A limitation of this review is that additional drug combinations may have been tested but not published in peer-reviewed journals because of unexpected or negative results. Collins et al; ; UK [ 20 ]. Physical incompatibility was observed with syringes stored at both temperatures, where a white precipitate was observed to form after 12 hours on the wall of the propylene syringe. Continuous subcutaneous administration of medicines using a syringe driver often becomes necessary for the control of symptoms during palliative care. If more than two medicines are to be mixed in an infusion, refer to The Palliative Care Handbook or contact your local hospice for commonly used combinations and additional compatibility information.

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Palliative care for adults: Ellershaw J, Ward C. If possible, doses should be syrinfe through a side port in the syringe driver cannula line to minimise patient distress.

If more than two medicines are to be mixed in an infusion, refer to The Palliative Care Handbook or contact your local hospice for commonly used combinations and additional compatibility information. The Australian Journal of Hospital Pharmacy. These sites are preferred because they are accessible, both for initial insertion and for monitoring, and they are rarely oedematous.

The compatibility and stability of midazolam and dexamethasone in infusion solutions.

Taking the above into account, of the 32 combinations investigated, 20 included drugs at concentrations that are relevant to current UK practice. The first formulation was comprised of morphine tartrate mg, dexamethasone 8mg, droperidol 2mg, hyoscine- N -butylbromide 20mg and midazolam 8mg.

Collins et al; ; UK [ 20 ]. Syringes containing midazolam 5mg or 7. This should occur at least every four hours when patients are in a hospice or residential aged care facility.

At present, current practice is to limit syringe driver infusion time to a maximum of 24 hours as dictated by available chemical stability data. Conclusion Given the current pressures on healthcare resources in the United Kingdom and further afield, innovation in how current clinical services are delivered is essential.


Prescribing the medicines for the syringe driver Convert the patient’s previous hour oral medicine requirements including regular and “as needed” doses to the equivalent subcutaneous dose. However, the final concentrations of drugs in mrophine admixtures were equivalent to that expected in most CSCI combinations in the UK. What is a syringe driver?

A syringe driver is useful when the oral route of administration is not possible and repeated subcutaneous doses are inappropriate, ineffective or impractical. Introduction With one third of all patients in UK District General Hospitals expected to be in last year of life, end-of-life care is considered one of the key domains of care[ 1 ]. Search terms were developed in relation to the aims, and MeSH headings were used syronge available.

When and how to use a syringe driver in palliative care

Diamorphine hydrochloride and haloperidol Allwood[ 16 ] investigated the compatibility and stability of diamorphine hydrochloride in combination with haloperidol over a period of 45 days. 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.

Nassr et al; ; Canada [ 26 ]. 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. Doses can be prescribed in a flexible manner to achieve haloperridol symptom control, e. Three electronic databases and the grey literature were searched with no time limits. The ability to administer CSCIs to patients over extended time periods may benefit patients through providing greater independence, autonomy and improved quality of life as a result of receiving a reduced number of interventions such as syringe changes.

Drug combinations in syringe drivers: With guidance and support from the local hospice or district nursing services, General Practitioners can arrange a syringe driver infusion for a patient in their home or in a residential care facility, prescribe and monitor the appropriate mix of medicines and morpbine breakthrough symptoms.


Current practice in Spain is the infusion of a 60mL syringe or medication cassette over a period of five days and is reflected in the experimental design of the Spanish studies included in this review[ 1418192829 ].

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

This pushes the pH dependent equilibrium of midazolam towards the closed-ring, more lipophilic structure, resulting in reduced solubility[ 36 ].

Selection of the infusion site Plastic cannulae are recommended, although metal butterfly needles can be used. Of the 15 articles identified from the syrinnge literature and hand-search of reference lists, 3 articles were excluded on basis of abstract.

Data Availability All relevant data are within the paper and its Supporting Information files. 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 mogphine 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.