Syringe drivers in palliative care

Syringe drivers (or syringe pumps) deliver a continuous flow of medication just under the skin. They can be used to help manage symptoms at any stage of treatment. They are not only used in palliative and end of life care. Here, we talk about why they’re used, syringe driver medications, potential problems, and how you can support patients and those close to them.

This page is aimed at non-specialist healthcare professionals, with little or no knowledge about syringe drivers. It may also be helpful for healthcare professionals looking to refresh basic knowledge.

This information is for health and social care professionals. You can use our My Learning form to reflect on how this page has helped with your continuing professional development. Download the form.

A syringe driver is a small battery-powered pump. It delivers medications through a small tube or needle just under the patient’s skin (subcutaneously) usually over a 24-hour period. Syringe driver medications are used for symptom management.

A syringe driver is also called a syringe pump, or continuous subcutaneous infusion (CSCI). Subcutaneous refers to giving medications under the skin. An infusion is a method of delivering medication through a tube or needle.

There are different syringe driver makes available. In the UK, the syringe drivers generally used are the BD BodyGuard T and the T34 models. Click here to see photographs of some of these syringe drivers.

A syringe driver might be used to give medications if a patient:

Lots of people believe syringe drivers are only used for end of life care. They are often used at this stage, but can also be used at any stage of someone’s illness. It’s important to discuss any worries or misunderstandings that patients or the people close to them may have. Read more about concerns around syringe drivers and life expectancy, and ways you could help with these below in Syringe drivers and life expectancy.

Syringe drivers must only be set up by healthcare professionals who have received the relevant training. They are usually set up by a trained nurse.

Each healthcare provider has their own training on setting up a syringe driver.

If you are setting up a syringe driver or training to do this, please follow your organisation’s training, and local guidance. The steps below should not be taken as formal training or guidance.

These steps are a basic overview of how a syringe driver is set up, and some of the equipment used. It may be helpful to familiarise yourself with these if you are caring for or monitoring a patient with a syringe driver.

A green light flashes when the syringe driver is delivering medication.

The small screen on the syringe driver will normally show:

The keypad will be locked and the syringe driver is usually placed in a clear locked box (a lockbox). This is to make sure settings cannot be changed, and to protect the syringe driver from damage.

Both the infusion line, and cannula or needle, will usually be changed every three to seven days. This can vary depending on local practice, and if the patient has any skin irritation at the infusion site. This is where the cannula or needle is inserted. Read about changes to the skin below.

If patients are moving around, they can carry the syringe driver with them in a bag.

Sometimes patients will have more than one syringe driver. This might be because:

It’s important for you to know whether the patient has more than one syringe driver. Each syringe driver needs to be monitored, and each infusion site should be checked for changes to the skin.

It’s important to follow the guidance from your organisation and local area about monitoring patients with syringe drivers. Here are some points to help you make sure the syringe driver is working as it should.

Check:

Avoid:

If you have any concerns or experience any of these problems, report them immediately to your manager or the healthcare professional looking after the syringe driver. This may be a district nurse, or a palliative care team.

You should also ask the patient how they’re feeling. Where appropriate, speak to people close to the patient too, such as family members or friends. This may help you assess how well the patient’s symptoms are being controlled.

There are different ways you can support patients that have a syringe driver, and the people important to them. We’ve listed some ideas below, but it’s important to follow any organisational and local guidance. Speak to your line manager or the patient’s specialist doctor or nurse if you’re not sure what type of support you should provide.

Syringe drivers are not waterproof. They may stop working if they are splashed with, or submerged in, water.

If a patient wants to have a shower or bath with their syringe driver, make sure they know the syringe driver cannot get wet. You could suggest they put it in a waterproof bag on a stool or windowsill next to the bath or shower cubicle. Tell the patient to:

If it’s within your role, you may be able to assist the patient, for example by replacing the dressing. If you’re unsure whether something is within your role, always check with your line manager.

Guidance on washing with a syringe driver may vary between healthcare providers, and where the patient is being cared for.
To keep the syringe driver away from water during other everyday activities, the patient can carry it in a bag. Some patients like to buy or make their own. If they ask you for a bag, check if your organisation provides syringe driver carry bags.

Some people have a fear of needles, or may struggle with how they feel. This may be due to:

There are specific adjustments you could make, that may help to make patients more comfortable with having a needle:

Some of these may not apply to your role. But it’s important to be aware of the patient’s needs and preferences. And it can be useful to know what might help, in case they speak to you about requesting adjustments.

