Clinical protocol for the use of syringe drivers in palliative care patients. The aim is to teach delegates the theoretical and practical skills required to safely and effectively use syringe drivers. Pca can direct you to your state or territory palliative care association. Syringe drivers are small portable usually battery operated devices used in palliative care. Benefits of early palliative care national cancer institute. Safe practice in syringe pump management nursing times. Clinical experience suggests parecoxib csci may be of benefit in this population, but empirical evidence in relation to its safety and efficacy is lacking. Serious illness can also often affect our ability to plan for the future, make important decisions about the treatments available or deal with difficult emotional issues which often arise. Syringe driver online learning package queensland health.
Guidelines for syringe driver management in palliative. If the patient is in pain, vomiting or very agitated, give a stat sc injection of appropriate medication while setting up the syringe driver. Specific to the use of syringe drivers in palliative care, one set of australian guidelines 2010 was found with a related learning module 2014. Jun 08, 2015 new research has been published that, for the first time, provides strong evidence on the economic benefits of early palliative care intervention for people with an advanced cancer diagnosis. Stability of injections containing diamorphine and. 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. Policy and protocol for the use of the cme mckinley t34 syringe driver for adults in palliative care policy no. Brocx s, cleaver h 2012 when and how to use a syringe driver in palliative care. Management of subcutaneous infusions in palliative care. What do palliativecare workers think about portable. The responsibility for prescribing is taken by the prescriber usually a doctor.
Guidelines for syringe driver management in palliative care. Terms and conditions cookie and privacy policy subscription terms cookie and privacy policy. For comprehensive practical guidance, see cht intranet link. Syringe pumps for palliative care are programmed to deliver the medicines over a 24hour period, so a new syringe of medicines is usually set up once per day. The syringe driver continuous subcutaneous infusions in.
Palliative care seeks to manage the symptoms of advanced. Many provide guidance on their use, although much of the data are. Syringe driver information if in any doubt about the use of a syringe driver or its contents, contact the specialist palliative care team for advice. Management of subcutaneous infusions in adults policy and procedure v2. However, there is wide experience of their use in palliative care.
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. Objectives to characterise the use of the parenteral nonsteroidal antiinflammatory drug parecoxib when given by continuous subcutaneous infusion csci in a hospice population. Review the benefits and drawbacks of syringe drivers in palliative care john costello, brian nyatanga, carole mula. A syringe driver helps reduce symptoms by delivering a steady flow of injected medication continuously under the skin. Pdf the benefits and drawbacks of syringe drivers in. 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. Mukoreka j, sisay i 2015 safe practice in syringe pump management. It is important to explain the rationale behind using a syringe driver fully to the patient.
These guidelines are written for the use of health care professionals in the. Benefits of palliative care often patients or their loved ones experience anxiety when attempting to cope with the medical treatments of a serious illness. Symptom control for cancer and non cancer patients. Palliative care, unlike many other specialties, has many of its roots in primary and community care. Online syringe driver learning package and associated quizzes. This must always be done to safeguard against errors even if the syringe has been made to the same volume. A syringe driver is useful when the oral route of administration is not possible and repeated subcutaneous doses are inappropriate, ineffective or impractical. Its sometimes called a continuous subcutaneous infusion. Jan 10, 2018 the pump holds a syringe containing medication and this is connected to the patient via a small needle and a line. Syringe driver check list and community subcutaneous medications record sheet community or syringe driver observation chart hospicehospital practice points t34 syringe drivers are calibrated in mls per hour the standard delivery period for a continuous subcutaneous infusion in palliative care is 24 hours.
Many drugs used in palliative care especially drug combinations in syringe driver are used outside of the product licence or datasheet recommendations. Reasons for using a syringe pump advantages and disadvantages of syringe pumps principles of patient care syringe pumps are a vital tool for administering medicine, especially in palliative care. Economic benefits of early palliative care intervention. Other common indications for using a syringe driver in palliative care. End of life care medicine bibliographies cite this for me. Our students benefit from setting up the syringe driver. The main advantages of a syringe driver are that it provides continuous delivery of medication, allows several medications to be administered simultaneously and. Please note that there are two syringe driver policies on this website one is the east. A syringe driver takes 34 hours to establish a steady state drug level in plasma. The christie website christie library and knowledge service. However, nurses must have training before using them to ensure patient safety safe practice in syringe pump management. This is of course untrue and some patients use the drivers intermittently when their symptoms present.
