Syringe drivers (also known as pumps)
Please be aware - this information is for healthcare professionals
When someone is at end of life, there may be occasions when the oral route for medication is not the best option.
This may be the case if:
- the patient’s swallowing is compromised
- the absorption rate of medication is questionable
- the patient is experiencing nausea and vomiting
- more effective delivery is required (an even dose over a period of time)
What is a syringe driver used for?
The main symptoms and typical drugs a 24-hour driver is used for are:
- pain – diamorphine, morphine, oxycodone, ketamine
- nausea and vomiting – metoclopramide, cyclizine,
- agitation – midazolam, haloperidol, levomapromazine
- secretions – hyoscine buyltbromide/hydrobromide, octreotide, glycopyrronium
- fluid overload
A driver can also be used over a shorter period of time for an infusion of specific medication.
If a driver is set up, will the patient die sooner?
A syringe driver is set up to manage symptoms and can be used at any point in a person’s illness. Sometimes they are used to manage chronic pain where other methods have been ineffective. They can also be used as an alternative to having regular, repeated injections, which can restrict what a person can do and where they can go.
It is important to recognise this as there can be some misconceptions surrounding the use of syringe drivers. Using one won’t cause the patient to die sooner and it is important to reassure families about this.
You may find it helpful to share our information about syringe drivers with patients and their family or friends.
Is there anything special that I need to know or look out for when a syringe driver is in place?
Things to look out for can include:
- alarms sounding
- a kinked line
- leaking from the equipment
- placement/positioning (tucked slightly under a pillow can be a good place)
- tissue damage at the site of the needle
- do not get the syringe driver wet – put it in a carrier bag when providing personal care
- report it if the driver gets wet or is dropped
- do not position the driver in the sun
It’s important to remember to check the site and the driver regularly and after any intervention.
What shall I do if the driver is in place when the patient dies?
You should have local guidelines that tell you what to do in this situation. However, as a general rule it is best to leave it in place until after death has been verified by a qualified person such as the GP or district nurse. There are several reasons for this:
- There is a ‘sharp’ to dispose of.
- There are usually controlled drugs in the syringe.
- The family may think the driver is keeping the person alive.
- The coroner is involved at the request of the patient’s GP.
The district nurse will usually remove the driver before the body is taken to the undertakers.
Points to remember
- A syringe driver can be used to manage symptoms when other routes are ineffective or compromised.
- A syringe driver does not hasten death.
- The site and equipment should be checked regularly and at every intervention.
- Check what your local guidelines are regarding if the patient dies while the syringe driver is in use.
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