Cyclizine is the drug which seems to precipitate most commonly in the syringe driver and causes problems with poor absorption and site reactions. Drug calculations for nurses infusion pump calculations by. The maximum number of drugs that respondents were prepared to mix in a single syringe was usually three 51% or four 35%. A syringe driver or syringe pump is a small infusion pump some include infuse and withdraw capability, used to gradually administer small amounts of fluid with or without medication to a patient or for use in chemical and biomedical research. Syringe driver adrenaline 3 mg50 ml 60 50 ml 12 mg ml gml0. Staff using syringe drivers should be adequately trained and different rate settings should be clearly identified and differentiated.
The formula to work out the dose is under each drug name. Ensure that drug calculations are checked according to legislative requirements and organisational policy and protocols when the syringe driver is setup17. If the patient is in pain, vomiting or very agitated, give a stat sc injection of appropriate medication while setting up the syringe driver. The method is the same, if the same final concentration is desired. To determine knowledge and skills criteria for the preparation, administration of medicine, use of mckinley t34 syringe driver and patient monitoring. The more drugs that are mixed together, the greater the risk of precipitation and reduced efficacy9. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Syringe drivers are often required to provide medicines for symptom. Opioid dose conversion chart, syringe driver doses, rescue prn doses and opioid patches use the conversion chart to work out the equivalent doses of different opioid drugs by different routes. 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. April 2017 introduction palliative care patients often exhibit multiple symptoms that require the use of numerous drugs.
Calculate the rate at which you should set the syringe driver, in mlhour. In many cases, drawing a picture that visually represents the problem is often a helpful strategy. Guidelines for syringe driver management in palliative care. A syringe driver takes 34 hours to establish a steady state drug level in plasma. If given in too high concentrations, local anaesthetic used in epidural infusions can cause extensive motor blockade, leading to immobility and pressure ulcers, which is. Medications commonly used in syringe drivers in new zealand. If the rate is to be set in mm, the volume to be adminstered by a syringe driver depends on the diameter of the syringe barrel as well as on the rate setting. Calculate fio2 when air is being used rather than n2o.
The syringe driver advisory group was set up by the new zealand palliative care working party in december 2007 to facilitate a smooth and safe transition to an approved alternative device. Clinical protocol for the use of syringe drivers in palliative care patients. They can be used in hospital, in hospices and at home. Subcutaneous ketamine infusion in a syringe pump 2 drug combinations.
Medications contraindicated for use in a syringe driver. The driver would then calculate the exact volume and a rate would be set in mlh. A syringe driver is a small, batterypowered pump that delivers medication at a constant rate throughout the day and night. Always indicate on the regular prescription chart that a 4 hourly care test syringe driver working syringe driver is in use. For some syringe drivers the rate is set according to the distance travelled by the plunger in mm per hour or mm per 24 hour. The preparation of the individual drugs for the syringe is unchanged, but attention to the rate of administration is needed. For most syringe pumps the rate is set according to the volume of solution injected per hour i. Three of the commonest syringe drivers in the west midlands region are 1,2. Helps you calculate the rate in whole drops per minute when administering iv bags of fluid. Syringe driver drug compatibilities guide to practice 20 july 20 these guidelines have been ed. You might have a syringe driver for medicines to help manage pain, sickness, fits, agitation or breathing problems. A syringe driver is used to give continuous medications subcutaneously when a person is no longer able to swallow. Syringe driver competency programme arohanui hospice.
You dont need to use any dosage calculation formulas. If compatibility is an issue, the use of two syringe driver devices3 or. What i hear, i forget, what i see, i remember, what i do, i understand. The syringe driver is a small, portable batterydriver infusion pump, used to give medication subcutaneously via a syringe usually over 24 hours. Calculate conversions from oral opioids to subcutaneous opioids. The syringe driver is a simple and costeffective method of delivering a continuous subcutaneous infusion csci.