This syringe driver awareness training course is aimed at registered nurses who want to upskill or refresh their knowledge around 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. It may be used to administer drugs in other circumstances but these, as well as the use. The needle, or soft plastic cannula, is usually placed in the upper arm, leg or abdomen. Jan 01, 2006 palliative care, unlike many other specialties, has many of its roots in primary and community care. Graham f, clark d 2005 the syringe driver and the subcutaneous route in palliative care. Other countries are in the process of developing certification for palliative care. Syringe pumps will be set up by a specialist nurse, district nurse or gp. Using syringe drivers in palliative care within a rural, community setting.
Check the infusion rate with the new syringe as before. While this care generally attempts to provide holistic comfort and dignity as death approaches, hospice might or might not be the right choice for you or a loved one depending on your unique needs andor situation. When and how to use a syringe driver in palliative care. This article will outline the use of continuous subcutaneous infusion pumps, known as syringe drivers, including their benefits and drawbacks in a palliative care context. Initiating use of a syringe driver in a patient during palliative care may represent a. Doctors most often made the decision to commence treatment with a portable syringe driver, often at the suggestion of a nurse. These guidelines are intended to provide clinicians and palliative care services with guidelines to inform practice, the development of policy and procedures, and associated training and education programs in relation to portable subcutaneous infusion device syringe driver management.
Guidelines for syringe driver management in palliative care developed by. Are there any disadvantages to using a syringe driver. Pdf the benefits and drawbacks of syringe drivers in palliative care. Guidelines for syringe driver management in palliative care in new. Wiley online library john costello, brian nyatanga, carole mula and jenny hull, the benefits and drawbacks of syringe drivers in palliative care, international journal of palliative nursing, 14, 3. These evidence based guidelines cover all aspects of the use of syringe drivers, and focus on safe practice, and patient and family education. Injectable medicines and syringe drivers the use of injectable medication can have many healthcare benefits for patients. Outcome given sub cut fluids over period of 23 weeks to maintain. A range of syringe drivers are now in use in australia the guidelines are applicable to all of these. Unlike care training providers that provide theory only syringe driver training. The pca website also has useful information about palliative care, a directory of palliative care services, and a sample pain diary and medicine chart.
Mar 30, 2015 this is particularly important for patients receiving palliative care, for whom a continuous infusion of medication can improve symptom control. If more than 3 drugs are needed in a syringe driver, discuss the situation with your palliative care team. A syringe driver is a small battery operated pump designed to deliver. Ownership, availability, and use of portable syringe drivers among hospices and home care services. Management of subcutaneous infusions in adults policy and. There is an increasing demand for psychosocial research in palliative care in order to provide a higher quality of care at the end of life. Use of parecoxib by continuous subcutaneous infusion for. Initiating use of a syringe driver in a patient during palliative care may represent a significant and unwelcome milestone for the patient and their familywhanau, because syringe drivers are often required when a patient is close to death. Home care teams in particular perceived the benefits of an alternative route for analgesia. Costello j, nyatanga b, mula c, hull j 2008 the benefits and drawbacks of syringe drivers in palliative care. For more information see the use of unapproved medicines in palliative care. A palliative diagnosis is a gift, said the nurse who led the workshop.
