The Experts below are selected from a list of 930 Experts worldwide ranked by ideXlab platform
G Zeppetella - One of the best experts on this subject based on the ideXlab platform.
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A prospective, within-patient comparison between metal butterfly needles and Teflon cannulae in subcutaneous infusion of drugs to terminally ill hospice patients.
Palliative Medicine, 2016Co-Authors: J R Ross, Y Saunders, M Cochrane, G ZeppetellaAbstract:We performed a prospective study of hospice in-patients requiring a Syringe Driver (SD), to determine the site duration and tolerability of metal butterfly needles compared to Teflon cannulae. Using patients as their own control, prescribed medications were divided equally between two SDs (Graseby MS16a), for delivery over 24 h. A butterfly infusion (Flo- safer 2 , 25 gauge) was connected to one SD and a Teflon cannula (Abbocath 1 -T, 24 gauge), to the second. These were inserted subcutaneously (sc) on opposite sides of the body at comparable sites; oedematous, broken or painful sites were excluded. SD sites were examined at 4-hourly intervals. The study was terminated when both devices had required resiting. Needle and cannula times were compared using the Wilcoxon signed rank test. Thirty patients entered the study, 13 males and 17 females, mean age (standard deviation): 70 (11) years. Thirteen patients completed the study. Nine patients died and eight patients discontinued the study before both needle and cannula had been resited. All 30 patients are included in the analysis. The time from insertion to resiting of the cannula was significantly longer than the needle: P
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Drugs and Syringe Drivers: a survey of adult specialist palliative care practice in the United Kingdom and Eire.
Palliative medicine, 2001Co-Authors: C A O'doherty, E J Hall, L Schofield, G ZeppetellaAbstract:Subcutaneous delivery of drugs using a Syringe Driver is common practice within specialist palliative care units. There is, however, little documented information regarding clinical practice. A survey performed in 1992 reported that at least 28 drugs were used in combination with others in a single Syringe Driver. The aim of the present study was to reassess practice in this field and to enquire more specifically about newer drugs. Postal questionnaires were sent to all adult specialist palliative care in-patient units in the UK and Eire (n = 208). One hundred and sixty-five units (79%) responded. The most common Syringe Driver in use was the Graseby 26 (61% of responding units). Most units delivered the contents of the Syringe over 24 h, and water was usually used as the diluent in 90% of cases. The maximum number of drugs that respondents were prepared to mix in a single Syringe was usually three (51%) or four (35%). In the UK, all units used diamorphine in doses from 2.5 mg/24 h upwards. All respondents also used haloperidol, in doses from 0.5 to 60 mg/24 h. A total of 28 different drugs were used in Syringe Drivers. The most common combinations were diamorphine and midazolam (37%), diamorphine and levomepromazine (35%), diamorphine and haloperidol (33%), and diamorphine and cyclizine (31%). In conclusion, there is much in common with regard to the way in which drugs are delivered in Syringe Drivers. However, a wide variety of drugs and drug combinations are still in use.
Dai Roberts - One of the best experts on this subject based on the ideXlab platform.
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Incidence and causes for Syringe Driver site reactions in palliative care: A prospective hospice-based study.
Palliative medicine, 2011Co-Authors: Kath Mitchell, Jennie Pickard, Annie Herbert, Jenny Lightfoot, Dai RobertsAbstract:BackgroundSyringe Drivers are routinely used in palliative care for the subcutaneous infusion of drugs for pain and symptom control. Local site reactions occurring at the site of infusion can lead to patient discomfort and the potential for sub-optimal symptom control.AimThe aim of this study was to investigate whether there was a correlation between drugs administered subcutaneously via a Syringe Driver and the incidence of Syringe Driver site reactions, further linking this to time to Syringe Driver site reaction.Design:Prospective quantitative data collection of Syringe Driver use for 170 hospice inpatients.Setting/participants:Specialist palliative care inpatient facility in the UK. Syringe Driver recording forms were retrieved from case notes of consecutive patients who received medication via a Syringe Driver.Results:An association between the presence of cyclizine and levomepromazine and the incidence of Syringe Driver site reactions was identified. A marked difference in incidence of Syringe drive...
Jennifer Schneider - One of the best experts on this subject based on the ideXlab platform.
