In this section : Palliative Care
Deactivation of Implantable Cardioverter Defibrillator
Palliative Care – How to Refer
Conversion Charts
Anticipatory ‘As Required’ Medications
Syringe Driver Chart
Scottish Palliative Care Guidelines
Breaking Bad News by Telephone
End of Life Diabetes Care
Fentanyl Patches in the Last Days of Life
Care in the Last Days of Life
Symptom Control
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Syringe Driver Chart
Last updated 12th January 2021
Syringe Driver Chart
- This can be completed in advance if someone is on a stable background oral opiate or benzodiazepine and is approaching end of life. The chart should be completed with the equivalent dose of subcutaneous opiate or benzodiazepine if unable to swallow (see charts if uncertain).
- If prescribing in anticipation of end of life and not on any background opiate or benzodiazepine, but there is an expectation they may be needed (eg) Covid, then 10mg – 20mg morphine over 24 hours (5mg-10mg oxycodone if moderate renal impairment); and 10mg-20mg midazolam over 24 hours is reasonable.
- Levomepromazine is long acting, so if not on antiemetic pre-syringe driver, use prn for 24 hours.
- Hyoscine butylbromide should be started at 120mg over 24 hours for most people with audible secretions. If aware of dry mouth and only mild secretions, start at 60mg.
- The driver should only be commenced if there is an indication to do so (eg) pain / breathlessness, and only using drugs for which there is an indication.
- For example, a patient has pain, breathlessness and is anxious as they are dying, but has no secretions nor nausea. Start the opiate and midazolam, but not hyoscine or antiemetic.
- Start with the lowest dose unless severe distress or high prn dose needed to “settle” at time of commencing driver.