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. Breakthrough pain can be treated with additional subcutaneous doses of the opioid being used usually morphine. Diamorphine was found to be compatible with haloperidol 0. Morphine hydrochloride and morphine tartrate are not licensed for use in the UK, however morphine as the sulphate salt is widely used. Study characteristics, design and quality Twenty-one empirical studies were included in this review. If possible, doses should be given through a side port in the syringe driver cannula line to minimise patient distress. Quantitative data was analysed in a variety of ways across the 21 studies, with 3 employing two-way analysis of variance with replicates[ 13 — 15 ], 2 employing regression analysis[ 16 , 17 ], 15 employing the mean of multiple replicates with standard deviations[ 18 — 32 ].
|Date Added:||28 July 2016|
|File Size:||69.42 Mb|
|Operating Systems:||Windows NT/2000/XP/2003/2003/7/8/10 MacOS 10/X|
|Price:||Free* [*Free Regsitration Required]|
Plastic cannulae are recommended, although metal butterfly needles can be used.
The combination of diamorphine hydrochloride 20mg and naloperidol 7. Syringe drivers can be placed into a carry bag or pouch when a patient is mobile or be tucked under a pillow if the patient is bed-bound.
Destro et al[ 33 ] investigated the physical and chemical compatibility of morphine hydrochloride and ketorolac tromethamine at a range of concentrations over a hour time period.
Guidelines for syringe driver management in palliative care in New Zealand. In a palliative care setting, subcutaneous administration of medicines given via a syringe driver is useful for managing symptoms jn as pain, nausea, anxiety and restlessness.
An example of a prescription chart for documenting medicines given via syringe driver is available at: However, extrapolation of the data for these salts would not be suitable.
When and how to use a syringe driver in palliative care
Twenty-one empirical studies wyringe included in this review reporting chemical compatibility and stability of 32 discrete combinations of twenty-four drugs tested at a variety of different drug concentrations. Hor et al; ; Singapore [ 24 ]. Syringes containing midazolam 5mg or 7. Triplicate syringes were stored at 25 degrees C.
Lung cancer in New Zealand News and updates: This is an open access article distributed under the terms of the Creative Commons Attribution Licensewhich permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Supportive Care in Cancer. The funders had no role mirphine study design, data collection and analysis, decision to publish, or preparation of the manuscript. Ellershaw J, Ward C. 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.
Twenty-one empirical studies were included in this review. Initial concentration ranges were 1.
BPJ When and how to use a syringe driver in palliative care
Given the current pressures on healthcare resources in the United Kingdom and further ahd, innovation in how current clinical services are delivered is essential. Medicine indications Medicines management Palliative care Professional practice and development.
Stability of Midazolam and Fentanyl in Infusion Solutions.
Negro et al; ; Spain [ 29 ]. Watson et al; ; UK [ 32 ]. Search terms were developed in relation to the aims, and MeSH headings were used where available. Study characteristics, design and quality Twenty-one empirical studies were included in this review. What is a syringe driver? The combination of an opioid with other drugs haloperiol lactate and hyoscine N-butyl bromide can be very valuable.
The lockable, battery operated, Niki T34 syringe driver is the current device available in New Zealand for the continuous subcutaneous administration of medicines in a community setting. 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. Hospice New Zealand; However, this treatment option may be unacceptable to some patients due to the increased bulk of the infusion device as a result of the larger syringe.
Australian Journal of Hospital Pharmacy. One study[ 25 ] investigated the microbiological stability of the solutions tested over a day period using the technique of membrane filtration to European Pharmacopoeia standards.
Morphine – use half the total 24 hour oral dose Oxycodone – use half the total 24 hour oral dose Metoclopramide, cyclizine and hyoscine hydrobromide the injectable hyoscine salt Buscopan – same as morohine oral dose Haloperidol – antiemetic dose is 1 – 2 mg for 24 hours Midazolam – morphije – 40 mg over 24 hours For patients who have not been on opioid medicine for analgesia, an example of an initial starting dose would be 10 mg morphine subcutaneously over 24 hours.