SYRINGE DRIVER MEDICATIONS Christine Hull & Anita Webb Staff Nurses, Hospice in the Home 2015
Analgesics:- Groups of Medication used in Syringe Drivers Morphine sulphate Diamorphine Oxycodone Alfentanil
Anti-emetics Cyclizine Metoclopramide Haloperidol Levomepromazine
Sedation Midazolam Levomepromazine Haloperidol
Anti-secretory Hyoscine Butylbromide (Buscopan) Hyoscine Hydrobromide Glycopyrronium
Others Diclofenac Dexamethasone Ondansetron Octreotide
Diluents and Compatibility Drugs in syringe drivers are generally prepared with a diluent, commonly water for injection or Sodium Chloride 0.9% The diluent used should be compatible with the medicines to minimise site reactions and enable medicines to be given over a set period The appropriate diluent can contribute to symptom management and wellbeing of the patient
Watson et al (2011) Palliative Adult Network Guidelines 3rd Edition recommend water for injection as the diluent of choice with specific exceptions For example:- Sodium Chloride is the diluent of choice for Ketamine and Diclofenac
Drug Compatibility This is dependant on a number of factors which include:- Dose and strength of medicine Ph of each medicine and the final solution Diluting the mixture to the maximum volume may reduce both the risk of adverse site reactions and incompatibility The more drugs mixed together, the greater the risk of incompatibility
Troubleshooting If the solution in the syringe driver precipitates, crystallises or discolours, it may result from:- Solution being too warm Solution being over exposed to sunlight Too many medications added to the syringe Medications are not compatible Medication is past its expiry date Subcutaneous infusions should be monitored regularly to avoid the above Patient should be monitored regularly if symptom control is to be maintained
Transdermal patches If a patient is currently using a transdermal Buprenorphine or Fentanyl patch, treatment should continue when starting a syringe driver Breakthrough pain should be treated with equivalent breakthrough doses of s/c opioid For example, a Fentanyl patch of 25mcgs/hr requires a breakthrough of 5mgs of Diamorphine The total daily breakthrough medication is then given via the syringe driver in addition to the transdermal patch
Drug Conversions Oral Morphine to s/c Diamorphine divide 24hr dose by 3 For Example:- 180mg Oramorph in 24 hrs = 60mg s/c Diamorphine in 24 hrs Breakthrough dose is 1/6 th of 24hr dose, which is 10mg s/c Diamorphine
Drug Conversions cont. Oral Morphine to s/c Morphine divide 24 hr dose by 2 For example:- 60mg Oramorph = 30mg s/c Morphine Sulphate Breakthrough dose is 1/6 th of the 24hr dose, which is 5mg of s/c Morphine Sulphate
Drug Conversions cont. Oral Oxycodone to s/c Oxycodone divide the 24hr dose by 2 For example:- 20mg of oral Oxycodone = 10mg s/c Oxycodone
Drug Conversions cont. s/c Diamorphine to s/c Oxycodone For example:- 40mg of s/c Diamorphine = 120mg Oramorph 120mg of oral Oramorph = 60mg oral Oxycodone 60mg of oral Oxycodone = 30mg s/c Oxycodone
Converting m/r Morphine to Diamorphine For example:- Zomorph 30mg bd = Zomorph 60mg in 24 hrs Divide by 3 = 20mg s/c Diamorphine Breakthrough dose = 2.5 5mg s/c Diamorphine
Converting s/c Diamorphine to s/c Alfentanil Alfentanil is approximately 10 times as potent as Diamorphine For example:- 10mg s/c Diamorphine = 1mg s/c Alfentanil Breakthrough dose is 1/10 th of the 24hr dose which is 0.1mg s/c Alfentanil