The syringe driver is a portable battery operated device for mechanically delivering drugs at a predetermined rate by continuous infusion.
The McKinley T34 is the syringe driver recommended by the National Patient Safety and most common used in nursing homes.
With a continuous infusion, medicines will ease distressing symptoms more effectively without the peaks and troughs of relief provided by ordinary injections.
The indications for using a syringe driver include:
- intestinal obstruction
- inability to administer a medication via oral route
- oral route ineffective
- profound weakness
- reduce numerous injections
- impaired consciousness
- resident choice where medication is required by a subcutaneous infusion
- End of Life Care
The most appropriate sites for Continuous Subcutaneous Infusion (CSCI) are:
- anterior chest wall
- anterior aspect of upper arms
- anterior aspects of thighs
- anterior abdominal wall
- upper back if there is a risk of patient pulling out the line
All sites must be free from hair. Sites which should be avoided: oedematous areas, sites over a bony prominence, sites near joint, previously irradiated skin, infected skin or skin lesions.
A transparent dressing should be used to permit visible monitoring of the site.
Rotate the infusion site at least every 72 hours to avoid the development of skin reaction. If there is evidence of inflammation or poor absorption (hard subcutaneous swelling), the infusion site should be renewed without delay. Change the site of infusion if a new drug is introduced. A change in dose doesn’t necessarily require a site change.
Prepare the syringe:
- use a luer lock syringe of 20 ml
- draw up prescribed medication and diluents as per patient authorisation form (diluting the mixture to the maximum volume of 18 mls)
- check immediately for any precipitation or cloudiness of medication
- label the syringe (name of patient, date and time of preparation, name and dose of drugs). Attach label to luer lock end of syringe ensuring it doesn’t obscure visual scales or interfere with the mechanism of the infusion device
- attach the butterfly cannula to the line and attach the infusion set to the syringe and prime the infusion line (takes 1ml of solution)
- assess for suitable site for insertion of butterfly cannula and insert the butterfly at a 45 degree angle
- safely dispose of sharps
- Check the battery level – If there is less than 40% life remaining the battery should be changed. (the average battery life, starting at 100% is approx. 3-4 days)
- Lock the syringe in the transparent box
- complete syringe pump chart and record of controlled medication chart. Syringe pump chart to be completed at least 4 hourly or more often if indicated. You may also need to complete a pain monitoring chart separately.