When the oral route is no longer appropriate, a syringe driver can be used to ensure continued symptom control. Please contact a pharmacist, the palliative care team tel. 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. Guidelines for subcutaneous infusion device management in. Subcutaneous levetiracetam keppra in palliative and end of life care. Basil martin wright, always known as martin, was born on december 20, 1912, in dulwich, london. 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. Portable, batterydriven syringe drivers enable predictable.
The syringe driver continuous subcutaneous infusions in palliative care. Metropolitan region palliative care consortium victoria syringe driver drug. 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. Dec 02, 2016 local palliative care guidelines should always be followed when mixing drugs in a syringe driver. The syringe driver and the subcutaneous route in palliative care. 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. Subcutaneous sc drug infusion by portable syringe driver has had a significant impact on pain management. The syringe drivercontinuous subcutaneous infusions in palliative care. 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. The syringe driver is normally used to deliver medications over a 24. Mixing of medications in this manner is unlicensed but is supported by practice. You might have been given a syringe driver, to help control pain, sickness, agitation or fits. Syringe drivers also known as pumps care and support.
The syringe driver pump is able to deliver a combination of medications and does so continuously without any inconvenience to the patient. Guidelines for syringe driver management in palliative care in new zealand iii. Syringe drivers are small portable usually battery operated devices used in palliative care. A syringe driver is useful when the oral route of administration is not possible and repeated subcutaneous doses are. Syringe pumps will be set up by a specialist nurse, district nurse or gp. 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. Clinical protocol for the use of syringe drivers in palliative care patients.
Subcutaneous levetiracetam for the management of seizures at. A person with palliative care needs who has difficulties ingesting or digesting medications may receive them subcutaneously under the skin using a syringe driver. A subcutaneous cannula, also known as a saftintima, is a little plastic tube. 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. Subcutaneous levetiracetam for the management of seizures. Syringe driver drug compatibilities guide to palliative care.
Preparations keppra 100 mgml concentrate for solution for infusion. 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. Guidelines for syringe driver management in palliative care developed by. When and how to use a syringe driver in palliative care. Exposure to light may cause degradation and discolouration.
Follow bdct syringe driver policy for use of syringe driver. Continuous subcutaneous infusions in palliative care. Guideline for administration of subcutaneous furosemide in. The management of subcutaneous sc furosemide by syringe driver introduction. It allows the continuous delivery of a range of therapies to aid patient comfort. When and how to use a syringe driver in palliative care bpac. 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. For subcutaneous infusions, the ms26 model syringe driver is recommended as it provides the greatest flexibility in the palliative care setting with. Feb 04, 2014 a brief video demonstrating how to insert the saftintima subcutaneous infusion set.
The continuous subcutaneous administration of drugs is both convenient and practical. Syringe drivers are routinely used in palliative care for the subcutaneous infusion of drugs for. It is most frequently used in palliative care particularly cancer care, bypassing problems such as. The subcutaneous sc administration of levetiracetam is unlicensed, but published reports and case studies suggest administration by either sc or continuous subcutaneous infusion csci at concentrations of up to 100mgml is well tolerated. Do not use if the solution is a yellow colour and protect from light. Subcutaneous syringe pump protocol palliative care see intranet for latest version of this document page 4 of 96 1. It is the responsibility of the prescriber to ensure that guidelines are followed when prescribing opioids. Subcutaneous levetiracetam keppra in palliative and end. If a deteriorating patient already has a fentanyl patch, leave patch on and titrate extra analgesic needs on top, either orally or via 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. The use of subcutaneous levetiracetam in palliative medicine. Subcutaneous levetiracetam keppra in palliative and. This is the case regardless of whether they are going home, to a residential care facility to a rural hospital or to hospice. The use of a subcutaneous or intravenous infusion using a syringe driver to deliver medications has certain advantages.
Its been developed for patients and their families, but may also be useful for health and social care professionals. Syringe driver drug compatibilities guide to palliative care practice 2016 sodium chloride 0. Guideline for administration of subcutaneous furosemide in the community setting in bradford, airedale, wharfdale and craven. Subcutaneous drug infusion compatibility guidelines. Cumbria syringe driver training attaching to patient. Continuous subcutaneous administration of medicines using a syringe driver often becomes necessary for the control of symptoms during palliative care. Patients must be using a niki t34 syringe driver when discharging from hospital.
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. October 2020 introduction palliative care patients often exhibit multiple symptoms that require the use of numerous drugs. Management of subcutaneous infusions in palliative care introduction. Subcutaneous sc drug infusion by portable syringe driver has had a significant impact on pain management 1. The syringe driver and the subcutaneous route in palliative. A syringe driver takes 34 hours to establish a steady state drug level in plasma. If unsure seek specialist palliative carepharmacy advice. Morphine remains the first choice, although there may be specific indications to use an alternative.
