Pain Pain management in palliative care is focused on achieving control of pain by administering the right drug in the right dose at the right time. Monitoring the infusion Patients being cared for at home should ideally have a daily visit from a health professional for review of symptom control and monitoring of the infusion. A number of factors influence the longevity of the insertion site. Fungating tumours can be treated by regular dressing and antibacterial drugs; systemic treatment with metronidazole is often required to reduce malodour but topical metronidazole is also used. Subcutaneous injections of hyoscine butylbromide , hyoscine hydrobromide , and glycopyrronium bromide can also be used to treat bowel colic.

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Upward titration of the dose of morphine stops when either the pain is relieved or unacceptable adverse effects occur, after which it is necessary to consider alternative measures. Any past experience they have had with syringe drivers The stage of illness they are at and what using a syringe driver means for them for the future, e.

The anterior chest wall The anterior abdominal wall The anterior aspect of the upper arms The anterior aspect of the thighs These sites are preferred because they are congersion, both for initial insertion and for monitoring, and they are rarely oedematous.

This can be a concern for patients and families if the clinicians or nurses visit is delayed. An initial subcutaneous injection may also be required as a loading dose to manage the patient’s symptoms for the initial two to four hours of syringe driver use until the medicines in the infusion reach effective blood plasma levels.


The first dose of the modified-release preparation is given with, or within 4 hours of, the last dose of the immediate-release preparation. Not all types of medication can be used in a subcutaneous infusion. Patients with neuropathic pain may benefit from a trial of a tricyclic antidepressant.

In severe chronic cholestasis, absorption of vitamin K may be impaired; either parenteral or water-soluble oral vitamin K see phytomenadione and menadiol sodium phosphate should be considered. Pain management with opioids Oral route Treatment with morphine is given by mouth as immediate-release or modified-release preparations.

When and how to use a syringe driver in palliative care

The equivalent subcutaneous dose of diamorphine hydrochloride is about one-third of the oral dose of morphine. Morphine equivalences for transdermal opioid preparations have been approximated to allow comparison with available preparations of oral morphine.

A syringe driver simply provides an alternative route for the administration of medicines.

If the patient’s symptoms remain uncontrolled despite an increase convesion dose, consider an alternative medicine e. Dexamethasonespecial care is needed to avoid precipitation of dexamethasone when preparing it.

BPJ When and how to use a syringe driver in palliative care

Similar documentation is recommended for patients who are receiving care at home. Syringd sites are preferred because they are accessible, both for initial insertion and for monitoring, and they are rarely oedematous. Capillary bleeding Capillary bleeding can be treated with tranexamic acid by mouth; treatment is usually discontinued one week after the bleeding has stopped, or, if necessary, it can be continued at a reduced dose.

Bowel colic and excessive respiratory secretions Hyoscine hydrobromide effectively reduces respiratory secretions and bowel colic and is sedative but occasionally causes paradoxical agitation. 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. Diazepam may be helpful for dyspnoea associated with anxiety. Diamorphine hydrochloride is sometimes preferred, because being more soluble, it can mophine given in a smaller volume.


Ketamine is sometimes used under specialist supervision for neuropathic pain that responds poorly to opioid analgesics. Injectable forms xyringe medicines conversioj 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. Constipation is a common cause of distress and is almost invariable after administration of an opioid analgesic.

Plastic cannulae are recommended, although metal butterfly needles syinge be used. Comments There are currently no comments for this article. In many cases, it will be the family who become aware of any issues with the device itself or that the medicines are not controlling the patient’s symptoms.

The Palliative Care Handbook, Guidelines for clinical management and symptom control. Metoclopramide hydrochloride can cause skin reactions.

Indicate the prescription is for a syringe driver. Each patient should be assessed on an individual basis. Midazolam is a sedative and an antiepileptic that may be used in addition to an antipsychotic drug in a very restless patient. Nausea and vomiting Haloperidol and levomepromazine can both be given as a subcutaneous infusion but sedation can limit the dose of levomepromazine. Nausea and vomiting are common in patients with advanced cancer.