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Syringe drivers

Key points about syringe driver

A syringe driver is a small, battery-powered pump that delivers medication from a syringe at a constant rate throughout the day and night.
It’s common to feel nervous about having a syringe driver but most people find that they are very helpful for managing pain and other symptoms and give a feeling of reassurance.

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A syringe driver is a small, battery-powered device that holds a syringe with medication. The device usually delivers the medication over 24 hours, occasionally less. The medication is given slowly through an injection under your skin (this is sometimes called continuous subcutaneous infusion).

You might have a syringe driver for medicines to help manage pain, sickness (nausea or vomiting), seizures, agitation or breathing problems. In New Zealand, the Niki T34 syringe driver is the device used in your home.

Syringe drivers are usually used if you can't take medications by mouth (tablets, capsules or liquids), eg, if you:

have ongoing nausea (feeling sick) and vomiting (being sick)
have swallowing difficulties or are too weak to swallow
have an obstruction in your stomach or gut
are not alert enough to swallow.

Syringe drivers can be used either short term or long term.

Syringe drivers may be used in the last few weeks and days of life but they can be useful at any stage. Some people are worried that a syringe driver can make death come sooner. There is no evidence to suggest that this is true. Syringe drivers are often used at the end of life because they are the easiest way to give someone the medicines they need to feel comfortable at that time.

Your medicines are put into a syringe, and the syringe driver pushes the medicines through a soft plastic tube and into your body. The needle to insert the tube is very fine. It is usually inserted just under the skin on your upper arm, thigh or abdomen (tummy) and then the needle is removed once the soft plastic tube is in place.

Your syringe driver has a computer and a small screen. It calculates the rate (how fast) your medicines should be given and displays this on the screen.

Your syringe driver will be set up for you by your nurse.
The medicines will be changed or topped up each day by your nurse or you may have a new syringe provided by a pharmacy (this will depend on your local situation).
Your nurse will change the soft plastic tubing and injection site regularly.
It might hurt a little bit when your nurse puts the needle under your skin to insert the thin plastic tubing, but after that, having a syringe driver should be painless.
The medicines take a few hours to reach a steady level in your body so you might not feel an effect from the medicines straight away.

Having your medicines in a syringe driver shouldn’t make you any less mobile than before. If you are active, you can carry it around with you in a special bag.

Advantages	Disadvantages
You don't need repeated doses of medication and a consistent dose is delivered. A combination of medicines can be used in one syringe to manage many symptoms. Giving medicines slowly under your skin (subcutaneous administration) is more comfortable than injections into your muscle (intramuscular injections). The syringe driver can be placed in a carry bag or pouch, so you can be mobile.	Your doctor or nurse will have to predict your medicine needs for a 24-hour period. Changes in your symptoms may require more injections for relief. Your symptoms and the effectiveness of the medicines must be reassessed regularly. You can get pain, redness and swelling or infection at the injection site, which can cause discomfort and interfere with the delivery and absorption of the medicines.

Advantages

Disadvantages

You don't need repeated doses of medication and a consistent dose is delivered.
A combination of medicines can be used in one syringe to manage many symptoms.
Giving medicines slowly under your skin (subcutaneous administration) is more comfortable than injections into your muscle (intramuscular injections).
The syringe driver can be placed in a carry bag or pouch, so you can be mobile.

Your doctor or nurse will have to predict your medicine needs for a 24-hour period. Changes in your symptoms may require more injections for relief.
Your symptoms and the effectiveness of the medicines must be reassessed regularly.
You can get pain, redness and swelling or infection at the injection site, which can cause discomfort and interfere with the delivery and absorption of the medicines.

In general, syringe drivers are safe, reliable and don’t need a lot of care. However, it’s important to:

keep the syringe driver and area around the needle dry
avoid dropping it
keep the syringe driver dry when washing — if you drop it into water, contact your nurse or doctor
take extra care when washing and dressing to make sure the tube isn’t pulled out.

Things to look out for

Your nurse will come to visit you and check the syringe driver every day, but there are things you or your carer can check too.

Keep the syringe driver and the area around the needle clean and dry. Your nurse will show you how to do this.
Look out for any changes in the area around the needle, such as skin irritation, redness or discomfort.
Let your nurse or doctor know if your symptoms are not under control. Your doctor can change or adjust your medicines.
If the syringe driver stops working, don't worry, the effect of the medicines will continue for a while. Call your doctor or nurse as soon as possible.
If the alarm goes off, there may be a problem with the syringe driver. Let your nurse know so they can come and check it. An alarm may just mean it needs a new battery. Your nurse will provide batteries and a spare one.
The driver display will alert you if there are any blockages or leaks. Blockages can happen if you accidentally lie on one of the tubes, for example.