You may notice the patient is distressed about having a needle, or they may speak to you about this. You could suggest they try some things themselves, that might help them feel more comfortable:

We have information about syringe drivers for patients and the people important to them.

Some people having a syringe driver might start thinking about the future. They may start thinking about their preferences for other parts of their care. Other people may not have thought about this at all.

You could start a conversation with them about advance care planning. This could include what their wishes and preferences are for the type of care they want. You could also ask if they currently have any plans in place.

Any health or social care professional can support someone with advance care planning. You do not need to be a specialist. Open and honest conversations can help make sure the patient’s wishes and preferences are communicated and respected. Some professionals worry about speaking about advance care planning with patients.

We have helpful information about advance care planning, including how to speak to patients about this.

Patients and the people important to them may have worries and questions about syringe drivers and life expectancy. Lots of people believe having a syringe driver means they’re at the end of life. Some people may ask how long someone will live once they have a syringe driver.

People can have a syringe driver at any stage of their illness, not just at the end of life. So it is not possible to give a definite answer about life expectancy.

Some patients use a syringe driver for a short time to manage their symptoms. For example, someone might have anti-sickness medicines (antiemetics) in a syringe driver, to manage nausea and vomiting caused by chemotherapy. Sometimes, with ongoing assessment from the patient’s healthcare team, syringe drivers are stopped. Patients can then switch to different medication methods, such as tablets, injections, or patches.

It’s important to speak with the patient about why the syringe driver is being prescribed. If appropriate, discuss this with the people important to them too. Listen to their concerns and reassure them the syringe driver is a safe and effective way to manage their symptoms. Where possible, the patient should be involved in making the decision to have a syringe driver.

Give them the opportunity to ask questions. If they ask anything you’re unsure about, let them know you will find out and get back to them. Or you could escalate the query to a more senior member of their healthcare team who can speak to the patient.

You can reassure them that painkillers and other medicines are safe and effective when prescribed appropriately and administered correctly.

Sharing resources about syringe drivers can be helpful for patients and the people important to them. You could read through the resources with them. Or give them time to read on their own and come back to you with any questions. Read more about sharing resources above.

Syringe drivers may be set up at a time when the patient is already approaching the end of their life, because the syringe driver is the best option to manage their symptoms. Some people think the syringe driver is responsible for the someone’s condition getting worse, but there’s no evidence for this.

There are some things to be aware of when supporting patients that have a syringe driver.

Check the skin around the infusion site (where the cannula or needle is inserted) regularly. Encourage patients to do this too. Ask the patient if they have any discomfort, and check for swelling and changes in skin colour.

Colour changes may be more subtle on darker skin tones. So it’s important to know what to look out for:

Any changes to the skin need to be assessed by the healthcare professional looking after the patient’s syringe driver.

Syringe drivers have an alarm to alert you when something is not working as it should. If the alarm goes off or the syringe driver stops working, contact the healthcare professional looking after the patient’s syringe driver. It’s important to do this straight away.

They might ask you if there is a message on the display screen, and give you advice on what to do before they arrive.

The alarm can go off for a number of reasons, including but not limited to the following:

Medications in syringe drivers are used for symptom management. They can help manage symptoms such as pain, nausea and vomiting, agitation, noisy chest secretions, seizures (fitting) and breathlessness.

There are four main groups of medications used in syringe drivers:

Under each symptom below, we’ve listed some of the medications most often used to treat these when using a syringe driver. Depending on the patient’s needs, their doctor or specialist nurse may also prescribe medications not listed here.

A syringe driver may contain more than one medication, to treat different symptoms at the same time.

Medications in syringe drivers can take at least three to four hours to reach a steady level in a patient’s body. This means patients may not feel the effect of the medications straight away. How long this takes is different for each medication.

A breakthrough dose is an extra dose of medication given to help a patient manage their symptoms during this time. There are different reasons a patient may be given a breakthrough dose:

Breakthrough doses may be given as an injection, or a tablet or liquid to swallow.

If the patient needs regular breakthrough doses, the doses of medication in their syringe driver may need to be reviewed and increased. If you suspect the patient’s medication may need to be re-assessed, contact their prescribing doctor or nurse, or your manager.

When a patient dies, contact their GP or nursing team. Leave the syringe driver in place until after the death has been formally verified by a qualified person.

The syringe driver will usually be removed by a member of the nursing team before the patient is moved.