This calculator may or may not be accurate or reliable. The method is the same, if the same final concentration is desired. Painbreathlessness nb if already on oral opioids, see below for conversion. Calculating subcutaneous morphine to subcutaneous diamorphine. Drugs for subcutaneous administration in syringe drivers. Dosch clinical mathematics 2019 6 what if, for some reason, you had to prepare a 20 ml syringe. A syringe driver is a small machine that slowly delivers medication under a. I know the math part of the problem, but i always get stuck when they ask which syringe i should use.
If severe renal impairment, seek specialist advice morphine 2. It is important to remember that a syringe driver is an alternative route for drug delivery. Syringe pumps must be serviced regularly according to local guidance and a least annually, whether used or not, to ensure their function is maintained. A syringe driver helps reduce symptoms by delivering a steady flow of injected medication continuously under the skin. The structure followed polyas four stages of problem solving of. However, it needs the continued multidisciplinary approach of nurses, doctors and pharmacists to limit prescribing and administration errors.
Read on to learn what the drug dosage calculation formula is and how to use it. Guidelines for syringe driver management in palliative care in new zealand. Provided that there is evidence of compatibility, selected injections can be mixed in syringe drivers. It allows the continuous delivery of a range of therapies to aid patient comfort. The nurses task will be to find out the amount of drug in each tablet and then to calculate how many tablets to give the patient.
Use only one type of syringe driver in each setting to prevent confusion which may lead to errors6, 8, 10, 18. The use of syringe drivers as a method of drug delivery to control symptoms in. Saftintima catheters are used to reduce local site reactions and therefore increase longevity and reduce needle stick injuries. Syringe driver competency programme 5 trainers gide resources and rationales for the programme workbook ensures that those participating in the programme have some baseline knowledge of the use and management of syringe drivers. Ensure that drug calculations are checked according to legislative requirements and organisational policy and protocols when the syringe driver is setup17. Parenteral drug dosage calculator for syringe liquid solutions medicine injectable dosage equations formulas. Nursing calculations and iv therapy for dummies uk, uk edition. Syringe driver guidelines page 4 72810page 4 of 29 indications for use the graseby ms16a syringe driver is a portable, batteryoperated device, for mechanically delivering drugs at a predetermined rate. Prereading workbook containing rationales, guidelines, drug information and practice calculations. Registration with permits access to latest additions, news, bulletin board for both drug and non drug issues, syringe driver survey drug compatibility database sdsd and document library. Example a syringe driver dose converting from oral morphine to syringe driver e. Some drug combinations, by nature of the large volumes of the drugs, may require to be made up in a 20 ml syringe.
This article will now look at some commonly used drug calculations and the way that mistakes can happen. The workbook also contains drug calculations to practise before attending the. Drug calculations for nurses infusion pump calculations. Twohour workshop consisting of one hour of tutorial based learning and then one hour of handson learning with a syringe driver. Pdf the benefits and drawbacks of syringe drivers in. Advanced medicines calculations infusion rates and strength. The benefits and drawbacks of syringe drivers in palliative car e. Dosage calculation there are several ways to determine how much of a medication you are supposed to administer to a patient.
When and how to use a syringe driver in palliative care. Prescribing in palliative care medicines guidance bnf. The dosage calculator finds what dose of a medication is appropriate for your weight. Graham f, clark d 2005 the syringe driver and the subcutaneous route in palliative care. Software programs, calculations, solutions, answers and calculators are intended for education purposes only. I am having trouble with dosage calculations and knowing which syringe to use when im solving a problem. When the oral route is no longer appropriate, a syringe driver can. Setting up a t34 syringe driver lock on prime and load when setting up a syringe driver or renewing the next 24 hour syringe, two qualified nurses should check the drugs, the rate and the identity of the patient 1 initial set up. They are a safe and effective way to give medicines for symptoms such as pain, nausea and vomiting, seizures, agitation and respiratory secretions. Syringe driver dose guidance for opioid naive patient for use in community and care homes please allow dose adjustment to maximise symptom control one, or all of these may be needed and should be available for optimum end of life care. When and how to use a syringe driver in palliative.
Drug calculations appear to be impossibly difficult, unless you break them down into small steps. Attach the syringe to the tubing, also in the pack from medical. The prepared syringe contains 4 mg noradrenaline in 50 ml of 5% glucose. Syringe drivers exercise 1 using the information given, consider the preparation of the syringe driver 1 hour graseby and answer the following. Palliative care patients often exhibit multiple symptoms that require the use of numerous drugs. Our online drug dosage calculation trivia quizzes can be adapted to suit your requirements for taking some of the top drug dosage calculation quizzes. A syringe driver takes 34 hours to establish a steady state drug level in plasma. Round doses up or down to a sensible number dependent upon the drug and formulations available.
