The dose and frequency is adjusted according to the level of patient distress and the response. Hyoscine butylbromide is used for bowel colic and for excessive respiratory secretions, and is less sedative than hyoscine hydrobromide. Patients with cerebral tumours or uraemia may be susceptible to convulsions. Capillary bleeding Capillary bleeding can be treated with tranexamic acid by mouth; treatment is usually discontinued one week after the bleeding has stopped, or, if necessary, it can be continued at a reduced dose. A prokinetic antiemetic may be a preferred choice for first-line therapy. The preferred sites for insertion of the cannula for a continuous subcutaneous infusion are:
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Follow us on facebook. If the patient becomes unable to swallow, generally morphine is administered as a continuous subcutaneous infusion syrinte details, see Continuous Subcutaneous Infusions below. A number of factors influence the longevity of the insertion site.
Hyoscine butylbromide is used for bowel colic and for excessive syronge secretions, and is less sedative than hyoscine hydrobromide. Octreotidewhich stimulates water and electrolyte absorption and inhibits water secretion in the small bowel, can be used by subcutaneous infusion to reduce intestinal secretions and to reduce vomiting due to bowel obstruction.
When and how to use a syringe driver in palliative care
Syringe drivers can be placed into a carry bag or pouch when a patient is mobile or be tucked under a pillow if the patient is bed-bound. These sites are preferred because they are accessible, both for initial insertion and for monitoring, and they are rarely oedematous.
Ministry of Health MOH. Restlessness and confusion Restlessness and confusion may require treatment with an antipsychotic, e. Te Omanga Hospice syringe driver protocol.
Pain control Diamorphine hydrochloride is the preferred opioid since its high solubility permits a large dose to be given in a small volume see under Mixing and Compatibility, below. Capillary bleeding Capillary bleeding can be treated with tranexamic acid by mouth; syrinbe is usually discontinued one week after the bleeding has stopped, or, if necessary, it can be continued at a reduced dose.
Although some families may at first be afraid of caring for the patient at home, support can be provided by community nursing services, social services, voluntary agencies motphine hospices together with the general practitioner. Nausea and vomiting Haloperidol and levomepromazine can both be given as a subcutaneous infusion but syirnge can limit the dose of levomepromazine.
Any past experience they have had with syringe drivers The stage of illness they are at and what using a syringe driver means for them for the future, e.
BPJ When and how to use a syringe driver in palliative care
Dry mouth may be caused by certain medications including opioids, antimuscarinic drugs e. It is kinder to give an intermittent bolus injection subcutaneously —absorption is smoother so that syrnge risk of adverse effects at peak absorption is avoided an even better method is to use a subcutaneous butterfly needle. Thereafter, the dose should be adjusted with careful assessment of the pain, and the use of adjuvant analgesics should also be considered.
Managing breakthrough symptoms First check that the medicines are being delivered effectively via the syringe driver. Hyoscine butylbromide Hyoscine hydrobromide Levomepromazine Metoclopramideunder some conditions infusions containing metoclopramide become discoloured; such solutions should be discarded.
conveesion The Palliative Care Handbook, Guidelines for clinical management and symptom control. Once their pain is controlled, patients started on 4-hourly immediate-release morphine can be transferred to the same total hour dose of morphine given as the modified-release preparation for hourly or hourly administration. Once mixed, syringes should be observed for any signs of precipitation or discolouration.
Oral medication is usually satisfactory unless there is severe nausea and vomiting, dysphagia, weakness, or coma, when parenteral medication may be necessary. Nausea and vomiting are common in patients with advanced cancer. 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.
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 can be given by mouth.
Midazolam is the benzodiazepine antiepileptic of motphine for continuous subcutaneous infusion. If supplementary doses are required regularly for breakthrough symptoms, include these doses when calculating the amount of medicine needed for the subsequent 24 hour period.
Prescribing in palliative care | Medicines guidance | BNF content published by NICE
Capillary bleeding can be treated with tranexamic acid by mouth; treatment is usually discontinued one week after the bleeding has stopped, or, if necessary, it can be continued at a reduced dose. Haloperidol and levomepromazine can both be given as a subcutaneous infusion but sedation can limit the dose of levomepromazine. The Graseby syringe driver has been gradually phased out of use as it was not tamper-proof.
Rectal route Morphine is also available for rectal administration as suppositories; alternatively oxycodone hydrochloride suppositories can be obtained on convdrsion order. Precipitation may morpbine as a result of a reaction between medicines in a syringe.
Continuous subcutaneous infusions Although drugs can usually be administered by mouth to control the symptoms of advanced cancer, the parenteral route may sometimes be necessary. Provided that there is evidence of compatibility, selected injections can be mixed in syringe drivers. Guidelines for syringe driver management in palliative care in New Zealand.