Mum was under hospital admission when she passed, however the day she died, the staff administrated a morphine syringe driver into the thigh. In fact, most benzodiazepine equivalence estimates are based on expert opinion, uncited tables in published documents, and clinical practice. Drugs for subcutaneous administration in syringe drivers. With combinations of 2 or 3 drugs in one syringe, a larger volume of diluent may be needed e. Because of widely differing views on the drugs that can be administered in combination, this study was undertaken to record the combination of drugs in syringe drivers that we had found to be compatible.
Calculating subcutaneous morphine to subcutaneous diamorphine. Mar 30, 2015 drugs in syringe pumps are generally prepared with a diluent commonly water for injections, or sodium chloride 0. The most common syringe driver in use was the graseby 26 61% of responding units. Thcontinue with prn midazolam calculate dose as 16 of syringe driver dose. Only use drugs that are known to be effective via the sc route.
Syringe drivers are battery operated pumps for delivering infusions that usually run over 24 hours. A syringe driver is a small batterypowered pump that delivers medication at a constant rate through a very fine needle under the skin. Data sources include ibm watson micromedex updated 4 may 2020, cerner multum updated 4 may 2020. The maximum volume of fluid in a 30ml syringe is 22ml if a 20ml luer lock system is used, the maximum volume of fluid in a 20ml syringe is 17ml lock on volume to be infused over 24 hours to stop syringe driver unlock cassing key in syringe driver medication box, press stop key diluent. Guidelines for syringe driver management in palliative care in new. Increase the dose of midazolam accordingly up to 30mg in syringe driver over 24 hours. Syringe driver drug compatibilities guide to practice 20. Identify medications commonly used in syringe drivers in palliative care and the rationale for. Calculate desired rate setting for iv infusion pumps, given weight, drug concentration, and desired dose. They are a safe and effective way to give medicines for symptoms such as pain, nausea and vomiting, seizures, agitation and respiratory secretions. If opiates or, indeed, most drugs, have been calculated incorrectly, the consequences for patients can be serious. Additional drugs may be needed if a syringe driver is required, or to cover a weekend. Safe practice in syringe pump management nursing times.
The niki t34 syringe driver is a small, portable battery operated, programmable, ambulatory syringe pump that delivers the contents of a 2 to 50ml syringe over a specified duration of time or at a given rate in millilitres per hour mlhr. A syringe driver pushes the plunger of a syringe forward at an accurately controlled rate. 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. The syringe driver is a small, portable battery driver infusion pump, used to give medication subcutaneously via a syringe usually over 24 hours. Calculate and combine doses for two medications to be mixed in one syringe to the nearest measurable dose.
When and how to use a syringe driver in palliative care. Calculate the total dose of drug required in 24 hours and then divide volume of solution by 24, to give a rate per hour. Slide 1 sc administration of medications using a syringe. Syringe pumps also known as syringe drivers are commonly used for people living with a terminal illness. Welcome to the syringe driver survey database sdsd the sdsd is a database of the visual appearance of drug combinations reported in prospective international multicentre surveys and also from individual reporting. The most common duration for a syringe driver is over 24 hours. The prescription states only the type and volume of fluid. Drugs in syringe pumps are generally prepared with a diluent commonly water for injections, or sodium chloride 0. Because of widely differing views on the drugs that can be administered in combination, this study was undertaken to record the combination of. The eastern metropolitan region palliative care consortium emrpcc grants permission to reproduce parts of this publication for clinical and educational use only, provided that the emrpcc is acknowledged. The dose will be adjusted using the syringe driver pump according to the response to treatment, with the aim to establish a normal blood pressure. Most units delivered the contents of the syringe over 24 h, and water was usually used as the diluent in 90% of cases.
