Subcutaneous infusion solution should be monitored regularly both to check for precipitation and discolouration and to ensure that the infusion is running at the correct rate. Constipation is a common cause of distress and is almost invariable after administration of an opioid analgesic. If the patient can resume taking medicines by mouth, then oral morphine may be substituted for subcutaneous infusion of morphine or diamorphine hydrochloride , see table above of approximate equivalent doses of morphine and diamorphine hydrochloride. Conversion ratios vary and these figures are a guide only. The dose is given either as an immediate-release preparation 4-hourly or as a modified- release preparation hourly, in addition to rescue doses.
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Midazolam Subcutaneous infusion solution should be monitored regularly both to check for precipitation and discolouration and to ensure that the infusion is running at the correct rate. Repeated administration of intramuscular injections can be difficult in a cachectic patient.
An antiepileptic may be added or substituted if pain persists; gabapentin and pregabalin are licensed for neuropathic pain.
Syringe Driver Drug Compatibility
Nerve blocks or regional anaesthesia techniques including the use of epidural and intrathecal catheters can be considered when pain is localised to a specific area. Morphine immediate-release 30mg 4-hourly or modified- release mg hourly is usually adequate for most patients; some patients require morphine immediate- release up to mg 4-hourly or modified-release mg hourly drygs, occasionally more is needed.
Diamorphine hydrochloride is the preferred opioid since its high solubility permits a large dose to be given in a small volume see under Mixing and Compatibility, below. The pain of bowel colic may be reduced by loperamide hydrochloride. Oral medication is usually satisfactory unless there is severe nausea and vomiting, dysphagia, weakness, or coma, when parenteral medication may be necessary.
Pain management with opioids Oral route Treatment with morphine is given by mouth as immediate-release or modified-release preparations. The pain of muscle spasm can be helped by a dyringe relaxant such as diazepam or baclofen. Dexamethasonespecial care is needed to avoid precipitation of dexamethasone when preparing it.
Palliative care is an approach that improves the quality of life of patients and their families facing drygs illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of sgringe and other problems, physical, psychosocial, and spiritual.
Syringe Driver Compatibility Chart
If symptoms persist, they can be given regularly via a continuous druga device. Drugs with antimuscarinic effects antagonise prokinetic drugs and, if possible, should not be used concurrently. Bowel colic and excessive respiratory secretions may be reduced by a subcutaneous injection of hyoscine hydrobromidehyoscine butylbromideor glycopyrronium bromide.
Constipation Constipation is a common cause of distress and is almost invariable after administration of an opioid analgesic.
Raised intracranial pressure Headache due to raised intracranial pressure often responds to a high dose of a corticosteroid, such as dexamethasone and should be given before 6 p.
Thereafter, the dose should be adjusted with careful assessment of the pain, and the use of adjuvant analgesics should also be considered. Once their pain is controlled, patients started on syrings immediate-release morphine can be transferred to the same total hour dose of morphine given as the modified-release preparation for hourly or hourly administration. The general principle that injections should be given into separate sites and should not be mixed does not apply to the use of syringe drivers in palliative care.
The infusion is discontinued when the first oral dose of morphine is given. Overview Palliative care is an approach that improves the quality of life fompatibility patients and their families facing life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial, and spiritual.
Confusion and restlessness Haloperidol has little sedative effect.
Careful assessment of symptoms and needs of the patient should be undertaken by a multidisciplinary team. Although some families may at first be afraid of caring for the patient at home, support can be provided by community nursing services, social services, voluntary agencies and hospices together with the general practitioner.
Hyoscine hydrobromide effectively reduces respiratory secretions and bowel colic and is sedative but occasionally causes paradoxical agitation. A corticosteroid, such as dexamethasonemay also be helpful if there is bronchospasm or partial obstruction.
Dry mouth Dry mouth may be relieved by good mouth care and measures such as chewing sugar-free gum, sucking drugss or pineapple chunks, or the use of artificial saliva ,dry mouth associated with candidiasis can be treated by oral preparations of nystatin or miconazolealternatively, fluconazole can be given by mouth.
In severe chronic cholestasis, absorption of vitamin K may be impaired; either parenteral or water-soluble oral vitamin Syrnge see phytomenadione and menadiol sodium phosphate should be considered. For the dose by subcutaneous infusion see below. The following can be mixed compwtibility diamorphine: Diamorphine hydrochloride is sometimes preferred, because being more soluble, it can be given in a smaller volume. Prescribers should ensure that they are familiar with the correct use of transdermal preparations, see under buprenorphine and fentanyl inappropriate use has caused fatalities.
Patients with advanced cancer may not sleep because of discomfort, cramps, night sweats, joint stiffness, or fear. Formulations of transdermal patches are available as hourly, hourly and 7-day patches, for further information cokpatibility buprenorphine.
For the administration of antiemetics by subcutaneous infusion using a continuous infusion device, see below.