The palliative care handbook a good practice guide ninth edition in association with all the wessex specialist palliative care units the palliative care. The use of a subcutaneous or intravenous infusion using a syringe driver to deliver medications has certain advantages. Opioid dose conversion chart, syringe driver doses, rescue prn doses and opioid patches use the conversion chart to work out the equivalent doses of different opioid drugs by different routes. Mar 15, 2015 an educational video to aid student nurses with infusion pump calculations by the minute. It is an extract from the nursing times learning unit drug calculations in practice, which includes clinical scenarios to test your calculations.
Actually this is the same formula used in the po dosage calculator. An aseptic technique should be used when preparing and setting. To convert tofrom methadone seek specialist advice. No matter what method you choose to use, if performed properly, they should all come up with the same answer.
The syringe should be measured every time the device is set up, as different brands of syringes have different diameters and lengths9. Zomorph 60mg 12 hourly 120mg 120mg3 40mg diamorphine subcutaneously via syringe driver over 24 hours 40mg key sc. Syringe driver operates rate calculator azcalculator. The answer is the syringe driver needs to be set to 3. Some people just use them for a short time to manage their symptoms. Never use solutions that have precipitated or become discoloured.
Example a syringe driver dose converting from oral morphine to syringe driver e. Dose see opioid conversion table overleaf subcut in 24 hr syringe driver. For information on the usual doses of drugs used in a syringe driver see inside of back cover. Calculate the total dose of drug required in 24 hours and then divide volume of solution by 24, to give a rate per hour. The method is the same, if the same final concentration is desired. Jul 27, 2008 i am having trouble with dosage calculations and knowing which syringe to use when im solving a problem. Clinical protocol for the use of syringe drivers in. Your patient is prescribed a dose of ceftriaxone 2 g in 20 ml, which needs to be infused over 30. Dosch clinical mathematics 2019 6 what if, for some reason, you had to prepare a 20 ml syringe. When calculating doses always double check your calculation, with someone else if possible. Start at 10mg24 hours in opioid naive patients less in very elderlyfrail. Dosage calculations for nursing students made easy on iv infusion rate calculations video 5 duration.
With higher subcutaneous infusion doses, consideration needs to be given to the volume of breakthrough medication. Unlike opioid equipotent dosing, benzodiazepine equivalence is much less evidencebased and poorly described in the literature. Drug calculations for nurses infusion pump calculations. Slide 1 sc administration of medications using a syringe. If you want to calculate the dose of a medication, you need to use the following equation. Calculate and combine doses for two medications to be mixed in one syringe to the nearest measurable dose. Drugs for subcutaneous administration in syringe drivers. The infusion is to be mixed as 25,000 units in 500 ml. Only use drugs that are known to be effective via the sc route. Always consider alternative routes, such as buccal, rectal, sublingual or transdermal. Review of dosage calculation methods there are three basic methods for calculating medication dosages. April 2017 introduction palliative care patients often exhibit multiple symptoms that require the use of numerous drugs.
Guidelines for syringe driver management in palliative care in new zealand 1 the patients experience syringe drivers are recommended for use when it has been determined that the continuous. Are used to administer subcutaneous injections as well as the intradermal purifies protein derivative ppd skin test that determines if a person has been exposed to tuberculosis. This calculator determines the liquid or solution volume to be injected by syringe into the patient. Whilst the preferred route of medication administration in paediatric palliative care is the oral one, there may be occasions when this is impractical or undesirable. Calculating the dose of morphine morphine remains the most commonly used opioid in syringe drivers in new zealand.
Formula method each method will allow an accurate calculation of the medication dosage. Prn dose is one sixth 16th of 24 hour subcutaneous sc syringe driver dose plus opioid patches if in. Single drugs used in a subcutaneous infusion over 24 hours in palliative care tables 1a to 1f diluent. Dosage calculation there are several ways to determine how much of a medication you are supposed to administer to a patient.
Drug calculations for nurses infusion pump calculations by. A syringe containing medication is attached to the driver, which pushes the plunger forward at a. Assess patient in the last days of life at least every 4 hours. Calculate syringe driver operates rate using simple dosage calculator. The location of a syringe driver site appeared to be an important factor. The label on the medicine bottle states the concentration of the medicine. Lets say you only happen to have a 20 ml syringe at hand.
However, this can cause confusion, because the product is. Guidelines for syringe driver management in palliative care in new. Symptom drug subcutaneous prn dosedoses for anticipatory symptoms subcutaneous starting dose range over 24 hours in syringe driver subcutaneous maximum dose over 24 hours. How to calculate drug doses and infusion rates accurately. Rate mm per hour stroke length mm infusion period hours. They are the maximum amounts of each drug that can be mixed in the syringe and generally be considered physically stable for 24 hours. Guidelines for syringe driver management in palliative care. Opioid dose conversion chart, syringe driver doses, rescueprn. Prescribe a breakthrough pain dose of diamorphine that is 16th of the calculated total diamorphine dose. The concentration is the mass of medicine contained in a volume of liquid.
Syringe drivers are indicated when other routes become inappropriate or difficult. Continuous subcutaneous administration of medicines using a syringe driver often becomes necessary for the control of symptoms during palliative care. Symptom control in the last days of life york teaching hospital nhs. The standard dose of a strong opioid for breakthrough pain is usually onetenth. When the oral route is no longer appropriate, a syringe driver can be used to ensure continued symptom control. If 2 or more doses given in 24 hoursrecurrent symptoms, start sc syringe driver 24 hourly, depending on what the patient has been having orally. The dosage calculator finds what dose of a medication is appropriate for your weight. My classmates are also confused because we havent been taught this material yet. If the patient is in pain, vomiting or very agitated, give a stat sc injection of appropriate medication while setting up the syringe driver.
