Using a Syringe Driver

1. Using a Syringe Driver Central Coast Palliative Care Service Prepared by Peter Cleasby CNC

2. Session Objectives Describe the role of the Syringe Driver in Palliative Care Identify key principles in using a Syringe Driver Introduce the Syringe Driver Learning Package and Accreditation process

3. What is a Syringe Driver? The Syringe Driver is a battery operated device designed to slowly empty a syringe over a period of time. Most commonly they deliver medications subcutaneously & continuously over a 24 hour period The Graseby MS16A is the Syringe Driver used in Palliative Care on the Central Coast

5. Warning A different syringe driver is used for neurology patients - The MS26 The MS26 has a different rate setting. It is vital that when using a syringe driver you are using the right rate setting for that device or an overdose / underdose may occur. Contact the Central Coast Palliative Care Service for advice if needed.

6. The Syringe Driver in Palliative Care The normal indication for the introduction of a syringe driver is the inability to maintain delivery of medications by the oral route. Examples include Increasing weakness Decrease in consciousness Profound nausea/vomiting Bowel obstruction Dysphagia

7. The Syringe Driver in Palliative Care Medications continued with a Syringe Driver are symptom specific and comfort orientated Clinical practice and clinical studies support the combination of a number of medications in the syringe driver. (Contact CCPCS for advice)

8. Key principles in using a Syringe Driver Medication orders are needed before a syringe driver can be started Client / carer consent is needed before a SD can be started In a home setting the carer may be trained to manage the SD and to administer additional medication as required

9. Key principles in using a Syringe Driver. Medications must be sourced and maintained Medication orders for symptom breakthrough are required (PRNs) In the community some medications will be obtained from the local pharmacy, and some will be supplied by the Central Coast Palliative Care Service The adequacy of all medications needs to be reviewed daily.

10. Key principles in using a Syringe Driver Most common site for continuous subcutaneous infusion is the abdomen The integrity of the site is assessed regularly and changed weekly or as needed

11. Key principles in using a Syringe Driver Common Palliative Care practice on the Central Coast is to run Syringe Drivers over a 24hr period using Becton Dickinson brand syringes. For 24 hr BD syringes fill volumes (which equate to 48 millimetres of distance) are Ten ml BD syringes are filled to 8ml All 20ml syringes are filled to 15.5mls Water for injection is used to bring medication volume up to fill volume (unless contraindicated)

12. Key principles in using a Syringe Driver The rate of administration is for a Graseby 16A to run over 24 hours is 2mm per hour. Contact the CC Palliative Care Service if using a different brand syringe

13. The Syringe Driver Learning Package The Central Coast Palliative Care Service has prepared a learning resource for clinicians A self paced learning workbook has been developed for Community Nurses Wyong Hospital All Other CCH Hospitals Non CCH Facilities Private Home Nurses

14. Accreditation It is common practice to be accredited to use a Syringe Driver Accreditation is a local issue, and your supervisor will advise of the local process / requirements

15. Conclusion Syringe Drivers are a valuable tool in Palliative Care practice A systematic approach to their use, based on appropriate education, is required to ensure safe and competent clinical practice Locate the training package for your care setting on the Central Coast Palliative Care Service Intranet site, or call 4336 7777 for a copy.

16. Bibliography Dickman A, Littlewood C & Varga, J 2002 The Syringe Driver: Continuous Subcutaneous Infusions in Palliative Care Mitten T. 2001 Subcutaneous drug infusions: a review of problems and solutions. International Journal of Palliative Nursing. 7(2): 75-6, 78, 80 O'Doherty CA. Hall EJ. Schofield L. Zeppetella G. 2001 Drugs and syringe drivers: a survey of adult specialist palliative care practice in the United Kingdom and Eire. Palliative Medicine. 15(2): 149-54. Torre MC. 2002 Subcutaneous infusion: non-metal cannulae vs metal butterfly needles. British Journal of Community Nursing. 7(7): 365-9