Syringe Drivers

Question 1

When should a syringe driver be considered in a palliative care setting?

Answer 1

When a patient is unable to take oral medication due to nausea, dysphagia, intestinal obstruction, weakness or coma.

Question 2

What are the 2 types of syringe drivers used in the UK?

Answer 2

Graseby MS16A (blue): delivered in mm per hour

Graseby MS26 (green): delievered in mm per 24 hours.

Question 3

Sodium chloride (0.9%) is recommended to be used to mix which drugs?

Answer 3

• Granisetron
• Ketamine
• Ketorolac
• Octreotide
• Ondansetron

Question 4

What drug is used for pain?

Answer 4

Diamorphine

Question 5

What drugs are used for agitation/restlessness?

Answer 5

• Midazolam (Doesn’t mix with Cyclizine)
• Haloperidol
• Levomepromazine (more sedating)

Question 6

What drugs are used for bowel colic?

Answer 6

Hyoscine butylbromide

(B for bowel)

Question 7

What drugs are used for respiratory secretions?

Answer 7

Hyoscine hydrobromide

Question 8

What drugs are used for N&V?

Answer 8

• Cyclizine
• Levomepromazine
• Haloperidol
• Metoclopramide

Question 9

Is diamorphine compatible or incompatible with most other drugs?

Answer 9

Compatible

Question 10

Is cyclizine compatible or incompatible with most other drugs?

Answer 10

Incompatible

Question 11

What drugs is cyclizine incompatible with?

Answer 11

• Hyoscine butylbromide (occasional)
• Metoclopramide
• Midazolam
• Sodium chloride 0.9%
• Dexamethasone
• Ketamine

Question 12

What drugs is diamorphine compatible with?

(Think Diamorphine HCL)

Answer 12

Most other drugs including:

• Cyclizine
• Dexamethasone
• Haloperidol
• Hyoscine butylbromide
• Hyoscine hydrobromide
• Metoclopramide
• Midazolam
• Levomepromazine

Question 13

You are reviewing a patient at home with metastatic colon cancer. She is receiving symptom palliation with a syringe driver and is being given diamorphine and cyclizine continuously via the device.

Over the previous 24 hours she has become more restless and agitated. Her family are with her and ask if she could be prescribed something that will ‘help her symptoms without sedating her too much’.

Which of the following medications would you prescribe to be administered via the syringe driver?

• Diazepam
• Haloperidol
• Levomepromazine
• Midazolam
• Propranolol

Answer 13

Haloperidol (5-15mg over 24 hours)

• Diazepam is not given IV/IM - site reactions.
• Midazolam - not compatible with cyclizine.
• Levopromazine - is more sedating.
• Haloperidol - less sedative and works well on restlessness and confusion.