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Using syringe drivers

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Syringe Drivers are small portable (usually battery-operated) devices used to administer medications in palliative care. A single drug, or more often 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.

Common indications for use of syringe drivers in palliative care include:

  • dysphagia
  • intractable nausea
  • intractable vomiting
  • poor enteral (gut) absorption of oral medications
  • weakness or altered level of consciousness.

Why it matters

The portability of syringe driver and suitability for all clinical settings are advantages to this means of administering medicines. This can remove or diminish the need for intramuscular or intravenous injections. As syringe drivers provide a constant level of medicine, the plasma concentration remains at the optimum therapeutic level with no peaks or troughs.

In practice

Syringe drivers can be used intermittently or discontinued if symptoms can later be managed by the oral route. If the person is able to move around, they might find it helpful to have a syringe driver bag to keep it safe and in a comfortable position.

Although syringe drivers are a convenient method of medication delivery, not all medications can be delivered subcutaneously.

For nurses to correctly use syringe drivers, they need to be adequately trained. Other disadvantages include:

  • Limited volume of the syringe may mean daily visits from community nurses.
  • Finding suitable skin sites for the syringe driver may be difficult for emaciated patients.
  • Local reactions at the needle insertion site can be uncomfortable and may result in sub-optimal symptom control. These reactions can be caused by irritation from medication(s) or infection.
  • Drugs may precipitate, that is, some solid matter forms. It is important to check the compatibility of drugs before combining in a syringe. If you notice indicators of precipitation such as the solution is cloudy or discoloured then discard.

Some people might be worried that the use of a syringe driver causes the person to die sooner. It is important to discuss with them why the syringe driver is being considered. Listen to their concerns and reassure them that the syringe driver is a safe and effective way to manage their symptoms. You can also reassure them that analgesics and other medicines are safe and effective when prescribed appropriately and administered correctly.

Nurses need to visit regularly (usually daily) to review the person’s symptoms and set up a new syringe of medication. They will also change the cannula regularly.

In the meantime, certain things need to be monitored routinely. These include:

  • checking that the syringe driver is working well and is free of damage
  • checking the area around the cannula for signs of infection, or irritation from the medicines, including:
    • skin irritation or
    • skin discomfort or
    • skin discolouration – redness on lighter skin tones or change to a colour different from the surrounding area (usually darker) in darker skin tones
  • checking that the area around the site clean and dry and that there is no leakage
  • checking the line to make sure it is not twisted, kinked, trapped, or caught
  • checking there are no white particles (precipitate) along the tube
  • placing the syringe pump in a safe and comfortable position, for example, tucked slightly under a pillow.

If the syringe driver alarm sounds check for empty syringe, blocked needle, or tubing (includes kinked tube), or jammed plunger.

Detailed information about commonly used medications, incompatibilities, contraindications, equipment, and techniques are available in the:

Caution must be taken when looking at any overseas information as there can be differences in the drugs, dosages and devices that are used.

Education

As with any intervention or change to patient care, adequate education and support should be provided to the person receiving care and their support network. Education and support are important for people caring for someone at home who has a syringe driver. Caring@home provides online education for nurses on supporting carers to manage subcutaneous medicines.

Visit Caring@home for online education

Caring@home

Learning about syringe drivers

For online education on using the NIKI T34™, T34™ & BodyGuard™ T syringe pumps visit PallConsult, an initiative of Queensland Health.

This information was drawn from the following resources:

 

  1. Dickman A, Schneider J. The Syringe Driver: Continuous subcutaneous infusions in palliative care. 4th ed. Oxford: Oxford Academic; 2016.
  2. Ferrell BR, Paice JA, editors. Oxford textbook of palliative nursing. 5th ed. Oxford: Oxford University Press; 2019.
  3. Mitchell K, Pickard J, Herbert A, Lightfoot J, Roberts D. Incidence and causes for syringe driver site reactions in palliative care: A prospective hospice-based study. Palliat Med. 2012 Dec;26(8):979-85.  doi: 10.1177/0269216311428096. Epub 2011 Nov 14.
  4. Safer Care Victoria (SCV). Syringe driver compatibility: Guidance document. Melbourne: SCV; 2021.
  5. Therapeutic Guidelines Limited. Palliative care [Internet]. 2016. [updated 2016 Jul; cited 2022 Aug 8].
  6. Thomas T, Barclay S. Continuous subcutaneous infusion in palliative care: a review of current practice. Int J Palliat Nurs. 2015 Feb;21(2):60, 62-4. doi: 10.12968/ijpn.2015.21.2.60.
  7. Principles of drug use in palliative care. In: Watson M, Ward S, Vallath N, Wells J, Campbell R, editors. Oxford handbook of palliative care [Internet]. Oxford: Oxford University Press; 2019. [cited 2022 Aug 8].

Syringe driver resources

Download CPCRE's Guidelines for subcutaneous infusion devices (4.7MB pdf)

View PallConsult's online learning package on syringe drivers

Access more Syringe Driver resources 

Page updated 11 November 2024

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