--- title: "Use of syringe driver" canonical: "https://clinicaldecisions.refined.site/space/Palliative/18582944/Use%20of%20syringe%20driver" format: markdown --- Syringe drivers are also referred to as CSCIs – Continuous Subcutaneous Infusions.  The brand of pump used in this hospital is the NIKI T34. ## Indications for syringe driver To assist staff to administer subcutaneous medications where there is evidence of: - Persistent uncontrolled nausea and vomiting - Poor symptom control - Oral or rectal route is not appropriate for patient eg altered level of consciousness, dysphagia, gastrointestinal obstruction or uncertain gastric absorption. ## Prescribing for NIKI T34 Prescribing for inpatients is done through E-prescribing.  For patients being discharged please see below. ### How many medications can be mixed in a syringe for subcutaneous infusion? **Commonly two to three and (occasionally up to four medications) may be mixed in a syringe driver.  An important safety consideration before mixing any medications together in a syringe to check for compatibility information.** [Syringe driver drug compatibility table](https://assets.nationbuilder.com/hospicenz/pages/342/attachments/original/1731461167/PC17074_Syringe_Driver_Compatability_Chart_-_colour_and_grey-scale.pdf?1731461167) *****If the mixture you wish to use is not on the table please contact pharmacy or the hospital palliative care team for further advice. ## Medication in syringe drivers ### Medications commonly used ### Medications less commonly used The hospital palliative care team may suggest other medications be included in a syringe driver. These may include: - Dexamethasone (low dose) – to reduce local irritation at the insertion site - Octreotide – in malignant bowel obstruction - Levomepromazine – for nausea or agitated delirium - Ketamine – as an analgesic in complex pain - Methadone – as an alternative opioid - Famotadine – for gastroesophageal reflux - Levetiracetam – for seizure management Please contact the hospital palliative care team for further advice. ## Prescribing syringe drivers on discharge from hospital [Pharmacies in the community able to make up and dispense syringes for continuous subcutaneous infusions](http://staffnet/QualityDocs/Information%20Sheets/O9%20Waitemata%20District%20(Organisation%20Wide)/1%20Patient%20Information%20Sheets/[I]%20Community%20Pharmacies%20that%20Dispense%20Prefilled%20Syringes%20and%20Subcut%20Medications%20V2%20Mar26.pdf) updated Prescriptions for a syringe driver that include a CD medication can be written on the CD prescription eg Morphine 20mg, Haloperidol 1mg, Midazolam 5mg (all bracketed/24hrs via CSCI). There is no need to issue a separate prescription for each medication in the driver. Most pharmacies in the community are able to make up pre-filled syringes – a list of these pharmacies is available on the link. Patients who do not have access to these pharmacies will have syringe driver medications drawn up by community nurses in their own homes and therefore may require prescriptions for medication ampoules. It is important when the patient’s preferred pharmacy is not on the list, to contact the respective pharmacy and enquire on a case-by-case basis. ## Setting up a syringe driver ### Diluents Normal saline or water for injection can be used for most drugs. **Exceptions are**: - **Cyclizine** must be diluted with water for injection. - **Levomepromazine**, **methadone** and **ketamine** should be diluted with normal saline to minimise skin irritation. ## Saf-T-Intima use [Saf-T-Intima use](http://staffnet/QualityDocs/Quality%20Documentation/O1%20Clinical%20Practices/%5bP%5d%20Subcut%20Site%20Selection%20Insertion%20Monitoring%20-%20%20BD%20Saf-T-Intima%20Cannula%20Apr23.pdf) Saf-T-Intimas are recommended for use when administering subcutaneous medications either prn or continuous. This document guides the use of Saf-T-Intimas. ## Volume in syringe drivers It is best practice to make the solution as dilute as possible to reduce the likelihood of drug incompatibility and site irritation (Dickman et al 2005; Mitten 2001). In Waitematā Health, only BD Plastipak luer lock 30ml and 50ml syringes are to be used with the NIKI T34 syringe driver. Fill volumes for BD Plastipak luer lock syringes are shown below. ## Documentation Documentation of administration must be recorded on e-prescribing at time of Niki T pump is being set up and a syringe driver monitoring form started. Date, time, medication and name must be documented on the "Medication added" label that is attached to the syringe (not on the pump case). ### Related [NIKI T34 syringe driver](https://clinicaldecisions.atlassian.net/wiki/spaces/Palliative/pages/18483916) --- Reviewed September 2024. [Send feedback](mailto:Palliativecare.team@waitematadhb.govt.nz) to page coordinator