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SYRINGE DRIVERS……

SYRINGE DRIVERS……. Indications for use: Inability to take drugs orally Swallowing difficulties Profound weakness Comatose or moribund patient Persistent nausea and vomiting Intestinal obstruction Poor alimentary absorption (rare). Setting the correct rate for the MS26 pump….

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SYRINGE DRIVERS……

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  1. SYRINGE DRIVERS…… Indications for use: • Inability to take drugs orally • Swallowing difficulties • Profound weakness • Comatose or moribund patient • Persistent nausea and vomiting • Intestinal obstruction • Poor alimentary absorption (rare)

  2. Setting the correct rate for the MS26 pump….. Calculate likely volume of fluid • Select syringe • Draw up medication and dilute to appropriate volume • Prime the line and needle. • Measure distance in millimetres (mm) from the beginning of the scale to the plunger • The length in mm = rate/24 hours • Set the dial on pump.

  3. Checking and starting the syringe driver… • Insert the battery. Alarm will sound for about 15 seconds then fade • Fully extend actuator. • Press and HOLD DOWN the start/boost button. Motor will turn and stop after 10 seconds • Alarm sounds again, continuing for approx 15 seconds • Let the alarm finish. • RELEASE the button –This starts the pump • Check the indicator light is flashing • Pump must not be used if motor fails to stop and /or alarm fails to sound

  4. Additional information…. • Label syringe with drugs used, patient’s name, date and time set up, and signature • Put into lockable box, don’t lose the key • Complete syringe driver chart • 10ml and 20ml syringes commonly used • 30ml syringes can be used, must fit securely. • Additional tape may be needed. • 10ml syringe = Max 8mls • 20ml syringe = Max 16mls • 30ml syringe = Max 21mls

  5. Sites for butterfly needle… • Upper arm, upper chest, anterior abdominal wall, anterior aspect of thighs • Exact placement may be influenced by patient preference, the disease process and common sense. • Avoid broken, inflamed, oedematous/ lymphoedematous areas.

  6. Checks whilst driver is running…. • Everything connected • The volume remaining corresponds to time left for driver to run. • Indicator light flashing • No redness, swelling, pain or discomfort at site • Check syringe and line for signs of crystallisation or precipitation.

  7. To boost or not to boost?….. • One press of boost button moves plunger along 0.23mm - press x 4 = <1mm of ALL medication • Always prescribe correct doses of breakthrough medications • Give breakthrough doses as a s/c injection • via anadditional s/c butterfly needle with a short line, flushed with a little 0.9% saline • DO NOT USE THE BOOST BUTTON.

  8. Re-loading the syringe… • Re-assess drug / dosage requirements • Draw up medication in syringe for the next 24hr period. • Measure length of fluid, as before. No need to change line if okay and not changing prescription • If measured volume is different, change dial on pump • Re-start pump. Check pump functioning.

  9. Commonly used drugs for s/cutaneous infusion… • Analgesics e.g. diamorphine, morphine • Anti-emetics e.g. metoclopramide, cyclizine, haloperidol, levomepromazine • Antispasmodics and anticholinergics e.g. hyoscine butybromide (buscopan ) • Sedatives e.g. midazolam, levomepromazine

  10. Drugs to avoid… • Chlorpromazine • Diazepam • Prochlorperazine • ALL TOO IRRITANT

  11. SYRINGE DRIVERS… Diluents: • Unless otherwise indicated, use water for injections • Skin reactions can occur with levomepromazine-less irritant if diluted with normal saline However, the use of normal saline increases the risks of precipitation Octreotide and ondansetron dilute with normal saline

  12. Conversion to subcutaneous morphine and diamorphine… • 30mg oral morphine = 15mg S/C morphine • 24hr dose s/c morphine = ½ (half) 24hr oral dose of morphine • 30mg oral morphine = 10mg s/c diamorphine • 24hr s/c dose of diamorphine equivalent to 1/3 (one third ) 24hr oral dose of morphine • Include the regular doses of oral morphine PLUS any breakthrough doses in calculation.

  13. Calculations…. • 90mg MST 12hrly • How much diamorphine is needed in 24hr pump? • 30mg oral morphine 4hrly • How much diamorphine is needed in 24 hrs pump ? • How much morphine is needed in 24hr pump?

  14. Calculations…. • 60mg MST 12hrly, plus 3 extra doses of 20mg oral morphine in last 24 hrs • How much diamorphine is needed in 24 hr pump? • What should the appropriate breakthrough dose be, if required?

  15. Calculations…. • 360mg MXL daily plus 3 extras doses of 60mg oral morphine is needed. • How much diamorphine is needed in 24 hr pump?

  16. What does having a driver mean?... • How might the decision to give drugs via a driver be interpreted? • What might cause misunderstandings ? • What are the implications for nursing/medical practice? • What happens to driver and contents when someone dies?

  17. Questions…..

  18. Summary… • Never use boost button • Don’t add medication to existing pump prescription • Always write up breakthrough doses • Don’t lose the key • Telephone Katharine House for advise • Consider what a driver means to patient/ family

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