Syringe pumps in palliative care
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Syringe pumps (also known as syringe drivers) are used to manage symptoms such as pain, nausea and vomiting, seizures, agitation and respiratory secretions. They continuously deliver medicines under the skin, to help manage symptoms in a comfortable way.
On this page:
This film is for people who want to learn more about syringe drivers and when they might be used. It's been developed for patients and their families, but may also be useful for health and social care professionals.
Update: In this video, we talk about skin changes (1:15). Our information has since been updated as follows: Check the skin around the needle regularly. Tell your nurse if there is any discomfort, swelling, redness (more easily seen on lighter skin tones), or change to a colour different from surrounding area.
What is a syringe pump?
A syringe pump is a small, battery-powered pump that delivers medication subcutaneously (under the skin) at a constant rate over a 24-hour period.
Uses of syringe pumps
There are several reasons why syringe pumps are used to give patients medicine:
- They have nausea or vomiting.
- They have difficulty swallowing oral medicine (for example, tablets).
- Their symptoms can’t be managed well with oral medicine.
- To avoid having to give injected medicines frequently.
- They can’t absorb medicines through their gut effectively.
Syringe pumps are often used in the last few weeks and days of life but they can be useful for managing symptoms at any stage of illness. For example, someone might have antiemetics (anti-sickness medicines) in a syringe pump to manage nausea and vomiting caused by chemotherapy.
Medicines in a syringe pump
Medicines used in syringe pumps are most often used to treat pain, nausea and vomiting, agitation, secretions and seizures. Medicines in a syringe pump can be adjusted to suit the patient’s needs.
These medicines are commonly used in syringe pumps for the following symptoms:
- Pain – morphine, diamorphine, oxycodone, alfentanil.
- Nausea and vomiting – metoclopramide, cyclizine, levomepromazine.
- Agitation – midazolam, haloperidol, levomepromazine.
- Secretions – hyoscine butylbromide, hyoscine hydrobromide, glycopyrronium.
- Seizures – midazolam, levetiracetam, dexamethasone.
Setting up syringe pumps
Syringe pumps will normally be prescribed by a specialist nurse or GP and set up by a district nurse. 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.
Sometimes patients will have more than one syringe pump. This might be because they’re taking a large number of medicines. It might also be because some medicines can’t be mixed together safely. In these cases, patients will have more than one syringe pump so they can get all their medicines safely.
If patients are able to move around, they can carry the syringe pump with them in a special bag.
Syringe pumps are often placed in a clear plastic, locked box (called a lock box). This protects the pump from being damaged or knocked. There will also be a keypad lock on the pump itself which means the settings can’t be changed accidentally.
Will the patient die sooner with a syringe pump?
Using a syringe pump won’t cause a patient to die sooner. But some patients, friends and family members might be worried about this.
It’s important to discuss why the syringe pump is being considered with the patient and those looking after them. Listen to their concerns and reassure them that the syringe pump is a safe and effective way to manage their symptoms. The patient should be involved in making the decision to have a syringe pump.
You can reassure them that painkillers and other medicines are safe and effective when prescribed appropriately and administered correctly.
Often syringe drivers are set up at a time when the patient is rapidly deteriorating and the syringe pump is the best option to manage their symptoms. Some people think the syringe pump is responsible for the deterioration but this isn’t the case. A syringe pump can also be used over a shorter period of time while the patient needs a specific medicine.
Read more about caring for patients in the last days or hours of life.
Supporting a patient with a syringe pump
You can also provide information to your patient and their family or friends. Share our page for the public on syringe drivers. It includes an animation that explains what they’re used for and how they work.
What should I do if the syringe pump stops working?
The nurse who sets up the syringe pump will visit daily to review the patient’s symptoms and set up a new syringe of medication. They will also change the cannula regularly. In the meantime, there are certain things you can do:
- Check the area around the cannula for signs of infection, or irritation from the medicines, including:
- skin irritation or
- skin discomfort or
- skin discolouration – redness on lighter skin tones, or change to a colour different from the surrounding area (usually darker) in darker skin tones.
- Keep the area around the site clean and dry, and check there’s no leakage.
- Check the line to make sure it’s not twisted, trapped, or caught. For example, under part of the body.
- Check there are no white particles along the tube (this means the medication has crystallised).
- Place the syringe pump in a safe and comfortable position.
- If the patient is able to move around, they might find it helpful to have a syringe driver bag to keep it safe and in a comfortable position.
- Avoid getting the syringe pump wet. If the patient wants to shower or bathe, suggest they speak to their district nurse for advice.
- Report immediately if the pump gets wet or is dropped. Contact the patient’s district nurse.
- Do not position the pump in sunlight or anywhere it can get too hot, as this can affect the medication inside the syringe.
You may find it helpful to share our online information for the public about syringe pumps.
You can also share our free booklet on syringe drivers.
What to do if the syringe pump stops working
If an alarm is going off, this might mean that the syringe pump has stopped working. A message might also appear on the pump’s display screen.
If this does happen, don’t panic – the medicines will keep working for a while. But call the patient’s district nurse straight away so they can come and check it and give you advice on what to do before they arrive. If you can’t reach the district nurse, call the patient’s GP.
An alarm may mean the battery needs replacing, or the patient is nearing the end of their medication. The patient will have a supply of new batteries, so you can help them to replace it.
If the syringe pump is in place when the patient dies
When the patient dies, contact the GP or district nurse. Leave the syringe pump in place until after the death has been formally verified by a qualified person.
The syringe pump will usually be removed by the district nurse before the patient is moved from the home.
Key points
- A syringe pump can be used to manage symptoms when other routes aren’t effective.
- A syringe pump does not speed up death – it is used when it’s the most appropriate route of treatment.
- The site and equipment should be checked regularly.
- Contact the district nurse if you have any concerns around the syringe driver, for example if the alarm goes off, the site looks red or leaking, or you don’t feel the patient’s symptoms are being managed.
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Disclaimer
This information is not intended to replace any training, national or local guidelines, or advice from other health or social care professionals.
The Palliative Care Knowledge Zone is not intended for use by people living with a terminal illness or their family and friends, who should access our information for the public.
