They can be used in hospital, in hospices and at home. Use either water for injection or sodium chloride 0. Syringe driver drug compatibilities practice guidelines 2016 eastern metropolitan region palliative care consortium victoriaclinical working party 3. For further information on compatibility in a syringe driver contact. Drug interactions alfentanil can interact with other drugs. Dec 02, 2016 a syringe driver takes 34 hours to establish a steady state drug level in plasma. Jan 22, 2020 cyclizine is a histamine h 1 receptor antagonist of the piperazine class which is characterised by a low incidence of drowsiness. A skin reaction at the infusion site is most commonly found with cyclizine, ketamine, levomepromazine. Drugs for subcutaneous administration in syringe drivers. Syringe drivers no long term studies have been conducted in animals to determine whether cyclizine has a potential for carcinogenesis. Combinations of two, three or more of these drugs occasionally need to be coadministered via.
Generally all of the drugs included in the section. Points on mixing medications adapted from palliative care matters website. Mixing of medications in this manner is unlicensed but is supported by practice. At higher diamorphine doses, either put cyclizine in a second syringe driver or use levomepromazine as a single daily sc injection instead. Portable infusion pumps are used in palliative care to deliver a continuous subcutaneous infusion of medication over 24 hours.
Water for injection, haloperidol, hyoscine hydrobromide, morphine sulfate, morphine tartrate. District health boards of new zealand dhbnz has recommended the ad ambulatory syringe. Posology for the prevention of postoperative nausea and vomiting, administer the first dose by slow intravenous injection 20 minutes before the anticipated end of surgery. Drowsiness may affect performance of skilled tasks e. Cyclizine is the drug which seems to precipitate most commonly in the syringe driver and causes problems with poor absorption and site reactions. When changing the syringe driver using new medication. Levetiracetam injection 100mgml can be given via a syringe driver using a po. Syringe driver drug compatibilities guide to palliative care practice 2016 sodium chloride 0. Dexamethasone compatibility is unpredictable and is best given in a separate syringe driverpump if possible or as a bolus subcutaneous dose once daily. 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. To mix or not to mix compatibilities of parenteral drug. When added to a syringe driver the diluent must be water for injection. Subcutaneous drug infusion compatibility guidelines. Cyclizine does not mix with oxycodone at therapeutic doses.
Syringe driver drug compatibilities guide to palliative. Syringe driver drug compatibilities the eastern metropolitan palliative care consortium has produced a guide to practice on syringe driver compatibilities. Cyclizine dosage in syringe driver this article is for information only and should not be used for the diagnosis or treatment of medical conditions. Guidelines for syringe driver management in palliative care. Isle of wight syringe driver compatibility guidelines.
All entries will be viewed by pharmacists before addition to the live database. The compatibility tables contain information for a subcutaneous infusion using a cme t34 syringe. Paper pocketbook available to all iow clinical staff ask your palliative care cns. Syringe driver drug compatibilities guide to practice 20. An audit of the compatibility of drug admixtures used for syringe. Alfentanil, at higher concentrations, may be incompatible with cyclizine. A compatibility chart based on studies performed at specified drug concentrations is. Mar 12, 2020 cyclizine dose syringe driver march 12, 2020 scsi and raid devices by admin leave a comment on cyclizine dose syringe driver in the absence of compatibility studies, this medicinal product must not be mixed with other medicinal products. Generally the more dilute the contents are, the lower the risk of compatibility problems and injection site reactions. Thank you for your email dated 22 january 2019 requesting information regarding the trusts syringe driver policy. 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 0. Apr 21, 2019 show table of contents hide table of contents 1. Some acute areas will use nonambulatory pumps, for example alaris pump. When combining medications for syringe driver use, be aware there is data available from compatibility studies for only a few combinations.
April 2017 mixing of drugs for subcut infusion special notes use sodium chloride 0. Aim the aims, through analysis of patient symptom management plans smps, were. Generally there are few compatibility problems with common two and three drug combinations containing. The main exception to this is cyclizine which should always be diluted in wfi. The compatibility tables contain information for a subcutaneous infusion using a cme t34 syringe pump or a nonambulatory pump containing. Cscis are delivered using a syringe driver or pump. Guidelines for the use of the cme t34 syringe pump for adults. Aug 07, 2019 cyclizine was not mutagenic in a full ames test, including use of s9microsomes syrinve can nitrosate in vitro to form mutagenic products. Request for information under the freedom of information act 2019. Samples were stored for periods up to seven days in the light and at room. Mixing and compatibility for the use of syringe drivers in palliative care. Cme t34 syringe pump for adults in palliative care.
Haloperidol and midazolam and cyclizine avoid if oxycodone dose 100mg may. Pregnancy in the absence of any definitive human data, the use of valoid in pregnancy is not advised. Drug combinations may be compatible only at certain concentrations, therefore the concentration of each drug in the syringe should be compared with compatibility data, not the dose. T34 adult syringe driver guidelines harrogate and rural. Syringe driver drug compatibilities guide to palliative care. This article is for information only and should not. When and how to use a syringe driver in palliative care. Syringe pumps also known as syringe drivers are commonly used for people living with a terminal illness. The compatibility and stability of 2b combinations of diamorphine hydrochloride 5100 mgml with cyclizine lactate 550 mgml, eight combinations. Cyclizine should be used with caution in patients with severe heart failure or acute myocardial infarction. Compatibility information compatibility information is limited. Subcutaneous drug infusion compatibility guidelines gippsland.
