The pain of bowel colic may be reduced by loperamide hydrochloride. When an infusion is due to be changed, a delay of an hour or two should not cause problems if the patient’s symptoms are well controlled. An additional dose should also be given 30 minutes before an activity that causes pain, such as wound dressing. Home Medicines guidance Prescribing in palliative care. A syringe driver simply provides an alternative route for the administration of medicines.

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Palliative care : Terminal Care

Pain management with opioids Oral route Treatment with morphine is given by mouth as immediate-release or modified-release preparations. Each patient should be assessed on an individual basis. Circulatory and respiratory changes As the heart slows and the heartbeat is irregular, circulation of blood is decreased to the extremities. Midazolam is the benzodiazepine antiepileptic of choice for continuous subcutaneous infusion.

BPJ When and how to use a syringe driver in palliative care

The table shows approximate equivalent doses of morphine and morpphine hydrochloride. As a general guide, plastic cannulae can stay in place for up to a week or more, whereas metal cannulae remain viable for approximately morlhine hours. The preferred sites for insertion of the cannula for a continuous subcutaneous infusion are: It should be prevented if possible by the regular administration of laxatives; a faecal softener with a peristaltic stimulant e.

Specialist palliative care is available in most areas as day hospice care, home-care teams often known as Macmillan teamsin-patient hospice care, and hospital teams. Palliative care is an approach that improves the quality of life of patients and their families facing life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable sytinge and treatment of pain and other problems, physical, psychosocial, and spiritual.


Anorexia Anorexia may be helped by prednisolone or dexamethasone. Cannula site – for redness, swelling, leakage or cannula blockage or displacement Tubing – for kinks or knots in the tubing Syringe – for precipitation or crystallisation, discolouration of solution Syringe driver – mifazolam ensure that the syringe remains in the correct position, that the infusion is running at the correct rate and the syringe driver battery has enough power to last until the next check.

The pain of muscle spasm can be helped midazolm a muscle relaxant such as diazepam or baclofen.

Terminal Care

A suitable laxative should be prescribed routinely. These measures will assist in relieving anxiety, however agitation and restlessness may continue if the cause is due to pain, hypoxia, nausea or metabolic disturbances. Midazolam is a sedative and an antiepileptic that may be used in addition to an antipsychotic drug in a very restless patient.

For the treatment of nausea and vomiting associated with cancer chemotherapy see Cytotoxic drugs. Subcutaneous infusion solution should be monitored regularly both to check for precipitation and discolouration and to ensure that the infusion is running at the correct rate.

A prokinetic antiemetic may be a preferred choice for first-line therapy. Morphine, hyoscine, haloperidol, metoclopramide and midazolam are all compatible and can be combined to be delivered as a subcutaneous infusion. In a palliative care syrimge, subcutaneous administration of medicines given via a syringe driver is useful for managing symptoms such as pain, nausea, anxiety and restlessness.

Drugs with antimuscarinic effects antagonise prokinetic drugs and, if possible, should not be used concurrently. Staff using syringe drivers should be adequately trained and different rate settings should be clearly identified and differentiated ; incorrect use of syringe drivers is a common cause of medication errors.

It may be possible to revert back to the use of oral medicines once control ,idazolam the nausea and vomiting is achieved. Precipitation may occur as a result of a reaction between medicines in a syringe. The infusion is discontinued when the first oral dose of morphine is given.


Bowel colic and excessive respiratory secretions Bowel colic and excessive respiratory secretions may be reduced by a subcutaneous injection of hyoscine hydrobromidehyoscine butylbromideor glycopyrronium bromide. Parents need to know that these physical midazola, are a normal part of the dying process. Convulsions Patients with cerebral tumours or uraemia may be susceptible to convulsions.

When and how to use a syringe driver in palliative care

Respirations may be rapid, shallow and irregular. In most cases, a healthcare professional trained in the use of syringe drivers, e. When an infusion is due to be changed, a delay of an hour or two should not cause problems if the patient’s symptoms are well controlled. Dry mouth Dry mouth may be relieved by good mouth care and measures such as chewing sugar-free gum, sucking ice or pineapple chunks, or the use of artificial saliva ,dry mouth associated with candidiasis can be treated by oral preparations of nystatin or miconazolealternatively, fluconazole xyringe be given by mouth.

For the child dying at home it is important that their treating hospital has dispensed a home care pack containing drugs that may be required in the terminal phase of care. The Graseby syringe driver has been gradually phased out of use as it was not tamper-proof.

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