Importantly and distinctively, the authors combined laboratory data with clinical observations to produce both a useable and practical text. This article will outline the use of continuous subcutaneous infusion pumps, known as syringe drivers, including their benefits and drawbacks in a palliative care context. Incidence and causes for syringe driver site reactions in palliative. Guidelines for clinical management and symptom control,2018, pages 160161. Syringe driver compatibility chart if commencing a subcutaneous infusion intravenous or subcutaneous fentanyl may occasionally be used under supervision of the acute pain team or palliative care team. Guidelines for syringe driver management in palliative care. Alternative opioids see opioid conversions p3840 for equivalence of doses. In palliative care, when a patient can tolerate neither oral nor parenteral administration of medicationsparticularly while on home hospicecontinuous. Jan 18, 2017 cumbria syringe driver training attaching to patient. A syringe driver is useful when the oral route of administration is not possible and repeated subcutaneous doses are inappropriate, ineffective or impractical. Since the early 1980s, the syringe driver has become a commonly used technology in british palliative care, used to administer continuous subcutaneous. Taking care with your syringe driver in general, syringe drivers are safe, reliable and dont need a lot of care, but its important to.
One part of the yarm can be connected to a syringe driver or infusion pump. Community team 01925 570781 hospice 01925 575780 hospital team 01925 662915. Doughty s 2014 families must get a say on dying patients care. There have been several developments in this field since the second edition of this highly successful book. Kain project officer, centre for palliative care research and education professor patsy yates acting director, centre for palliative care research and education. The syringe driver is a simple and costeffective method of delivering a continuous subcutaneous infusion csci. A guide for caregivers 3 palliative care is care provided for people of all ages who have a life limiting illness, with little or no prospect of cure, and for whom the primary treatment goal is improved. Portable infusion pumps are used in palliative care to deliver a continuous subcutaneous infusion of medication over 24 hours. It is not something that is used by every patient in palliative care, but it can be very useful. The syringe driver is used to administer a continuous subcutaneous. Evidencebased information on subcutaneous syringe driver from hundreds of trustworthy sources for health and social care. Drugs for subcutaneous administration in syringe drivers. Syringe drivers are indicated when other routes become inappropriate or difficult.
An infusion time of 24 hrs or longer for a 10 ml infusion volume. Its sometimes called a continuous subcutaneous infusion. Opioid drugs other than morphine are available and are often used for palliative care patients. Management of subcutaneous infusions in palliative care. A brief video demonstrating how to insert the saftintima subcutaneous infusion set. Continuous subcutaneous infusion in palliative care. The effect of dexamethasone on the longevity of syringe.
A syringe driver helps reduce symptoms by delivering a steady flow of injected medication continuously under the skin. Syringe drivers are often required to provide medicines for symptom management in patients who are terminally ill. The effect of dexamethasone on the longevity of syringe driver subcutaneous sites in palliative care patients article pdf available in the medical journal of australia 17810. A continuous subcutaneous infusion csci delivered via syringe pump is a. We describe the serendipitous circumstances whereby the syringe driver came into use in palliative care, the extent of its adoption, and the insights this can offer into the use of csci more generally. For further advice contact specialist palliative care. You might have been given a syringe driver, to help control pain, sickness, agitation or. 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. For advice and support, contact nurse maude hospice palliative care service, phone 03 3754274.
T34 syringe driver instruction video for oxfordshire. Consultant in palliative care, marie curie hospice, bradford belinda marks, clinical lead palliative care, bradford district care trust. Pdf the benefits and drawbacks of syringe drivers in. If the patient is in pain, vomiting or very agitated, give a stat sc injection of appropriate medication while setting up the syringe driver.
Subcutaneous administration of medication is common practice in palliative care to manage pain and other distressing symptoms when other routes are inappropriate or ineffective. A syringe driver, or pump, represents a simple and costeffective method of delivering a continuous subcutaneous infusion csci. Queensland health management of subcutaneous infusions in palliative care learning package the aim of this learning package is to assist the clinician to develop knowledge and skills of the basic principles of care for people with subcutaneous infusion devices in palliative care settings. Jan 10, 2018 the pump holds a syringe containing medication and this is connected to the patient via a small needle and a line. Guidelines for syringe driver management in palliative. The needle, or soft plastic cannula, is usually placed in the upper arm, leg or abdomen. Syringe driver, subcutaneous infusion, palliative care, innovation introduction the subcutaneous route, in particular, continuous subcutaneous infusion csci, is a commonly used symptom management technique in contemporary palliative care. Thus, north american palliative care practitioners considered drug. Subcutaneous syringe pump protocol palliative care see intranet for latest version of this document page 6 of 96 1. The pump holds a syringe containing medication and this is connected to the patient via a small needle and a line. April 2017 introduction palliative care patients often exhibit multiple symptoms that require the use of numerous drugs. Always indicate on the regular prescription chart that a 4 hourly care test syringe driver working syringe driver is in use. The benefits and drawbacks of syringe drivers in palliative care. Given over 24 hours via a syringe pump csci using water for injection as diluent.
Identification of drug combinations administered by continuous. Syringe drivers continuous subcutaneous infusion marie curie. Remove the empty syringe from the driver by loosening the rubber strip and sliding back the mechanism. It is worth noting that not all medications can be given subcutaneously see below. Objectives to report the results of a combined case series analysis of subcutaneous levetiracetam keppra for the management of seizures in palliative care patients. A syringe driver is a small portable battery operated pump that administers drugs subcutaneously by continuous infusion. Do not exceed 2g due to volume capacity in the 30ml syringe driver and monitor for site reaction and seizure activity. Patrick russell who, in 1979, first described the use of the. There have been several developments in this field since the third edition of this highly.
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