Syringe Drivers in Practice
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Syringe Drivers

What we know

Syringe drivers are small portable (usually battery-operated) devices used to administer medication in palliative care. A single drug or a combination of drugs is given via a slow continuous subcutaneous infusion to help control symptoms when other routes of administration are no longer viable, feasible or preferred. Although reliable and convenient, some patients and carers may be reluctant to use a syringe driver as it may have negative connotations. For end-of-life care for older people in residential aged care, syringe drivers can be effective in managing symptoms of nausea, vomiting, pain and respiratory distress. People who use syringe drivers need to be competent and confident so that errors do not occur.

What can I do?

When reviewing medications, consider the place of care, availability of medications and equipment, and who will be available to manage the medications.

When considering the use of a syringe driver, consider:
  • the practicalities - clothing, bathing, showering, sleeping position
  • the medication transition from oral to subcutaneous; a breakthrough dose is usually given to ensure there is not a gap in medication
  • drug compatibilities.
     
Explain to carers and the client or the resident and carer(s) the benefits of a syringe driver.

Check whether those providing care have the skills to manage a syringe driver.

The use of the syringe driver needs to be done in consultation with the patient, carer, and family, in a manner that ensures that any concerns are addressed. These may include:
  • reassurance that if the person continues to experience symptoms, breakthrough medication can be given on these occasions
  • an explanation that a syringe driver allows the symptoms associated with the process of dying to be managed, without speeding up the process of dying
  • addressing any concerns or anxieties about the syringe driver, including the medications used, e.g. opioids
  • concerns from previous experience with syringe drivers.
     
Choose the insertion site carefully if the person is agitated or distressed.

Ensure that the carer can check the site and battery level every four hours during the day and that he/she has access to a 24-hour support.

Ask the carer to keep a record of when ‘as needed’ or ‘breakthrough' medications are used to control symptoms (such as pain, dyspnoea or nausea). Healthcare providers can use this information to adjust a person's medication or the mode of delivery of medication.

Use the syringe driver drug compatibility calculator (704kb pdf).

Remember that a syringe driver is a dynamic administration system which means that when multiple drugs are in the syringe driver, increasing the rate will increase the dose of all drugs in the syringe.

Use the resources from the Caring Safely at Home Project to help carers manage subcutaneous medications. Provide a carry bag for the syringe driver to help the person to be mobile.

 

What can I learn?

Complete the learning module: Management of Subcutaneous Infusions in Palliative Care from Centre for Palliative Care Research and Education (CPCRE), Queensland.

Complete the free online NIKI T34™ syringe pumps learning module (intermediate to advanced level) from PallConsult Queensland which includes a handbook, an illustrated guide, three videos and a competency checklist

Undertake caring@home education modules on supporting carers to manage breakthrough symptoms safely using subcutaneous medicines.

Read:

 

What can my organisation do?

Develop a policy and procedures for managing palliative care medication including the use of syringe drivers.

Use this Drug compatibilities resource (704kb pdf) to formulate a list of medications that are commonly used for symptoms in the terminal phase and those which are suitable for syringe drivers. (Eastern Metropolitan Region Palliative Care Consortium, 2016)

Educate staff about the appropriate use of medications to control common terminal symptoms and ensure appropriate staff members have regular training to maintain a good level of competency with syringe drivers.

Limiting use to only one type of syringe driver can minimise procedural risk.

Where more than one device is used in a particular setting, ensure that are staff competent in the use of each individual device.

Page updated 24 April 2020