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Symptom control with the Syringe Driver
Oxford Medicine Online, 2016Co-Authors: Andrew Dickman, Jennifer SchneiderAbstract:Symptoms tend to increase during the last days and weeks of life and pharmacological interventions are essential for adequate alleviation. Common symptoms experienced by patients at the end of life include pain, respiratory tract secretions, agitation, delirium, restlessness, nausea, and vomiting. The oral route should be used where possible, but as the patient’s condition deteriorates, it may no longer be feasible to administer medication this way. It is likely that patients will require a combination of drugs to control their coexisting medical conditions as well as for pain and other symptom management. A CSCI provides a simple and effective way to maintain control of commonly encountered symptoms experienced by patients with advanced disease. This chapter discusses how CSCIs of certain drugs can be used to manage such symptoms.
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The Syringe Driver
Oxford Medicine Online, 2016Co-Authors: Andrew Dickman, Jennifer SchneiderAbstract:A Syringe Driver, or pump, represents a simple and cost-effective method of delivering a continuous subcutaneous infusion (CSCI). A CSCI provides a safe and effective way of drug administration and can be used to maintain symptom control in patients who are no longer able to take oral medication. There have been several developments in this field since the third edition of this highly successful book. The text in this edition has been completely revised, including a new chapter describing the compatibility and stability of drugs in addition to incorporating new treatment options and an extensive list of new compatibility data. This book serves as a valuable reference source, providing a comprehensive review of Syringe pump use and administration of drugs via CSCI. The first chapter provides an overview of Syringe pumps and CSCIs, including a useful array of frequently asked questions and reference to needlestick injuries. The new second chapter discusses the reasons why drugs in solution are at risk of compatibility and stability issues. The third chapter incorporates revised and referenced information relating to most drugs likely to be administered via a CSCI using a Syringe pump. The fourth chapter briefly discusses the control of specific symptoms that are often encountered when CSCIs are required. The fifth and final chapter contains an extensive, referenced (where possible) list of physical and chemical stability data relating to drug combinations administered via CSCI.
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Continuous subcutaneous infusions and Syringe Drivers
Oxford Medicine Online, 2016Co-Authors: Andrew Dickman, Jennifer SchneiderAbstract:Chapter one provides an overview of Syringe pumps and CSCIs. The reader is introduced to the development of the Syringe Driver, or pump, and the need for a CSCI. Specific indications for a CSCI are described. Practical advice about how to avoid and manage the risks of an infusion site reaction are presented, as well as ten FAQs related to the set-up and use of the Syringe pump. The currently available Syringe pumps are then further discussed in more detail. The chapter closes with a discussion about the risk of needlestick injury, with reference to current legislation and techniques that can reduce the risk.
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Effect of Tubing on Loss of Clonazepam Administered by Continuous Subcutaneous Infusion
Journal of pain and symptom management, 2006Co-Authors: Jennifer Schneider, Phillip Good, Peter J. RavenscroftAbstract:Previous studies have reported loss of clonazepam from solutions administered intravenously from plastic infusion bags and administration sets. In palliative care, clonazepam is sometimes administered through Syringe Drivers using polyvinyl chloride (PVC) infusion tubing. No data currently exist to show whether use of PVC tubing affects the amount of clonazepam actually received by the patient. This study compared the use of two different types of PVC tubing with a non-PVC tubing. Solutions containing clonazepam or clonazepam and morphine were prepared with either normal saline or water for injection as diluent. Concentrations of morphine and clonazepam were determined using high-performance liquid chromatography. Significant loss of clonazepam (up to 50%) was observed in all solutions infused through PVC tubing. Solutions infused through non-PVC tubing retained greater than 90% of the initial concentration of clonazepam. It is recommended that when administering clonazepam using a Syringe Driver, non-PVC tubing be used.
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the Syringe Driver continuous subcutaneous infusions in palliative care
2002Co-Authors: Andrew Dickman, Jennifer SchneiderAbstract:List of Abbreviations 1. Continuous subcutaneous infusions and Syringe Drivers 2. Drug information 3. Symptom control with the Syringe Driver 4. Compatibility tables
Stephen Barclay - One of the best experts on this subject based on the ideXlab platform.
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Continuous subcutaneous infusion in palliative care: a review of current practice.
