under controlled conditions. The use of a subcutaneous or intravenous infusion using a syringe driver to. Definitions drugs which can be administered subcutaneously. Prescribing in palliative care medicines guidance bnfc. Advice on end of life medication is available from the nursing and medical team at st nicholas hospice care telephone 01284 7663. They are a safe and effective way to give medicines for symptoms such as pain, nausea and vomiting, seizures, agitation and respiratory secretions. Before mixing any drugs together in a subcutaneous infusion, check.
If compatibility is an issue, the use of two syringe driver devices3 or regular or prn subcutaneous injection should be considered. They can be used in hospital, in hospices and at home. Ensure that the drugs used are compatible with each other. 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. Subcutaneous drug infusion compatibility guidelines. Various drug combinations are used in clinical practice and typically include opiates, antiemetics, anxiolytics and. Guidelines for setting up and changing the mckinley t34 syringe driver for children receiving palliative care. Care should be taken when mixing more than two drugs in a syringe and ensuring that the diluent is compatible with each of the drugs. Jun 08, 2009 part two of our educational video, looking at the best way of setting up a syringe driver in the community.
When and how to use a syringe driver in palliative care. Control of multiple symptoms often possible with a combination of drugs that can be mixed together. Mixing drugs in syringe drivers is breaking the law, cancer. Incompatible drugs syringe driver download admin october 28, 2019 no comments. District health boards of new zealand dhbnz has recommended the ad ambulatory syringe. Oct 28, 2019 incompatible drugs syringe driver download admin october 28, 2019 no comments mixing must only be undertaken when it is essential to meet the needs of the patient and should never be performed at the convenience of the healthcare professional 1. The syringe driverpump is a small portable batterydriven infusion pump, used to deliver medication as a continuous subcutaneous infusion csci usually over 24 hours. Ppt syringe drivers powerpoint presentation free to. Care should be taken when mixing two or more drugs in a syringe driver. If you still need to speak to a healthcare professional you can call our 24 hour advice line on 0116 231 3771.
The following points are useful to consider when mixing drugs in a syringe pump, especially if compatibility data is lacking. The device and the prescriptions for the driver can pose many problems. Alcohol or lipid solvents are watermiscible organic solvents used to improve the solubility of poorly water soluble drugs. Many drugs used in palliative care especially drug combinations in syringe driver are used outside. Administer in separate syringe pump, incompatible with most drugs. Controlled drugs that are no longer required for a patient can be returned to the. There are a number of drugs that are commonly delivered via syringe driver to patients having palliative care in the community.
September 2018 page 4 of 31 palliative care department 2. Commission on human medicine advised mhra mixing must only be undertaken when clinically appropriate and essential for patient. Part one our educational video, looking at the best way of setting up a syringe driver in the community. Concentration is particularly important when multiple drugs incompativle being infused subcutaneously via a syringe driver, in which minimal volumes are required. Drugs for subcutaneous administration in syringe drivers. Mixing of drugs in this manner is unlicensed but is supported by clinical practice. Syringe driver drug compatibilities guide to palliative. Incompatible drugs syringe driver download mixing must only be undertaken when it is essential to meet the needs of the patient and should never be performed at the convenience of the healthcare. April 2017 introduction palliative care patients often exhibit multiple symptoms that require the use of numerous drugs. 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. 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. Syringe driver drug compatibilities practice guidelines 2011. Concentration is particularly important when multiple drugs are being infused subcutaneously via a syringe driver, in which minimal volumes are required. A continuous subcutaneous sc infusion is used to provide symptom control in patients unable to tolerate oral administration, particularly in the palliative care setting.
Syringe pumps also known as syringe drivers are commonly used for people living with a terminal illness. Jun 08, 2009 part one our educational video, looking at the best way of setting up a syringe driver in the community. Mixing of drugs in this manner is unlicensed but is supported by clinical. Syringe drivers are indicated when other routes become inappropriate or difficult. If the patient is in pain, vomiting or very agitated, give a stat sc injection of appropriate medication while setting up the syringe driver. Combinations of three drugs should be checked with the british national formulary, the palliative. Part two of our educational video, looking at the best way of setting up a syringe driver in the community. Ensure that the diluent used is compatible with the drugs used. 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. A syringe driver takes 34 hours to establish a steady state drug level in plasma. Welcome to the syringe driver survey database sdsd the sdsd is a database of the visual appearance of drug combinations reported in prospective international multicentre surveys and also from individual reporting. Jun 16, 2019 concentration is particularly important when multiple drugs incompativle being infused subcutaneously via a syringe driver, in which minimal volumes are required.
Check the infusion after set up and in acute setting every 4 hours for any signs of precipitation, cloudiness, particles or colour change as. The syringe driver continuous subcutaneous infusions in palliative care 3rd ed. There are a number of different syringe drivers or pumps available but this research concentrates on the use of a mckinley t34 syringe pump, as presently it is the most popular syringe pump being adopted nationwide. Combinations of two, three or more of these drugs occasionally need to be coadministered via.274 156 1554 1508 847 1182 1242 284 910 1585 233 1175 1455 1437 366 885 287 682 727 727 1494 311 352 176 886 655 1246 274 217 960 1107