A continuous subcutaneous infusion (CSCI) delivered via syringe pump is a method of drug administration used to maintain symptom control when a patient is no longer able to tolerate oral medication. Several classes of drugs, such as opioids, antiemetics, anticholinergics, antipsychotics and benzodiazepines are routinely administered by CSCI alone or in combinations. Previous studies attempting to identify the most-common CSCI combinations are now several years old and no longer reflect current clinical practice. The aim of this work was to review current clinical practice and identify CSCI drug combinations requiring analysis for chemical compatibility and stability.
UK pharmacy professionals involved in the delivery of care to palliative patients in hospitals and hospices were invited to enter CSCI combinations comprised of two or more drugs onto an electronic database over a 12-month period. In addition, a separate Delphi study with a panel of 15 expert healthcare professionals was completed to identify a maximum of five combinations of drugs used to treat more complex, but less commonly encountered symptoms unlikely to be identified by the national survey.
A total of 57 individuals representing 33 separate palliative care services entered 1,945 drug combinations suitable for analysis, with 278 discrete combinations identified. The top 40 drug combinations represented nearly two-thirds of combinations recorded. A total of 23 different drugs were administered in combination and the median number of drugs in a combination was three. The Delphi study identified five combinations for the relief of complex or refractory symptoms.
This study represents the first step towards developing authoritative national guidance on the administration of drugs by CSCI. Further work will ensure healthcare practitioners have the knowledge and confidence that a prescribed combination will be both safe and efficacious.
Dickman A, Schneider J. The Syringe Driver: Continuous Subcutaneous Infusions in Palliative Care. 3rd ed. Oxford: Oxford University Press; 2011.
David J. A survey of the use of syringe drivers in Marie Curie Centres. Eur J Cancer Care. 1992;1(4):23–8. CrossRef
Johnson I, Patterson S. Drugs used in combination in the syringe driver— a survey of hospice practice. Palliat Med. 1992;6(2):125–30. CrossRef
Palliativedrugs.com. Syringe Driver Survey Database. 2015. Available at: www.palliativedrugs.com. [Accessed 14 June 2015].
Palliative Care Matters. Sdrivers - Drug Compatibility database. 2015. Available at www.pallcare.info. [Accessed 14 June 2015].
National Institute for Health and Clinical Excellence (NICE) 2012. Opioids in palliative care: safe and effective prescribing of strong opioids for pain in palliative care of adults. GG140. Available from: http://guidance.nice.org.uk/cg140. (Accessed 4 Mar 2016).
LeBelle MJ, Savard C, Gagnon A. Compatibility of morphine and midazolam or haloperidol in parenteral admixtures. Can J Hosp Pharm. 1995;48(3):155–60.
Gardiner PR. Compatibility of an injectable oxycodone formulation with typical diluents, syringes, tubings, infusion bags and drugs for potential co-administration. Hosp Pharm. 2003;10:354–61.
Hines S, Pleasance S. Compatibility of an injectable high strength oxycodone formulation with typical diluents, syringes, tubings, infusion bags and drugs for potential co-administration. EJHP Pract. 2009;15(5):32–8.
Allwood MC, Brown PW, Lee M. Stability of injections containing diamorphine and midazolam in plastic syringes. Int J Pharm Pract. 1994;3(1):57–9. CrossRef
Dickman A, Roberts E, Bickerstaff M, Jackson R, et al. Chemical compatibility/stability of commonly used drug combinations administered by continuous subcutaneous infusions for end of life care. Support Care Cancer. 2015;23 Suppl 1:S202.
Dickman A, Kean H, Ellershaw J, Rigge D, Weir D. Chemical Compatibility/Stability of Alfentanil with Commonly Used Supportive Drug Combinations Administered by Continuous Subcutaneous Infusions for End of Life Care . Poster presented at: 12th Congress of the European Association of Palliative Care; 18-21 May 2011; Lisbon.
Allwood MC. Diamorphine mixed with antiemetic drugs in plastic syringes. Br J Pharm Pract. 1984;6:88–90.
Regnard C, Pashley S, Westrope F. Anti-emetic/diamorphine mixture compatibility in infusion pumps. Br J Pharm Pract. 1986;8:218–20.
Dickman A, Kean H, Rigge D, Weir P, Ellershaw J. Chemical Compatibility/Stability of Common Drug Combinations Administered by Continuous Subcutaneous Infusions for End of Life Care. Palliat Med. 2010;24(4 Suppl):S141.
Dickman A. Continuous subcutaneous infusions – are we certain the patient is getting what we prescribe? Poster presented at: 13th World Congress of the European Association for Palliative Care; May 30 – June 2 2013; Prague.
Dickman A. Drugs and Continuous Subcutaneous Infusions - A Study to Identify Common Combinations. Poster presented at: 8th Palliative Care Congress; March 10-12 2010; Bournemouth.
Murphy MK, Black NA, Lamping DL, McKee CM, Sanderson CF, et al. Consensus development methods, and their use in clinical guideline development. Health Technol Assess. 1998;2(3):i–iv. 1-88. PubMed
Hill KQ, Fowles J. The methodological worth of the Delphi forecasting technique. Technol Forecast Soc. 1975;7(2):179–92. CrossRef
Letrilliart L, Milliat-Guittard L, Romestaing P, Schott AM, et al. Building a shared patient record for breast cancer management: a French Delphi study. Eur J Cancer Care (Engl). 2009;18(2):131–9. CrossRef
Boslaugh S, Watters PA. Statistics in a Nutshell. Sebastopol: O’Reilly Media Inc; 2008.
- Identification of drug combinations administered by continuous subcutaneous infusion that require analysis for compatibility and stability
- BioMed Central
Neu im Fachgebiet AINS
Meistgelesene Bücher aus dem Fachgebiet AINS
Mail Icon II