Palliative Care
in Dumfries and Galloway
Staff Area
A “syringe driver” or “continuous subcutaneous infusion” (CSCI) is a way of delivering a continuous stable dose of mediation via a pump through a line under the skin.
Before starting a syringe driver, identify any potentially reversible causes for the patient’s deterioration. These may include:
• dehydration
• infection
• opioid toxicity
• steroid withdrawal
• acute kidney injury
• delirium
• hypercalcaemia
• hypo or hyperglycaemia
When staring a CSCI, make sure this is appropriate for the individual patient and care setting. Plan and review. If treatment is not appropriate this needs to be clearly
documented including discussions with patients and those close to them.
Discussion at this time may include appropriate levels of intervention (known sometimes as ceilings of treatment or ceilings of care).
Discuss prognosis (the patient is deteriorating and at risk of dying), agree goals of care and preferred place of care with the patient or a
welfare attorney, and the family.
Take account of any advance/anticipatory care planning or documented patient wishes.
When prescribing a syringe driver, take a look at our “symptom control” pages. The Scottish Palliative Care Guideline has information about choosing and changing opioids and their App has a handy table for conversions between oral and subcutaneous medication.
It is possible to manage a syringe driver in the community but this needs daily input from district nurses. Prompt and careful planning is needed for a safe discharge home or to a care home.
If patient or family needs are complex, or you feel you need specialist input, contact the palliative care team for advice.