Syringe pumps for palliative care are programmed to deliver the medicines over a 24-hour period, so a new syringe of medicines will be set up once per day, at the same time each day. The soft plastic cannula or butterfly needle is usually placed in the upper arm, leg or abdomen.
Syringe drivers are indicated when other routes become inappropriate or difficult. They are generally programmed to deliver their contents over 24 hours. Morphine, midazolam and cyclizine are common examples of drugs given in this way, but not all medicines are suitable to be administered via a syringe driver.
Terminally ill cancer patients near the end of life can experience refractory symptoms, which require palliative sedation. Midazolam is the most common benzodiazepine used for palliative sedation therapy.
Medicine for pain in palliative care – an appropriate opioid, for example, morphine, diamorphine, oxycodone or alfentanil. Medicine for breathlessness – midazolam or an opioid. Medicine for anxiety – midazolam. Medicine for delirium or agitation – haloperidol, levomepromazine, midazolam or phenobarbital.
The medicines take three to four hours to reach a steady level in your body so you might not feel an effect straight away.
The most commonly prescribed drugs include acetaminophen, haloperidol, lorazepam, morphine, and prochlorperazine, and atropine typically found in an emergency kit when a patient is admitted into a hospice facility.
The syringe pump will usually be removed by the district nurse before the patient is moved from the home. Read more about providing care after death.
Palliative sedation is the use of sedative medications to relieve refractory symptoms when all other interventions have failed. The phrase "terminal sedation" was initially used to describe the practice of sedation at end of life, but was changed due to ambiguity as to what the word 'terminal' meant.
A maximum of 3 compatible drugs in any one syringe driver/pump is recommended. Do not leave drugs in a syringe driver/pump for more than 24 hours.
The intent of palliative sedation is to relieve the burden of otherwise intolerable suffering for terminally ill patients in a manner that preserves the moral sensibilities of the patient, the medical professionals involved in their care, and concerned family and friends [1].
The emotional discomfort and interpersonal conflicts go hand in hand in causing suffering at the end of life. Financial instability, marital discord, conflicts with family members, and an inability to get one's affairs in order before death are common causes of total pain.
Bathing and showering
Do not immerse the syringe driver in water. You can have a bath or shower but try to keep the needle site dry and keep the machine out of the water by putting it on a stool out of the water.
Palliative care can be helpful at any stage of illness and is best provided soon after a person is diagnosed. In addition to improving quality of life and helping with symptoms, palliative care can help patients understand their choices for medical treatment.
Syringe pumps are generally considered to be the most accurate, with a flow accuracy of ±1 – 3%. Most peristaltic infusion pumps typically state a flow accuracy between ±2.5 – 6%.
The procedure is relatively simple and involves inserting a butterfly needle into the subcutaneous layer of skin, where an extensive network of lymphatic and blood vessels allows the fluids to be readily absorbed (Mei and Auerhahn, 2009). This is the route most commonly used in palliative and end-of-life care settings.
Syringe pumps are more compact and take up less space than infusion pumps. This becomes important when the patient is on many different infusions. If a patient has very high fluid requirements, or is cold (hypothermic), a special infusion pump with a built in heater can be used.
Alarms on the syringe driver to be aware of
There is an alarm on the syringe driver that will beep if there is a problem. The alarm usually sounds for one of two reasons: There is a blockage to the flow of medication caused by a kink in the long tubing. The syringe is empty.
Agonal breathing or agonal gasps are the last reflexes of the dying brain. They are generally viewed as a sign of death, and can happen after the heart has stopped beating.
The end-of-life period—when body systems shut down and death is imminent—typically lasts from a matter of days to a couple of weeks. Some patients die gently and tranquilly, while others seem to fight the inevitable. Reassuring your loved one it is okay to die can help both of you through this process.
To reduce the impact of excessive oropharyngeal and / or pulmonary secretions in the dying patient.
A morphine injection into a vein gives the quickest pain relief. It works almost straight away. Morphine tablets and liquid work in 30 to 60 minutes but wear off after 4 to 6 hours.
According to one study, you cannot survive for more than 8 to 21 days without food and water. Individuals on their deathbeds who use little energy may only last a few days or weeks without food or water.
You might be unable to stop crying and worrying. Or you might feel that there is no point in doing anything. You might also find it difficult to see life going on as normal for most people. It can feel very strange to watch people go about their daily lives, do shopping, drive, and work.