This advice is sourced from Dr Ros Taylor a senior palliative physician
Q. How do I decide when it is appropriate to start a syringe pump? And where can I find information on how to prescribe medication for this?
Syringe pumps (or drivers) are small battery operated pumps that allow continuous subcutaneous drug infusions over 24 hours.
When to consider starting a syringe pump:
- If a person is persistently vomiting e.g. in cases of bowel obstruction, and unable to keep medicines down. A pump allows anti-sickness and pain medicines to be absorbed
- If swallowing is impaired eg with head and neck cancer, neurological conditions and reduced conscious level
- If doses of pain medicine need to be titrated up quickly to get pain control - when the dose is established, medicines can often switch back to the oral route
- Syringe pumps are often also used in the last weeks and days when swallowing has become unsafe, or the person is too drowsy to swallow. The pump allows the continuation of pain relief and other symptom control medicines, without the burden of multiple tablets
Usual starting doses:
- Morphine or Oxycodone - half the oral dose. If opioid naive, start with 5mg -10mg over 24 hrs depending on frailty
- Midazolam 5mg -10mg over 24 hrs depending on frailty. Titrate according to level of sedation needed up to 30mg. Discuss with palliative team if need higher doses.
- Cyclizine for nausea 75mg over 24 hours
- Metoclopramide for nausea 30mg over 24 hours
- Haloperidol for nausea or agitation 2.5mg -5mg over 24 hours
- Glycopyrronium for secretions 600mcg -1200mcg over 24 hours
- Buscopan for secretions or colic 80mg -160mg over 24 hours
- Levomepromazine for nausea or agitation 12.5mg - 75mg. If very frail, 6.25mg over 24 hours may be sufficient to control nausea
A good source of information on syringe pumps can be found in the West Midlands Guidelines:
Top Tip
- When starting a syringe pump remember to review the oral medications to avoid duplication of dose. E.g. if putting Oxycodone into a pump, you will need to stop the oral Oxycodone tablets
- MAAR Chart - is a Medication Authorisation and Administration Record. It allows safe administration of medication and needs to be completed by a doctor or nurse prescriber to support the administration of anticipatory injections or an infusion via a syringe pump. See downloads on the right for a paper or writeable PDF MAAR Chart.
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The MAAR chart is also integrated into EMIS under the EOL template for GPs
- Provide full name and GMC number on pages 1-3 of chart.
- Type initials in the prescriber 'sign and print' area for EACH medication prescribed.
- The completed chart can be emailed from clinicians nhs.net email address to another nhs.net email