Syringe Driver Online Learning Package

Objectives:

Following completion of this section, you will be able to:

• Describe the most commonly used syringe drivers in palliative care
• Explain management principles when caring for patients with these devices
• Describe important safety principles when using this equipment

Types of Syringe Drivers:
The most common syringe drivers in clinical use in Queensland were previously the SIMS Graseby® MS16A and the MS26, which are electronic, battery driven syringe drivers. The Graseby MS16A has a blue colour plate, and delivers its dose in mm per hour. The Graseby MS26 has a green colour plate, and delivers its dose in mm per 24 hours.

Important Principles when using Syringe Drivers:
The guidelines discuss the following principles in reference to the equipment used for subcutaneous infusions via a syringe driver. When you set up the equipment for a subcutaneous infusion, it is always important to verify your individual organisation’s protocol regarding the preparation and set-up for changing the device.

General Principles:
There are general management principles that are the same for both the MS16A and the MS26 syringe drivers. These principles include:

• You should always refer to your organisation’s protocol regarding the preparation and set-up for changing the device, and this should always be used to guide practice;
• The syringe driver is normally used to deliver medications over a 24 hr period to reduce the risk of errors in setting up the device;
• It is important for you to maintain an aseptic technique when preparing and setting up the infusion;
• Consider using a tamper-proof ‘lock-box’ if there is a possibility of the patient or others tampering with the device, or using the boost facility. It is possible that a tamper-proof box is mandatory within your organisation as a risk management stipulation;
• Ensure that the patient and the family have received a full explanation of how the syringe driver works, and its indications for use.

Syringe Related Principles:

• A 10 ml Luer lock^® syringe, to prevent risk of disconnection, should be used if volume/concentration permit. Note that with the newer generation of devices such as the Niki T34, a 20 ml syringe is the minimum recommended size. Twenty and 30 ml syringes can be used with the Graseby, but they may not fit as well;
• The same brand of syringe should be used each time to prevent confusion and errors;
• The syringe should be measured every time you set the device up, noting that different brands of syringes have different diameters and lengths, since these differences impact upon the preparation of the medications used;
• No matter which syringe driver you use, the size and brand of the syringe you use is an important variable: note that different brands of syringes have different diameters and lengths;
• This impacts upon the preparation of the medications used. Note: the easiest way to overcome any error in relation to syringe type is to measure the syringe against the scale on the syringe driver every time it is changed.

Cannula Related Principles:

• Teflon or Vialon cannulas, rather than metal needles, should be used, as they are associated with less site inflammation.

Dosage Related Principles:

• When changing the extension set and/or cannula, prime the line after drawing up the prescribed medications to the appropriate length in the syringe. After priming the line, measure the syringe and document the line change and the time the syringe is calculated to finish;
• A minimum volume extension set should be used;
• It is the length of the solution within the syringe – not the volume – that will determine the rate, i.e. the syringe driver delivery rate is a measure of distance, not a measure of volume administered.

ACTIVITY :Section 2 : General Equipment