The sedation and pupillary changes produced may interfere with accurate monitoring of the patient. Continuous subcutaneous infusion should be monitored regularly both to check for precipitation and discoloration and to ensure that the infusion is running at the correct rate. To bookmark a medicine you must sign up and log in. By subcutaneous injection, or by intramuscular injection. Diamorphine causes drowsiness and mental clouding. Consider using a syringe driver when: Care needs to be taken with unconscious intensive care patients on fixed dose schedules where their renal function is impaired.
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Any past experience they have had with syringe drivers The stage of illness they are at and what using a syringe driver means for them for the future, e. In many cases, it will be the family who become aware of any issues with the device itself or that the medicines are not controlling the patient’s symptoms. State the dose and diluents, and remember a triplicate controlled drug prescription for any opioids.
Each ampoule contains mg of Diamorphine Hydrochloride BP. Alcohol may enhance the sedative and hypotensive effects of diamorphine. Patients being cared for at home should ideally have a daily visit from a health professional for review of symptom control and monitoring of the infusion. Extra doses of antiemetics and other medicines in the ysringe can also be given subcutaneously at the usual dose. Marketing authorisation number s 9. Prescribing the medicines for the syringe driver Convert the patient’s previous hour oral medicine requirements including regular and “as needed” diaorphine to the equivalent subcutaneous dose.
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BPJ When and how to use a syringe driver in palliative care
Hospices and diluring aged care facilities are likely to have standardised prescribing and administration charts for syringe driver prescriptions. They allow continuous subcutaneous administration of medicines to enable effective symptom control when medicines given by other routes are inappropriate or no longer effective.
Diamorphine should not be given to women who are breast-feeding as there is limited information available on diamorphine in breast milk. Diamorphine may be used in the treatment of severe pain associated with surgical procedures, myocardial infarction or pain in the terminally ill and for the relief of dyspnoea in acute pulmonary oedema. Medicines are drawn up into a syringe that is then attached to the driver, which is set to move the plunger of the syringe forward at an accurately controlled rate.
Indicate the prescription is for a syringe driver. It is predominantly a central nervous system depressant but it has stimulant actions resulting in nausea, vomiting and miosis. By stringe intravenous injection For Adult 1.
DIAMORPHINE HYDROCHLORIDE | Drug | BNF content published by NICE
The majority of the drug is excreted via the kidney as glucuronides and to a much lesser extent as morphine. Glucose intravenous infusion is the preferred diluent, particularly when the drug is administered by a continuous infusion pump over 24 to 48 hours, although it is also compatible with sodium chloride intravenous infusion.
Selection of the infusion site Plastic cannulae are recommended, although metal butterfly needles can be used. Active ingredient diamorphine hydrochloride. Class 1 glass ampoules containing mg Diamorphine Hydrochloride BP lyophilisate each.
The preferred sites for insertion of the cannula for a continuous subcutaneous infusion are:. To email a medicine you must sign dilutimg and log in.
Breakthrough pain can be treated with additional subcutaneous doses syrnige the opioid being used usually morphine. Lung cancer in New Zealand News and updates: Usual starting doses for subcutaneous infusion for commonly used medicines are: Care should be exercised in treating the elderly or debilitated patients and those with hepatic or renal impairment.
When and how to use a syringe driver in palliative care
The usual initial dosage for children is 10 micrograms idamorphine kg body weight. Last updated on eMC: This should occur at least every four hours when patients are in a hospice or residential aged care facility. The product is prepared by dissolving Diamorphine Hydrochloride Lyophilisate for Solution for Injection in the requisite amount of water for injection immediately before use.
Once mixed, syringes should be observed for any signs of precipitation or discolouration. Guidelines for syringe driver management in palliative care in New Zealand.
In most cases, a healthcare professional trained xiamorphine the use of syringe drivers, e. Concurrent use of monoamine oxidase inhibitors or within two weeks of their discontinuation.