A marked difference in incidence of syringe driver site reaction was observed between the two study centres 26. Incidence and causes for syringe driver site reactions in. Syringe driver drug compatibilities guide to practice 20 july 20 these guidelines have been ed. April 2017 introduction palliative care patients often exhibit multiple symptoms that require the use of numerous drugs. 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. In this article arrowdown setting up the syringe driver arrowdown drugs used in the syringe driver arrowdown drug compatibility arrowdown problems with syringe drivers. The use of alfentanil in a syringe driver in palliative medicine. For the prevention of postoperative nausea and vomiting, administer the first dose by slow intravenous injection 20 fosage before the anticipated end of surgery. The cme t34 ambulatory syringe driver is a portable, battery operated device for delivering medication by continuous subcutaneous infusion csci, which. Where there is no symbol indicating medication compatibility or unknown symbol, it is not recommended for use, or proceed with caution and closely monitor administration site. 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. Syringe driver drug compatibilities practice guidelines 2011 july 2011. Tachycardia palpitations, arrhythmias see section 4.
Click here to continue to sdsd search page the syringe driver drug compatibility charts, available in the palliative care formulary, summarize both the compatibility data submitted to the sdsd and that from published compatibility references. For information on the usual doses of drugs used in a syringe driver see inside of back cover. T34 adult syringe driver guidelines nhs harrogate and rural. There are a number of different syringe drivers or pumps available but this research concentrates on the use of a mckinley t34 syringe pump, as presently it is the most popular syringe pump being adopted nationwide. Syringe driver drug compatibilities practice guidelines. Please report any incompatibilities to the pharmacy. The british national formulary carries some information about compatibilities in the section prescribing in palliative care. Syringe driver drug compatibilities practice guidelines 2011. Compatibility and stability of subcutaneous infusions. Mixing and compatibility for the use of syringe drivers in palliative care cyclizine may precipitate at concentrations above 10 mgml or in the presence of sodium chloride 0. Syringe driver recording forms were retrieved from case notes of consecutive patients who received medication via a syringe driver. Cyclizine may precipitate at concentrations above 10 mgml or in the presence of sodium chloride 0. Most antihistamines are present in breast milk in varying amounts. Common medicines are compatible with morphine and diamorphine, however cyclizine compatibility is concentration dependent.
If the patient is in pain, vomiting or very agitated, give a stat sc injection of appropriate medication while setting up the syringe driver. Examine the availability of information regarding syringe driver use from patient records within the palliative care database audit and assess the most commonly prescribed drug combinations investigate data supporting the compatibility of the most frequently prescribed drug combinations inform the methodology for. Syringe driver drug compatibilities eastern metropolitan region. Isle of wight syringe driver compatibility guidelines produced by the earl mountbatten hospice, isle of wight written january 2015, revision due january 2018 this guideline is available as a paper pocketbook and a hyperlinked pdf. Only use drugs that are known to be effective via the sc route. Syringe driver drug compatibilities grampians regional palliative. Syringe drivers are frequently used to administer the drugs in. Diazepam, chlorpromazine and prochlorperazine are too. York and scarborough hospital enquiries york medicines information gp enquiries. Therefore, the initial dose by sc infusion should be the same as the previously administered total daily dosage taken orally. Introduction this protocol covers all inpatient and community services within harrogate and district nhs foundation trust hdft. Subcutaneous levetiracetam keppra in palliative and end. The compatibility and stability of 28 combinations of diamorphine hydrochloride 5100 mgml with cyclizine lactate 550 mgml, eight combinations of diamorphine 10100 mgml with haloperidol 24 mgml and eight combinations of all three drugs was assessed after storage in 1 ml polypropylene syringes. Please find detailed below a summary of your request, together with our response.
Morphine, diamorphine and oxycodone combinations in. When the oral route is no longer appropriate, a syringe driver can be used to ensure continued symptom control. Palliative care there are a number of drugs that are commonly delivered via syringe driver to patients having palliative care in the community see box. Use a larger syringe to enable a more dilute solution therefore decreasing drug concentration 2. An association between the presence of cyclizine and levomepromazine and the incidence of syringe driver site reactions was identified. Hyoscine butyl bromide buscopan is occasionally incompatible with cyclizine.
With combinations of 2 or 3 drugs in one syringe, a larger volume of diluent may be needed e. Request for information under the freedom of information act. Subcutaneous ketamine infusion in a syringe pump 2 drug combinations. Isle of wight syringe driver compatibility guidelines palliative drugs. Syringe driver drug compatibilities palliative care victoria. Drug compatibility in subcutaneous infusions chart in. Syringe driver drug compatibility mims online psychiatric wyringe not known disorientation, restlessness or agitation, nervousness, euphoria, insomnia and auditory and visual hallucinations have been reported. Always check on waitemata dhb controlled documents site that this is the most recent version. For guidance on converting between opioids see the coloured opioid conversion chart. They are a safe and effective way to give medicines for symptoms such as pain, nausea and vomiting, seizures, agitation and respiratory secretions.
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