Syringe Drivers

Although syringe drivers are a convenient method of medication delivery, not all medications can be delivered subcutaneously.

For nurses to correctly use syringe drivers, they need to be adequately trained. Other disadvantages include:

• Limited volume of the syringe may mean daily visits from community nurses.
• Finding suitable skin sites for the syringe driver may be difficult for emaciated patients.
• Local reactions at the needle insertion site can be uncomfortable and may result in sub-optimal symptom control. These reactions can be caused by irritation from medication(s) or infection.
• Drugs may precipitate, that is, some solid matter forms. It is important to check the compatibility of drugs before combining in a syringe. If you notice indicators of precipitation such as the solution is cloudy or discoloured then discard.

Some people might be worried that the use of a syringe driver causes the person to die sooner. It is important to discuss with them why the syringe driver is being considered. Listen to their concerns and reassure them that the syringe driver is a safe and effective way to manage their symptoms. You can also reassure them that analgesics and other medicines are safe and effective when prescribed appropriately and administered correctly.

Nurses need to visit regularly (usually daily) to review the person’s symptoms and set up a new syringe of medication. They will also change the cannula regularly.

In the meantime, certain things need to be monitored routinely. These include:

• checking that the syringe driver is working well and is free of damage
• checking the area around the cannula for signs of infection, or irritation from the medicines, including:
  • skin irritation or
  • skin discomfort or
  • skin discolouration – redness on lighter skin tones or change to a colour different from the surrounding area (usually darker) in darker skin tones
• checking that the area around the site clean and dry and that there is no leakage
• checking the line to make sure it is not twisted, kinked, trapped, or caught
• checking there are no white particles (precipitate) along the tube
• placing the syringe pump in a safe and comfortable position, for example, tucked slightly under a pillow.

If the syringe driver alarm sounds check for empty syringe, blocked needle, or tubing (includes kinked tube), or jammed plunger.

Detailed information about commonly used medications, incompatibilities, contraindications, equipment, and techniques are available in the:

• Guidelines for subcutaneous infusion device management in palliative care and other settings (4.7MB pdf), Queensland Health, 2021
• Syringe driver compatibility: Guidance document, Safer Care Victoria, 2021
• PallConsult learning packages for NIKI T34™, T34™ & BodyGuard™ T syringe pumps and SurefuserTM+ infusion device
• Therapeutic Guidelines (subscription required)
• Syringe Driver: Continuous Subcutaneous Infusions in Palliative Care, 4th ed.
• Oxford Textbook of Palliative Medicine (subscription required)
• Oxford Handbook of Palliative Care (subscription required)

Caution must be taken when looking at any overseas information as there can be differences in the drugs, dosages and devices that are used.

This information was drawn from the following resources:

• Dickman A, Schneider J. The Syringe Driver: Continuous subcutaneous infusions in palliative care. 4th ed. Oxford: Oxford Academic; 2016.
• Ferrell BR, Paice JA, editors. Oxford textbook of palliative nursing. 5th ed. Oxford: Oxford University Press; 2019.
• Mitchell K, Pickard J, Herbert A, Lightfoot J, Roberts D. Incidence and causes for syringe driver site reactions in palliative care: A prospective hospice-based study. Palliat Med. 2012 Dec;26(8):979-85. doi: 10.1177/0269216311428096. Epub 2011 Nov 14.
• Safer Care Victoria (SCV). Syringe driver compatibility: Guidance document. Melbourne: SCV; 2021.
• Therapeutic Guidelines Limited. Palliative care [Internet]. 2016. [updated 2016 Jul; cited 2022 Aug 8].
• Thomas T, Barclay S. Continuous subcutaneous infusion in palliative care: a review of current practice. Int J Palliat Nurs. 2015 Feb;21(2):60, 62-4. doi: 10.12968/ijpn.2015.21.2.60.
• Principles of drug use in palliative care. In: Watson M, Ward S, Vallath N, Wells J, Campbell R, editors. Oxford handbook of palliative care [Internet]. Oxford: Oxford University Press; 2019. [cited 2022 Aug 8].