The use of a subcutaneous or intravenous infusion using a syringe driver to deliver medications has certain advantages. Remove the empty syringe from the driver by loosening the rubber strip and sliding back the mechanism. Management of subcutaneous infusions in palliative care introduction. The graseby ms26 syringe driver is the recommended device used to deliver a continuous subcutaneous infusion in order to maintain good symptom control in patients with palliative care needs. The syringe driver pump is able to deliver a combination of medications and does so continuously without any inconvenience to the patient. Local palliative care guidelines should always be followed when mixing drugs in a syringe driver. Promoting high quality care for all adults at the end of life. Combined units actually used more portable syringe drivers despite reporting more disadvantages to patients, staff and carers. Clinicians who are specifically trained in palliative care provide indepth pain and symptom management, communication regarding goals of care, and care coordination across settings and over time. Cyclizine is the drug which seems to precipitate most commonly in the syringe driver and causes problems with poor absorption and site reactions. Setting up a syringe driver this should be done by an appropriately trained nurse usually a districtcommunity nurse or specialist nurse.
Bc palliative care benefits information for prescribers. The benefits and drawbacks of syringe drivers in palliative care. The benefits and drawbacks of syringe drivers in palliative care 2008 international journal of palliative nursing. Centre for palliative care research and education cpcre. The palliative care handbook syringe drivers a syringe driver is a batteryoperated pump which administers drugs subcutaneously consult a specialist for information on the pump used in your area and how to use. Costello j nyatanga b mula c hull j 2008 the benefits and drawbacks of syringe drivers in palliative care. There have been over 5000 articles published globally describing syringe drivers in the medical and nursing literature within the last decade. Cicely saunders original vision on her pioneering journey to establish hospices and hospice care worldwide, was primarily to ensure that excellent care relieved patients suffering as they approached death. The use of a subcutaneous or intravenous infusion using a syringe driver to deliver medications has certain advantages there is less patient discomfort as the.
Burden and benefit of psychosocial research at the end of life. We have now shown the benefits of early palliative care for patients with advanced cancer in two clinical trials, said joseph. Indeed, by 1989, a survey of uk palliative care providers found that most undertook csci in the management of symptoms and that wrights syringe driver was used by the overwhelming majority 96%. Authors andrew dickman and jennifer schneider produced a wellwritten, wellreferenced, and efficient treatment of the modern syringe driver for subcutaneous infusions as used in palliative care. This guideline concentrates on safe use of the mckinley t34 ambulatory syringe driver in adult palliative care. However, in order for the large and rapidly growing number of. Advantages and disadvantages of using a syringe driver46. Complete the medication additive label and place on the extension line.
Use of t34 syringe driver hospital palliative care service. This article explains how to administer drugs safely using these devices. There is a common misconception that they are the last resort and that using one means that you are close to passing away. In conclusion to the above information our syringe driver training can be booked easily. Morgan s, evans n 2004 a small observational study of the longevity of syringe driver sites in palliative care. Procedure for the use of mckinley t34 syringe driver to deliver a continuous subcutaneous infusion in palliative care for adults policy authors palliative care team kate hall accountable executive lead chief nurse approving body patient safety committee, drugs and therapeutic committee. Do not put the label on the syringe or any part of the pump this alters the syringe diameter and the volume will be miscalculated by the pump.
Policy and protocol for the use of the cme medical mckinley t34 syringe driver for adults in palliative care policy no. You might have been given a syringe driver, to help control pain, sickness, agitation or fits. Kain project officer, centre for palliative care research and education professor patsy yates acting director, centre for palliative care research and education. Patients who received early palliative care also scored better on an assessment of their ability to cope with their disease and were more likely to discuss endoflife care preferences with their health care team. Christine hirsch, jeremy johnson and christina faull, medicines management in palliative care, handbook of palliative care, 409436, 2008. Bc palliative care benefits are available to bc residents of any age who have reached the end stage of a lifethreatening disease or illness and who wish to receive palliative care at homemeaning wherever the person is living, whether in their own home, with family or friends, in a supportiveassisted living residence, or in a hospice unit at a residential care facility e. Here are some of the possible advantages and disadvantages of hospice care that you should consider. Home cpcre centre for palliative care research and education. Syringe pumps are a vital tool for administering medicine, especially in palliative. Pdf this article will outline the use of continuous subcutaneous infusion pumps, known as syringe drivers, including their benefits and. 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. In a palliative care setting, subcutaneous administration of medicines given via a syringe driver is useful for managing symptoms such as pain, nausea, anxiety and restlessness.
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