For carers, friends and families of people with a terminal diagnosis to discuss their emotions about the prospect of losing their loved ones, as well as practical issues about palliative care and end of life. Syringe drivers continuous subcutaneous infusion marie curie. A syringe driver takes 34 hours to establish a steady state drug level in plasma. Pdf the benefits and drawbacks of syringe drivers in. The recent gosport war memorial hospital inquiry1 has increased uk patient, public and clinician awareness about syringe drivers for continuous subcutaneous delivery of opioids and other medications at the end of life. When and how to use a syringe driver in palliative care. Identification of drug combinations administered by. Cyclizine is not compatible with hyoscine butylbromide or oxycodone in a syringe driver. You may not get pain but if you do, there are ways to manage it. Syringe drivers are often required to provide medicines for symptom management in patients who are terminally ill. The guidance above are well accepted drugs and doses used at the end of life. A continuous subcutaneous infusion csci delivered via syringe pump is a method of drug administration used to maintain symptom control when a patient is no longer able to tolerate oral medication. Guidelines for syringe driver management in palliative. Syringe drivers are small portable usually battery operated devices used in palliative care.
Guidelines for syringe driver management in palliative care in new zealand. Guidelines on the management of pain due to cancer in adults bpcc. Syringe pumps for palliative care are programmed to deliver the medicines. This identified relevant websites relating to syringe driver management. Although first seizures are not usually treated, for those with intracranial tumours, anti. End of life journal, 20, vol 3, no 3 page 2 of 6 2010. Patients and families sometimes worry that opioids. Its common to feel nervous about having a syringe driver but most people find that they are very helpful for managing symptoms and give a feeling of reassurance. In order to assist clinicians with these difficult issues, the general medical council gmc has published guidance treatment and care towards the end of life. The medical devices team have a key training and operational role, which includes monitoring of syringe drivers sent with patients outside of the trust. Administering anticipatory medications in endoflife care. Includes advice on starting and changing opioids plus easy opioid conversion tables. A syringe driver is a small, portable, battery operated device that administers medicines subcutaneously over a selected time period, usually 24 hours.
Managing symptoms, including pain, is an important part of end of life care. He obviously has trouble swallowing his morphine tablet and anti sickness tablet so as of 4 days ago he had a syringe driver fitted. Syringe drivers are good for people who are unable to take oral medicines but they still need medication to control symptoms. End of life care guidelines symptom control for cancer and non cancer patients fourth edition. I know someone who has cancer and has just been put on a syringe driver with morphine. Call the advice line if advice is needed at any time. Doctor answers on symptoms, diagnosis, treatment, and more. They are a safe and effective way to give medicines for symptoms such as pain, nausea and vomiting, seizures, agitation and respiratory secretions.
The palliative care handbook a good practice guide. The syringe pump will usually be removed by the district nurse before the deceased is moved from the home. A new community drug chart for the authorisation of. North of england cancer network palliative care guidelinespalliative and end of life care guidelines fourth edition 2016 foreword. Management of pain in the elderly at the end of life. There are several opioid drugs that palliative care physicians most commonly prescribe for moderate to severe pain in the context of a serious, life threatening illness. Your doctor or nurse may suggest a syringe driver sometimes called a syringe pump to provide your pain relief and other medication such as antisickness. Over 80% of cancer pain can be controlled with inexpensive oral drugs. Advice on end of life medication is available from the nursing and medical team at st nicholas hospice care telephone 01284 7663. How long to live now having morphine through syringe driver.
Conversion of oral opioids to parenteral opioids is overleaf. It covers how to manage common symptoms, and dignity and respect for the dying person and their relatives and carers. These guidelines are written for the use of health care professionals in the oxford radcliffe nhs trust and. New nice guidance urges safer use of controlled drugs. Record sheet for issuing medical devices outside the rcht now available on sisters shelf under end of life forms in use or the document library. Medicines are drawn up into a syringe that is then attached to the driver, which is set to move the plunger of the syringe forward at an accurately controlled rate. When and how to use a syringe driver in palliative. I understand the stigma related to syringe drivers. Syringe drivers are often used at the end of life because they are the easiest way to give someone the medicines they need to feel comfortable at that time.
Many people with pancreatic cancer worry about having pain towards the end of life. Many drugs used in palliative care especially drug combinations in syringe driver are used outside of the product licence or datasheet recommendations. Moses on end of life expectancy of patient on syringe driver. Everyone is different, so its not easy to say exactly what will happen when someone approaches the end of their life. A single drug, or more often a combination of drugs is given via a slow subcutaneous infusion to help control symptoms when other routes of administration are no longer viable, feasible or preferred. It is most frequently used in palliative care particularly cancer. Providing drug compatibilities have been checked, a combination of three drugs can usually be administered safely with the advantage that vomiting will not affect absorption, as it is given. Northern england clinical networks palliative and end of.