Pdf the benefits and drawbacks of syringe drivers in. Smith has ordered a heparin infusion of unitshour for john doe in bed 7. Remember to prescribe breakthrough doses for prn use 16 of total daily dose. Iv rate calculations for nurses dosage calculations duration. This conversion tool estimates a reasonable equipotent dose between two benzodiazepines. They are small syringes used when small doses of medication, less than 1ml, are administered. Prescribing in palliative care medicines guidance bnf content. The same brand of syringe should be used each time to minimise errors in setting up the syringe driver and calculating the rate6, 9. Accurate paramedic dosing of mg of a drug when drawing it from a vial or ampule. Oct 16, 2017 this article provides essential information on how to calculate drug doses and infusion rates.
Once you have calculated this, the infusion rate can be worked out as in the type b calculations. A syringe driver is a portable battery powered device that administers medication subcutaneously over a chosen period of time. Symptom drug subcutaneous prn dose doses for anticipatory symptoms subcutaneous starting dose range over 24 hours in syringe driver subcutaneous maximum dose over 24 hours. It is not something that is used by every patient in palliative care, but it can be very useful. Initially the preferred replacement option was the ad ambulatory syringe driver, however, the company involved was unable to supply and support these drivers and a further decision was made so that by 30 june, 2011, the niki t34 syringe driver was used exclusively. Calculated by dividing 24 hour oral morphine dose by 30.
The opiate antagonist naloxone reverses opiate overdose and is usually needed quickly. When and how to use a syringe driver in palliative care. The fentanyl patches do not reach steady state for several days. See conversion table for calculating doses, changing from oral to sd use and using other opioids e. Drug calculations for nurses made easy nursing times. The palliative care handbook the palliative care a good. Typically an upper limit of 2ml for example 20mg oxycodone is acceptable by the subcutaneous route in a single site. Staff using syringe drivers should be adequately trained and different rate. Subcutaneous ketamine infusion in a syringe pump 2 drug. Your patient is prescribed a dose of ceftriaxone 2 g in 20 ml, which needs to be infused over 30 minutes using a syringe pump. Ensure breakthrough dose remains at 16th of syringe driver dose.
Dec 02, 2016 a syringe driver takes 34 hours to establish a steady state drug level in plasma. Round doses up or down to a sensible number dependent upon the drug and formulations available. Oxycodone in doses above 100 mg given via a syringe driver may. Read on to learn what the drug dosage calculation formula is and how to use it. The prn dose of opioid should be calculated from the dose of. Unlike nearly all other benzodiazepine conversions, the conversion between intravenous midazolam and lorazepam has been well studied in mechanically ventilated patients.
It can also recalculate the dosage expressed in mgkg into doses of liquid medication. If this is the case take extra care when calculating and amending doses for syringe driver and prn use. Zomorph 60mg 12 hourly 120 mg 120mg2 60mg dose of morphine subcutaneously via syringe driver over 24 hours 60mg key. However, syringe drivers can be used at any stage of your illness. The formula to work out the dose is under each drug name. If a deteriorating patient already has a fentanyl patch, leave patch on and titrate extra analgesic needs on top, either orally or via syringe driver. But errors resulting in overdose of intravenous opiate can lead rapidly to respiratory depression. For example, syringe drivers can be very useful for taking antisickness medicines alongside chemotherapy. Most health care professionals become comfortable with one method and use that method exclusively. Syringe drivers are often required to provide medicines for symptom. If the patient is on a opioid patch leave the patch on and top up with prn oxycodone or alfentanil. Math dosage and calculations syringe types quizlet. A syringe driver is a small portable battery operated pump that administers drugs subcutaneously by continuous infusion. First you need to convert the mg per kg into total mg by multiplying it by the patients weight.
Palliative and end of life care guidelines south tees hospitals nhs. Diazepam, chlorpromazine and prochlorperazine are too. A syringe driver is useful when the oral route of administration is not possible and repeated subcutaneous doses are inappropriate, ineffective or impractical. I know the math part of the problem, but i always get stuck when they ask which syringe i should use. Guidance for syringe driver prescribing st lukes hospice plymouth. If 2 or more doses in 24 hours recurrent symptoms, stop above and give.
In fact, most benzodiazepine equivalence estimates are based on expert opinion, uncited tables in published documents, and clinical practice. Refer to relevant guidelines to obtain the usual dose range to prescribe for each drug. A syringe driver is a small, portable, powerdriven device used to administer a continuous 24hour dose of medication. Calculating subcutaneous morphine to subcutaneous diamorphine.
If the calculated subcutaneous morphine dose requirement exceeds 360mg24hrs it will be necessary to. In this example, unitshr dose ordered 25,000 units dose available. The figures in these tables are not clinical doses to prescribe. Advanced medicines calculations infusion rates and. Parenteral opiates are often relied on to manage acute pain in patients needing effective analgesia. A syringe containing medication is attached to the driver, which pushes the plunger forward at a controlled rate. Wright k, shepherd e 2017 how to calculate drug doses and infusion rates accurately. Cyclizine 100mg 150mg use water for injection andor haloperidol 3mg 5mg. The benefits and drawbacks of syringe drivers in palliative care.
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