Safe practice in syringe pump management nursing times. A syringe driver is a small, portable, battery operated device that administers medicines subcutaneously over a selected time period, usually 24 hours. With the introduction of the t34 mckinley syringe drivers use a 20ml syringe as standard and if a larger volume is required use a 30ml syringe. The required dose of nozinan injection 25mg to 200mg per day should be diluted with the calculated volume of normal saline. When the oral route is no longer appropriate, a syringe driver can be used to ensure continued symptom control. If severe renal impairment, seek specialist advice morphine 2. Brand names include nozinan, levoprome, detenler, hirnamin, levotomin and neurocil. Indications, dose, contraindications, sideeffects, interactions, cautions, warnings and other safety information for levomepromazine. Other phenothiazines such as chlorpromazine and prochlorperazine also suffer from a similar lack of evidence from rcts but are widely used for nausea and vomiting as there is a consensus that they are likely to be beneficial keeley 2009. Syringe driver drug compatibilities guide to palliative care practice 2016 sodium chloride 0. Opioids refer to choosing and changing opioids guideline. This trusted source goes beyond standard references providing health professionals with indepth and practical guidance on drugs and treatment regimens to help improve.
Syringe driver competency programme arohanui hospice. 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. Use levomepromazine prescribe prn antiemetic of levomepromazine 6. Initially the preferred replacement option was the ad ambulatory syringe driver, however, the company involved was unable to supply and support these drivers and a further decision was made so that by 30 june, 2011, the niki t34 syringe driver was used exclusively. Scottish palliative care guidelines levomepromazine. Levomepromazine metoclopramide midazolam octreotide ondansetron 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. Syringe driver drug compatibilities guide to practice 20 july 20 these guidelines have been ed. Equivalent doses orally 24h dose morphine 30mg oxycodone 15mg by injection 24h dose diamorphine 10mg oxycodone 10mg morphine 15mg water for injection 10ml x 10 ampoules should be added to every prescription targeted anticipatory prescribing. Promoting safer use of injectable medicines by the national patient safety agency in march 2007 includes the. Diamorphine hydrochloride is compatible with this solution and may be added if greater analgesia is required. A compatibility study heather kean1,3, diane rigge1, phil weir1, andrew dickman2, andrew evans3, elsie gaskell3 background the issue of patient safety alert 20. When and how to use a syringe driver in palliative.
Levomepromazine injection may be administered over a 24 hour period via a syringe driver. Syringe driver drug compatibilities guide to palliative. Syringe driver drug compatibilities guide to practice 20. Only use drugs that are known to be effective via the sc route. Anticipatory medications for end of life patients doses. Syringe driver drug compatibilities practice guidelines 2011. Subcutaneous prn dosedoses for anticipatory symptoms subcutaneous starting dose range over 24 hours in syringe driver subcutaneous maximum dose over 24 hours 1. 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. The maximum volume of fluid in a 30ml syringe is 22ml 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. Nozinan injection may be administered over a 24 hour period via a syringe driver. If dexamethasone is to be mixed with other medications in a syringe driver. Levomepromazine remains widely used by palliative care physicians despite the lack of data from rcts. Anticipatory medication stat dose and syringe pump. A syringe driver is a portable battery powered device that administers medication subcutaneously over a chosen period of time.
Graham f, clark d 2005 the syringe driver and the subcutaneous route in palliative care. If the patient is in pain, vomiting or very agitated, give a stat sc injection of appropriate medication while setting up the syringe driver. Drugs for subcutaneous administration in syringe drivers. Care of the dying severe renal failure clinical guideline. If the symptoms are not controlled on levomepromazine 25mg over 24 hours, contact the specialist palliative. For carers, friends and families of people with a terminal diagnosis to discuss their emotions about the prospect of losing their loved ones, as well as practical issues about palliative care and end of life.
Subcutaneous drug infusion compatibility guidelines. Levomepromazine subcut and start a syringe pump with levomepromazine at the same time levomepromazine by syringe pump start at 6. Morgan s, evans n 2004 a small observational study of the longevity of syringe driver. Syringe driver drug compatibilities practice guidelines 2011 july 2011 these guidelines have been ed. A syringe driver takes 34 hours to establish a steady state drug level in plasma. The palliative care formulary provides unrivalled and expert drug information for health professionals when caring for adult patients facing progressive lifelimiting diseases. Choice of diluent the choice of diluent for the infusion solution varies according to local guidelines as there is evidence for and against the two most commonly used diluents sterile water. Syringe pumps also known as syringe drivers are commonly used for people living with a terminal illness.
They can be used in hospital, in hospices and at home. The required dose of levomepromazine injection 25mg to 200mg per day should be diluted with the calculated volume of normal saline. Guidance for anticipatory prescribing and symptom control. Prescribing in palliative care overview palliative care is an approach that improves the quality of life of patients and their families facing lifethreatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial, and. Guidance for anticipatory prescribing for patients in. Quality control north west morphine, diamorphine and oxycodone combinations in palliative care. Painbreathlessness nb if already on oral opioids, see below for conversion. Primary care medication guidelines for anticipatory last. It is sometimes necessary to miss step 2 and go straight to step 3. There is variation between brands regarding dispersion and scoring. It is a lowpotency antipsychotic approximately half as potent as chlorpromazine with strong analgesic, hypnotic and antiemetic properties that are primarily used in palliative care. Morphine and its metabolites are most likely to cause toxicity. Morphine, diamorphine and oxycodone combinations in. Cyclizine, haloperidol, promethazine, levomepromazine, midazolam2,3, 4 o mixing with dexamethasone should be avoided if possible o if used, the solution must be carefully checked for precipitation at least once a shift note.
Levomepromazine drug bnf content published by nice. Syringe driver drug compatibilities practice guidelines 2016 eastern metropolitan region palliative care consortium victoriaclinical working party 3. Always check on waitemata dhb controlled documents site that this is the most recent version. Levomepromazine, also known as methotrimeprazine, is a phenothiazine neuroleptic drug. Levomepromazine for nausea and vomiting in palliative care. Diazepam, chlorpromazine and prochlorperazine are too. April 2017 introduction palliative care patients often exhibit multiple symptoms that require the use of numerous drugs. A syringe containing medication is attached to the driver, which pushes the plunger forward at a controlled rate. The use of medicines in syringe drivers guidelines for. Levomepromazine is a phenothiazine used widely in palliative care to treat intractable nausea or vomiting, and for severe deliriumagitation in the last days of life. Syringe driver administration is far more acceptable to the patient than intramuscular or intravenous. If the patient is still nauseated vomiting or has required breakthrough doses, then increase the dose of levomepromazine accordingly in the syringe driver to a maximum of 37. If dexamethasone is to be mixed with other medications in a syringe driver, as much diluent as. If using levomepromazine in a syringe driver, the syringe should be shielded from sunlight.
Anticipatory medication stat dose and syringe pump driver guidance anticipatory medication guidance updated 24. Please select the drug combination to search for below, browse the index, submit an entry or go back to sdsd home page. They are a safe and effective way to give medicines for symptoms such as pain, nausea and vomiting, seizures, agitation and respiratory secretions. If severe renal impairment, seek specialist advice diamorphine 2. Many of the opioid analgesics and their metabolites may accumulate in renal failure causing toxicity with myoclonic jerks, profound narcosis and respiratory depression. They are a safe and effective way to give medicines for symptoms such as pain, nausea and vomiting, seizures, agitation and.
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