Suitable drugs to prescribe for a syringe driver would be. T34 syringe driver instruction video for oxfordshire youtube. There is no evidence of benefit of prophylactic antiepileptic drugs before any seizure occurs. The process of dying in the frail older population is not thought to be painful worcester, 1940. The delivery of medicines through syringe drivers is commonly used in many end of life situations not just in cancer care. Towards the end, the district nurse filled a syringe driver and placed it in andrews arm. If the coroner is involved, the syringe pump will have to be left in place as they will need to see how the person was receiving their medicines. Drugs for subcutaneous administration in syringe drivers. Writing a prescription for end of life drugs consider how many days supply is needed enough to cover a weekend and the time needed to arrange further supplies 3 days minimum, 5 days more comfortable provide enough for at least 3 4 prn as needed doses per day as well as for csci syringe driver prescribe. You might have been given a syringe driver, to help control pain. Syringe pumps also known as syringe drivers are commonly used for people living with a terminal illness. I am a manager of a nursing home and we care for a lot of palliative end of life people and we face this situation with our residents and their families too.
Whilst the preferred route of medication administration in paediatric palliative care is the oral one, there may be occasions when this is impractical or undesirable. This may be because of persistent nausea, vomiting, dysphagia, weakness or coma. They are used primarily when patients are no longer able to take medicines by mouth. Regional anticipatory prescribing project and bpcc. It gave out a steady flow of drugs so that there werent any breaks in andrews pain control or times when the drugs were wearing off. Local palliative care guidelines should always be followed when mixing drugs in a syringe driver. Use the current local protocols for setting up and monitoring the syringe pump you are using. Syringe driver for mum lung cancer group discussion. This type of pneumonia is common in the elderly and is often terminal but unfortunately i do not have any hard statistics. My dad was diagnosed with terminal oesophageal cancer with secondary mets in his lungs and liver on 23rd december. It is so important for the patient, family and healthcare team that the person suffering the disease is kept comfortable at all times. In end of life care, broadspectrum antiemetics that can be delivered via a syringe driver are chosen, most usually phenothiazines haloperidol effective for vomiting caused by morphine, hypercalcaemia and uraemia and levomepromazine broadspectrum but sedating. Guidelines for syringe driver management in palliative care in new zealand iii.
Prescribing of strong opioids for pain in palliative care of adults nice guideline 25 july 2012 summary of nice guidance on prescribing opioid analgesics. Macmillan cancer support has useful information on describing your pain. Anticipatory endoflife care medication for the symptoms. Sometimes a small batteryoperated pump called a syringe driver is used to give medicine continuously under the skin for a period of time, such as 24 hours. Managing pain and other symptoms end of life care nhs. It is most frequently used in palliative care particularly cancer care, bypassing problems such as. End of life care when to start using syringe driver. A syringe driver was prescribed to administer morphine and an antiemetic over a 24 hour period which could be increased or decreased as required. In safe hands, syringe drivers facilitate appropriate and effective control of pain and other symptoms for patients who are no longer able to swallow or absorb oral medication, commonly when close to the end of life. There are many ethical issues surrounding end of life care, from the ethics of removing intravenous feeding to assisted dying. It allows the continuous delivery of a range of therapies to aid patient comfort. As it is likely that he will need a syringe driver in the near future, and you can anticipate his likely needs, you should consider prescribing drugs needed for a syringe driver, as well as prn drugs for end of life care targeted anticipatory prescribing.
Tell your doctor or nurse straight away if you have any new pain or your pain gets worse. A syringe driver is set up to manage symptoms and can be used at any point in. He felt that she needed a syringe driver for pain relief,and felt mum had just days to live. Understand when pain control in palliative care in necessary and learn more about assessing pain and pain management in palliative care. Management of subcutaneous infusions in adults policy and. When the oral route is no longer appropriate, a syringe driver can be used to ensure continued symptom control. If you dont feel ready to read this information just yet, you can come back to it at any time. Guidelines for syringe driver management in palliative care. 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. Claire britton, specialist nurse practitioner from sobell houses community team, demonstrates how to set up the t34 syringe driver. These medications may be used to control pain or shortness of breath throughout an illness or at the end of life. Several classes of drugs, such as opioids, antiemetics, anticholinergics, antipsychotics and benzodiazepines are routinely administered by csci alone or in combinations. Does anyone know if this indicates the worst is closely looming.
Updated 2017 anticipatory prescribing for end of life symptoms in the community. Subcutaneous sc drug infusion by portable syringe driver has had a significant impact on pain management. The literature was rated for its level of evidence using the joanna briggs. The national institute for health and care excellence nice has produced guidance for the care of dying adults in the last days of life. The sooner you get treatment, the better the chance of.
The terminal stage 63 pain control at the end of life 66 terminal restlessness 67 respiratory tract secretions at the end of life 68 nausea and vomiting at the end of life 69 dyspnoea at the end of life 70 24. But in the last weeks and days before death, its common to experience certain changes. They can be used in hospital, in hospices and at home. April 2017 introduction palliative care patients often exhibit multiple symptoms that require the use of numerous drugs. End of life expectancy of patient on syringe driver. Clinical protocol for the use of syringe drivers in. The information is written for people who have cancer, but is relevant for. Dr lovell is a consultant physician in palliative medicine at greenwich hospital. The use of a subcutaneous or intravenous infusion using a syringe driver to deliver medications has certain advantages. Prescribing for end of life care oxleas nhs foundation trust. The tables in this guideline contain information about preparations, dose ranges, diluents and indications for single drugs that can be given by subcutaneous infusion for symptom control in palliative and end of life.
154 935 135 1385 784 389 135 96 613 425 706 1175 1588 1325 1537 50 374 989 1232 1363 371 769 503 87 541 679 201 404 379 1270 1403 1114 1291 525 381 1031 1238 225 1482 139 687 1057 44 813 124 1044