Syringe Driver Use
Continuous subcutaneous infusion in end-of-life care — indications, drugs, and compatibility
A syringe driver (continuous subcutaneous infusion) is used in palliative care when a patient can no longer take medicines by mouth. The evaluation of the correct drug combinations, compatibility rules, and dose conversions is essential knowledge for pharmacists working in palliative and end-of-life care.
What is a syringe driver?
A syringe driver is a small battery-operated pump that delivers a continuous slow infusion of medicines under the skin (subcutaneously) over 24 hours. It is set up when a patient is no longer able to swallow tablets or liquid medicines — for example because they are too weak, unconscious, vomiting, or have difficulty swallowing. It ensures medicines for pain, nausea, agitation, and respiratory secretions are given continuously without interruption, keeping the patient comfortable at all times.
When is it used?
A syringe driver is started when a patient is unable to take oral medicines reliably. Common situations include the last days of life when swallowing becomes impossible, uncontrolled vomiting that prevents oral medicines being absorbed, unconsciousness or profound weakness, and bowel obstruction where oral absorption is impaired. It is always combined with a written anticipatory prescription for breakthrough doses of each medicine so that nurses can give extra doses quickly if symptoms break through.
What medicines are used?
The four standard medicines prescribed in anticipation for palliative patients cover the four main end-of-life symptoms: an opioid for pain, midazolam for agitation and anxiety, an antiemetic for nausea, and an antisecretory agent for respiratory secretions. Drug compatibility in the syringe is critical — not all medicines can be mixed together. Use the evaluation trigger to access full drug combination tables, dose conversion charts, and compatibility rules for common syringe driver combinations.