International Journal of Palliative Nursing, 2015Co-Authors: Tabitha Thomas, Stephen BarclayAbstract:Syringe Drivers are widely used in palliative care, and this article reviews the challenges and outstanding questions associated with their use. Misperceptions among the lay public and some health professionals can be addressed by sensitive communication with patients and families and clear thinking in clinical teams concerning the drugs and doses used, particularly in non-malignant disease. Good levels of knowledge concerning Syringe Driver use has been found among GPs and community nurses, although this is not the case in some nursing home teams. The advantages of newer devices, safety and efficacy of drug combinations, selection of diluent, and management of site reactions are discussed.
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Managing pain in advanced cancer: a survey of United kingdom general practitioners and community nurses
Journal of pain and symptom management, 2012Co-Authors: Natalie Momen, Peter Hadfield, Katy Harrison, Stephen BarclayAbstract:Context. General practitioners (GPs) and community nurses (CNs) have a central role in palliative care. With health policy focusing more and more on enabling patients to die at home, primary health care professionals are increasingly responsible for symptom management of patients near the end of life. Objectives. 1) To investigate GPs’ and CNs’ training and knowledge in palliative care and 2) to identify the characteristics of GPs and CNs with lower levels of palliative care knowledge. Methods. A postal questionnaire was sent to all GPs and CNs in two areas of the U.K. A panel of doctors and nurses with palliative care expertise rated the response categories with regard to correctness and questions with regard to importance for their professional group. These weightings were combined and applied to answers to assess knowledge levels. Results. Response rates were 54% and 35% for GPs and CNs, respectively. Respondents reported receiving training in most areas of palliative care throughout their careers, with the exceptions of Syringe Driver use and bereavement care. High levels of knowledge concerning pain management and Syringe Driver use were found, with no significant differences in the overall knowledge between the professions. Some important gaps were identified for future educational focus. Regression analyses did not identify characteristics that explained the variation in knowledge scores. Conclusion. Both groups had a high level of knowledge concerning key issues in pain management and Syringe Driver use that should equip them well for their central role in palliative care. Recommendations for the focus of future education sessions are made. J Pain Symptom Manage 2013;46:345e354. 2013 U.S. Cancer
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A UK-wide postal survey to evaluate palliative care education amongst General Practice Registrars:
Palliative medicine, 2006Co-Authors: Joseph Low, Michele Cloherty, Susie Wilkinson, Stephen Barclay, Arthur HibbleAbstract:Objectives: To evaluate the content of General Practice Registrars’ (GPRs) palliative care education in the UK. Methods: Postal questionnaires were sent to 492 eligible GPRs across six purposively sampled UK postgraduate deaneries. Results: GPRs were satisfied with their course coverage on control of pain, other symptoms and communication skills, and were also moderately confident in applying the knowledge gained in these areas. They showed a high level of knowledge in the management of cancer-related pain. There was less satisfaction with the coverage given to Syringe Driver use (38%) and bereavement care (36%), with fewer expressing confidence in applying their knowledge to these areas. Conclusions: GPRs have mixed perceptions about their palliative care education. Future educational packages should ensure that GPRs receive planned systematic training in bereavement care and some practical experience in the use of Syringe Drivers. Both Postgraduate General Practice Education departments and specialist p...
Kath Mitchell - One of the best experts on this subject based on the ideXlab platform.
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Incidence and causes for Syringe Driver site reactions in palliative care: A prospective hospice-based study.
Palliative medicine, 2011Co-Authors: Kath Mitchell, Jennie Pickard, Annie Herbert, Jenny Lightfoot, Dai RobertsAbstract:BackgroundSyringe Drivers are routinely used in palliative care for the subcutaneous infusion of drugs for pain and symptom control. Local site reactions occurring at the site of infusion can lead to patient discomfort and the potential for sub-optimal symptom control.AimThe aim of this study was to investigate whether there was a correlation between drugs administered subcutaneously via a Syringe Driver and the incidence of Syringe Driver site reactions, further linking this to time to Syringe Driver site reaction.Design:Prospective quantitative data collection of Syringe Driver use for 170 hospice inpatients.Setting/participants:Specialist palliative care inpatient facility in the UK. Syringe Driver recording forms were retrieved from case notes of consecutive patients who received medication via a Syringe Driver.Results:An association between the presence of cyclizine and levomepromazine and the incidence of Syringe Driver site reactions was identified. A marked difference in incidence of Syringe drive...
