For the administration of antiemetics by subcutaneous infusion using a continuous infusion device, see below. The use of physiological saline sodium chloride 0. Syringe drivers You might have a syringe driver for medicines to help manage pain, sickness, fits, agitation or breathing problems. Pharmacy will supply syringes containing either morphine or alfentanil-morphine mixture based on a computer-generated randomisation. The presence or absence of adverse effect will be recorded on a data sheet.
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Nausea and vomiting Nausea and vomiting are common in patients with advanced cancer. Oxycodone hydrochloride immediate-release preparations can be given for breakthrough pain.
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. Fungating tumours Fungating tumours can be treated by regular dressing and antibacterial drugs; systemic treatment with metronidazole is often required to reduce malodour but topical metronidazole is also used.
We hypothesize that within the emergency department, the alfentanil-morphine mixture will safely reduce the time to effective analgesia. If the alarm goes off The alarm will go off if there is a problem with the syringe driver. Name  0. Restlessness and confusion Restlessness and confusion may require treatment with an antipsychotic, e. Secondary sponsor category  0.
Constipation is a common cause of distress and is almost invariable after administration of an opioid analgesic.
Syringe Driver Drug Compatibility
A regular maintenance dose should also be considered, given twice daily either by mouth or by subcutaneous injection; alternatively use a continuous infusion device.
A syringe driver is a small, battery-powered pump that delivers medication at a constant rate throughout the day and night. Professor Guy Ludbrook Query! Care is required to avoid the discomfort of dry mouth. Problems encountered with syringe drivers The following are problems that may be encountered with syringe drivers and the action that should be taken: Syringe drivers are often used to give medicines to treat the following symptoms: Pain Morphine and similar drugs — for example, diamorphine, alfentanil and fentanyl — can all be used for pain.
Practical aspects of alfentanil infusion.
Medicines for different symptoms Here we discuss the common medicines used in syringe drivers to treat these symptoms. Midazolam is a sedative and an antiepileptic that may be used in addition to an antipsychotic drug in a very restless patient. Rectal route Morphine is also available for rectal administration as suppositories; alternatively oxycodone hydrochloride suppositories can syringw obtained on special order.
If this fails, metoclopramide hydrochloride by mouth or by subcutaneous or intramuscular injection can be added; if this also fails, baclofenor nifedipineor chlorpromazine hydrochloride can be tried.
Morphine equivalences for transdermal opioid preparations have been approximated to allow comparison with available preparations of oral morphine.
This film is for people who want to learn more about syringe drivers and when they might be used. Morphine is also available for rectal administration as suppositories; alternatively oxycodone hydrochloride suppositories can be obtained on special order. The family may be reassured by the knowledge that the patient will be admitted to a hospital or hospice if the family cannot cope. Midazolam is the benzodiazepine antiepileptic of choice for continuous subcutaneous infusion.
For the use of midazolam by subcutaneous infusion using a continuous infusion device see below.
Syringe drivers You might have a syringe driver for medicines to help manage pain, sickness, fits, agitation or breathing problems. Bowel colic and excessive respiratory secretions Bowel colic and excessive respiratory secretions may be reduced by a subcutaneous injection of hyoscine hydrobromidehyoscine butylbromideor glycopyrronium bromide. The equivalent subcutaneous syrine of diamorphine hydrochloride is about one-third of the oral dose of morphine.
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. Cyclizine is given by mouth. Prescribers should ensure that they are familiar with the correct use of transdermal preparations, see under buprenorphine and fentanyl inappropriate use has caused fatalities. 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 and hospices together with the general practitioner.
Drug treatment The number of drugs should be as few as possible, for even the taking of medicine may be an effort. Bowel colic and excessive respiratory secretions Hyoscine hydrobromide effectively reduces respiratory secretions and bowel colic and is sedative but occasionally causes paradoxical agitation.