What are syringe drivers?
Syringe drivers, also known as syringe pumps, are battery-operated devices that deliver a continuous subcutaneous infusion (CSCI) of medications, typically over 24 hours. [1,2] These devices are commonly used in palliative care when oral medication administration is not possible due to conditions such as difficulty swallowing, persistent nausea, vomiting, concerns with oral absorption or reduced consciousness. [3,4]
These devices may help maintain steady medication levels in the body, supporting symptom control for pain, nausea, vomiting, agitation and a variety of other symptoms. [5,6] Medications commonly used in syringe drivers include opioids for pain relief, antiemetics for nausea and vomiting, and sedatives for agitation or distress. [7] The continuous delivery of medications can help reduce symptom fluctuations, making them a valuable tool in terminal care. [1,6]
Why syringe drivers matter in aged care
In aged care settings, syringe drivers are often used to support symptom management for residents receiving palliative care. [2,5] Many older people experience progressive frailty or cognitive decline, making it difficult to take medications by mouth. [3,7,12] The use of syringe drivers may help ensure consistent symptom relief, particularly in settings where access to specialist palliative care is limited. [6]
The Aged Care Quality Standards highlight the importance of providing safe and effective clinical care that aligns with residents’ needs and preferences. Standard 3, which focuses on personal and clinical care, is particularly relevant as it emphasises effective management of health conditions and symptoms. [8] The use of syringe drivers support compliance with the Quality Standards by ensuring appropriate symptom management and person-centred care. [4] However, their use should be guided by careful clinical assessment and regular monitoring to avoid unnecessary or inappropriate administration. [7]
What the evidence tells us
Research on syringe drivers highlights both benefits and challenges associated with their use. Studies have shown that continuous subcutaneous infusions can help stabilise symptoms more effectively than intermittent dosing, particularly in people experiencing refractory pain, persistent nausea, or severe agitation. [1,9] Evidence also suggests that prescribing practices vary considerably between care settings, with some inconsistencies in medication choices and dose titration. [3,10]
Another key consideration is the role of anticipatory medications. While obtaining prescriptions for syringe drivers in advance of need may help prevent crisis situations, this should be done cautiously to ensure that medications are only initiated when clinically necessary. [6] Practice should instead be to write pre-emptive prn medications on drug chart for end-of-life symptoms such as pain and respiratory secretions. Then based on prn use, a syringe driver can be commenced when clinically required. Regular review by skilled clinicians can help mitigate risks and optimise patient outcomes. [7]
Cultural considerations
Cultural factors play a significant role in how syringe drivers are perceived and accepted in different communities. Some people associate syringe drivers with the final stages of life, which may result in reluctance to use them. [5,6] Providing culturally responsive care is essential to addressing these concerns. Healthcare practitioners have reported challenges in delivering palliative care to patients from culturally and linguistically diverse (CALD) backgrounds, highlighting the importance of open communication and understanding individual cultural beliefs and preferences. [9,10,11]
For Aboriginal and Torres Strait Islander peoples, traditional therapies are often integrated into palliative care, which can influence attitudes towards medical interventions such as syringe drivers. [11] Incorporating traditional healing practices alongside syringe drivers, where appropriate, may improve acceptance and engagement with palliative care services. [10,11] Healthcare providers should adopt a person-centred approach that respects cultural beliefs while ensuring effective symptom management. [9,10,11]
Implications for families and carers
Families and carers in both residential and home care settings may experience challenges when syringe drivers are introduced. It is important to initiate early discussions about palliative care, ensuring that families understand the role of syringe drivers in managing symptoms rather than hastening death. [2,8] Effective communication can help alleviate concerns and support informed decision-making for both families and care teams. [7]
The need for clear guidance is particularly relevant in-home care settings, where family members often take on caregiving responsibilities with minimal clinical support. Ensuring that carers receive adequate education on recognising distress, understanding medication administration, and knowing when and how to seek professional input is essential. [4] In residential aged care, staff training and interdisciplinary collaboration play an important role in promoting comfort and symptom control while supporting families during the transition to end-of-life care. [6]
Healthcare professionals can assist families by offering ongoing education, practical resources, and reassurance about the benefits of syringe drivers in improving comfort. Collaborative decision-making, where families are engaged in discussions about their loved one’s care, can help address concerns and foster a sense of preparedness. [9]
Page updated 24 February 2025