Syringe drivers in palliative care

The syringe driver is a small, portable battery-driver infusion pump, used to give medication subcutaneously via a syringe usually over 24 hours. It can be used when other routes (e.g. oral, buccal, rectal, transdermal) are unsuitable.

Three of the commonest syringe drivers in the West Midlands region are (1,2):

• Graseby MS16 (Blue) - set at mm per hour, i.e. with 48 mm infusion set at 02mm per hour
• Graseby MS26 (Green) - set at mm per day, i.e. with 48 mm infusion set at 48 mm per day
• McKinleynT34 - set up according to volume of fluid

Indications include:

• nausea and vomiting
• dysphagia
• intestinal obstruction
• other inability to swallow or absorb drugs
• rectal route inappropriate
• semi-comatose/comatose patient
• acute pain
• patient convenience (eg massive doses of morphine)
• terminal stage debility

Choice of infusion sites:

Sites of choice include:

• anterior chest wall
• lateral upper arms
• anterior abdominal wall
• anterior outer thigh
• area over scapula (in confused or disorientated patient)

Avoid areas of inflammation, oedema, broken skin, bony prominences, recently irradiated areas, sites of tumour, sites of infection, skin folds or lymphoedema

Prescribing for the syringe driver:

• the dose of each drug to be given by infusion over a specified time period (usually 24 hours) should be clearly written

Note that it is important to seek expert advice before initiating a syringe driver. Also check local guidelines as to the appropriate use of syringe drivers.

Notes: (2):

• it is recognised that many palliative care teams will be phasing out the use of Graseby syringe drivers in accordance with NPSA Alert Dec 2010. However Graseby syringe drivers are still currently in use in some areas while the changeover to the new syringe drivers takes place

Reference:

1. West Midlands Palliative Care Physicians (2007). Palliative care - guidelines for the use of drugs in symptoms control.
2. West Midlands Palliative Care Physicians (2012). Palliative care - guidelines for the use of drugs in symptoms control.
3. Dr Michael Cushen, St Elizabeth Hospice, Ipswich 5/96