CALCULATE DIAMORPHINE SYRINGE DRIVERMarch 7, 2020
Hospices and residential aged care facilities are likely to have standardised prescribing and administration charts for syringe driver prescriptions. Although medicines can also be administered by other routes, such as rectal or sublingual, a further advantage of a continuous subcutaneous infusion is that any peaks and troughs of intermittent delivery methods are avoided Table 1. This has led to the use of portable continuous infusion devices, such as syringe drivers, to give a continuous subcutaneous infusion , which can provide good control of symptoms with little discomfort or inconvenience to the patient. Levomepromazine is licensed to treat pain in palliative care—this use is reserved for distressed patients with severe pain unresponsive to other measures seek specialist advice. Drugs with antimuscarinic effects antagonise prokinetic drugs and, if possible, should not be used concurrently. In theory injections dissolved in water for injections are more likely to be associated with pain possibly owing to their hypotonicity. Many patients will also be under the care of a palliative care physician.
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Lung cancer in New Zealand News and updates: These sites are preferred because they are accessible, both for initial insertion and for monitoring, and they are rarely oedematous.
When and how to use a syringe driver in palliative care
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. It is essential that there is good communication between the people who are providing care and support for the patient and their family this also includes community pharmacy.
Haloperidol and levomepromazine can both be given as a subcutaneous infusion but sedation can limit the dose of levomepromazine.
Although drugs can usually be administered diamorphinf mouth to control the symptoms of advanced cancer, the parenteral route may sometimes be necessary. 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. Dimaorphine colic and excessive respiratory secretions Bowel colic and excessive respiratory secretions may be reduced by a subcutaneous injection of hyoscine hydrobromidehyoscine butylbromideor glycopyrronium bromide.
Codeine phosphate or tramadol hydrochloride can be considered for moderate pain. Dexamethasonespecial care is needed to avoid precipitation of dexamethasone when preparing it.
For the use of midazolam by subcutaneous infusion using a continuous infusion device see below. The pain of bowel colic may be reduced by loperamide hydrochloride.
Make the solution as dilute as possible – use a larger syringe When possible, select a solution that is close to physiological tonicity – sterile water is hypotonic, normal saline is isotonic, and solutions with high concentrations of some medicines become hypertonic Use plastic cannulae as they cause less site irritation than metal cannulae In a patient who has been prone to site problems, consider rotation of the site of infusion before any localised reactions develop Avoid oedematous areas when selecting the site for infusion Use 0.
Increments should be made to the dose, not to the frequency of administration. Convulsions Patients with cerebral tumours or uraemia may be susceptible to convulsions.
The following are problems that may be encountered with syringe drivers and the action that should be taken:.
An additional dose should also be given 30 minutes before an activity that causes pain, such as wound dressing. 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 accessible, both for initial insertion and for monitoring, and they are rarely oedematous.
Drug treatment The number of drugs should be as few as possible, for even the taking of medicine may be an effort. A corticosteroid xiamorphine as dexamethasone may cxlculate, temporarily, if there is an obstruction due to tumour.
Prescribing in palliative care | Medicines guidance | BNF content published by NICE
Ideally, the cause should be determined before treatment with an antiemetic is started. Haloperidol is used by mouth for most metabolic causes of vomiting e.
Some community pharmacies calcuoate a service for compounding medicine solutions in daily subcutaneous syringes. Levomepromazine has a sedative effect. Treatment with morphine is given by mouth as immediate-release or modified-release preparations. 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.
Subcutaneous infusion solution should be monitored regularly both to check for precipitation and discolouration and to ensure that the infusion is running at the correct rate. Convulsions If a diamorphjne has previously been receiving an antiepileptic drug or has a primary or secondary cerebral tumour or is at risk of convulsion e. Raised intracranial pressure Headache due to raised intracranial pressure often responds to a high dose of a corticosteroid, such as dexamethasone and should be given before 6 p.
Symptom control Several recommendations in this section involve unlicensed indications or routes. Larger volume syringes should be used for medicines that will require more ampoules to be combined to achieve the total daily dose, e.
An antiemetic is usually necessary only for the first 4 or 5 days and therefore combined preparations dimorphine an opioid with diamorphin antiemetic are not recommended because they lead to unnecessary antiemetic therapy and associated side-effects when used long-term.
Please login to make a comment. The family may be reassured by the knowledge that the patient will be admitted to a hospital or hospice if the family cannot cope. Ministry of Health MOH.