Dosch clinical mathematics 2019 6 what if, for some reason, you had to prepare a 20 ml syringe. Lets say you only happen to have a 20 ml syringe at hand. Your medicines are put in a syringe, and the syringe driver pushes the medicines through a soft plastic tube and into your body. The patient may require a dose of immediate release medication prior to commencement of the syringe driver, as medication from a syringe driver may take up to four hours to reach the desired blood level. When the oral route is no longer appropriate, a syringe driver can be used to ensure continued symptom control. This dilutes the medicine to minimise site reactions and enables it to be given over a set period. Syringe drivers have been the mainstay of delivery and administration of drugs in palliative care for many years. Double this measurement to calculate the rate in mm per 12 hours ie, twice as fast. There are many uses of syringe drivers, with the most common use being in palliative care for symptom control.
Drug calculations for nurses made easy nursing times. Mar 15, 2015 an educational video to aid student nurses with infusion pump calculations by the minute. When and how to use a syringe driver in palliative. 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. The use of the niki t34 syringe pump via the subcutaneous route is. The device and the prescriptions for the driver can pose many problems. Different makes of syringe may have different barrel sizes. Advanced medicines calculations infusion rates and. Drug calculations for nurses infusion pump calculations. Call the advice line if advice is needed at any time. A csci provides a safe and effective way of drug administration and can be used to maintain symptom control in patients who are no longer able to take oral medication.
Commonly used drugs drug usual dose range indication clonazepam 16 mg24 hours agitation, confusion, seizures cyclizine 75150 mg24 hours. Cyclizine is not compatible with hyoscine butylbromide or oxycodone in a syringe driver. The guidance above are well accepted drugs and doses used at the endoflife. The prn dose of opioid should be calculated from the dose of. In cases where patients are already on significant doses of opioids, or already on injectable medications, and. A macmillian nurse later visited mum and the driver was changed to also include antisickness drugs as well as the pain releif and then within about 45 hours mum had passed away. If midazolam 30mg in syringe driver is reached and symptoms are not controlled, please seek advice. A critically ill patient who weighs 75 kg is prescribed noradrenaline. District health boards of new zealand dhbnz has recommended the ad ambulatory syringe. In cases where patients are already on significant doses of opioids, or already on injectable medications, and the circumstances of their likely. For some syringe drivers the rate is set according to the distance travelled by the plunger in.
Calculate syringe driver operates rate using simple dosage calculator. Present absent prescribe in anticipation of symptom midazolam. Different, fixed dosages the dosage of these drugs is usually set by the doctor according to the patients needs or age e. The pack contains enough drugs to achieve initial symptom control or to last overnight only. Syringe driver operates rate calculator azcalculator. Prescribing in palliative care medicines guidance bnf. Dec 02, 2016 a syringe driver takes 34 hours to establish a steady state drug level in plasma.
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. The label on the medicine bottle states the concentration of the medicine. For information on the usual doses of drugs used in a syringe driver see inside of back cover. Guidelines for syringe driver management in palliative. Drug compatibility in subcutaneous infusions chart in. Amount of fluid ml infusion time hours working out iv drip rates gravity method. They are a safe and effective way to give medicines for symptoms such as pain, nausea and vomiting, seizures, agitation and. Unlike opioid equipotent dosing, benzodiazepine equivalence is much less evidencebased and poorly described in the literature.
If given in too high concentrations, local anaesthetic used in epidural infusions can cause extensive motor blockade, leading to immobility and pressure ulcers, which is distressing to the patient lee, 1991. Feb 09, 2014 ems drug calculations vial to syringe ems seo. Syringe drivers are particularly valuable for patients in the community. Any patient receiving medication via a syringe driver check volume of fluid remaining. This calculator determines the liquid or solution volume to be injected by syringe into the patient. Diazepam, chlorpromazine and prochlorperazine are too. July 2015 part 2 drug infusion guidelines page 1 1 adrenaline infusion adultadrenaline a. One dosage drugs with one fix dosage are the easiest in use. This conversion tool estimates a reasonable equipotent dose between two benzodiazepines. It is important to remember that a syringe driver is an alternative route for drug delivery. How to solve drug calculations identify what type of drug calculation and as a first step, use common sense to estimate a rough answer.