Drug calculations for nurses by kerri wright companion. The work on mathematical problem solving by polya 1957 and schoenfeld 1985a has been applied to drug calculations to highlight a potential structure that could guide the teaching and learning of drug calculation problems wright, 2009b, wright, 2009c, wright, 2009d. Commonly used drugs drug usual dose range indication clonazepam 16 mg24 hours agitation, confusion, seizures cyclizine 75150 mg24 hours. Clinical protocol for the use of syringe drivers in palliative care patients. Fluids used to prepare iv solutions normal saline 0. Medication management medical assistant math practice.
Safe practice in syringe pump management nursing times. Subcutaneous sc drug infusion by portable syringe driver has had a significant impact on pain management. Remove syringe pumps from use immediately and send them to your local medical physics department, if there is. Syringe driver operates rate calculator azcalculator. The lockable, battery operated, niki t34 syringe driver is the current device available in new zealand for the continuous subcutaneous administration of medicines in a community setting. Guidelines for syringe driver management in palliative. Subcutaneous syringe driver niki t43 with documented prescription by rmo niki t34 syringe pump, rigid locked box and carry pouch saftintima catheter. Calculate the total dose of drug required in 24 hours and then divide volume of solution by 24, to give a rate per hour.
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. Subcutaneous ketamine infusion in a syringe pump 2 drug. Agency mda, 1998, for example, errors in drug calculations, drug stability. The aim of this learning package is to assist the clinician to develop knowledge and skills of the basic principles of care for people with subcutaneous infusion devices in palliative care settings. Kingston hospital nhs foundation trust 4,553 views. Once conversion is calculated, ensure opioid dose is prescribed in divided doses as appropriate. A syringe driver pushes the plunger of a syringe forward at an accurately controlled rate. They can be used in hospital, in hospices and at home. The use of a syringe driver for subcutaneous infusion allows several symptoms to be relieved via one route of administration and avoids the. The graseby syringe driver has been gradually phased out of use as it was not tamperproof. Syringe driver competency programme arohanui hospice. Ensure breakthrough dose remains at 16th of syringe driver dose. You also input these figures volume divided by time the fluids need to go through.
They are vitally important to get right, yet so easy to get wrong. Our medication management training course creates a safe and more responsible healthcare worker when administering any form of medication. Calculating rates for syringe drivers principles 1. Calculate the rate at which you should set the syringe driver, in mlhour. Drug subcutaneous prn dosedoses for anticipatory symptoms subcutaneous starting dose range over 24 hours in syringe driver subcutaneous maximum dose over 24 hours 1. Most benzodiazepines included in this calculator are only available as oral dosage forms. Mckinley t34 syringe p or the use of the yringe y cme.
Oct 23, 2019 a comprehensive database of more than drug dosage calculation quizzes online, test your knowledge with drug dosage calculation quiz questions. This paper describes how a small, simpletouse, help card was developed for use with a graseby ms16a syringe driver that can be used with a variety of sizes and manufacturers syringes. If the patient is in pain, vomiting or very agitated, give a stat sc injection of appropriate medication while setting up the syringe driver. Mckinley t34 syringe p or the use of the yringe y cme medical. Wright k, shepherd e 2017 how to calculate drug doses and infusion rates accurately. Its sometimes called a continuous subcutaneous infusion.
Here is a simple way for calculating volume for injections. It contains an extensive, referenced list of compatibility and stability data. Given the numerous issues with benzodiazepine equivalence, the importance of reasonable clinical judgment, clinical experience, appropriate patient monitoring, and dose titration are of even greater significance. For administration by continuous subcutaneous infusion drug dose duration diluent. How to calculate drug doses and infusion rates accurately.
The nurses task will be to find out the amount of drug in each tablet. How many millilitres of each of the drug ampoules would you draw up. Accurate paramedic dosing of mg of a drug when drawing it from a vial or ampule. Therefore the calculation shows that, to give 30mg per hour, the infusion pump. No matter what method you choose to use, if performed properly, they should all come up with the same answer. During office hours contact pharmacy or the palliative care team for advice. This article provides essential information on how to calculate drug doses and infusion rates. Calculate syringe driver operates rate using simple dosage calculator. Remember to prescribe breakthrough doses for prn use 16 of total daily dose.
Dec 02, 2016 local palliative care guidelines should always be followed when mixing drugs in a syringe driver. To convert tofrom methadone seek specialist advice. A syringe containing the medication is attached to the driver, which pushes the plunger. When using this chart, calculate the total daily dose of morphine. Calculate and combine doses for two medications to be mixed in one syringe to the nearest measurable dose. Complete the niki t34 syringe driver module oneoff course complete the palliative care syringe driver competency course complete the drug calculation test complete the feedback form print certificate register for a syringe driver practical session hospice or in facility. Morgan s, evans n 2004 a small observational study of the longevity of syringe driver. Remove syringe pumps from use immediately and send them to your local medical physics department, if there is any doubt at all about their operation whilst in use. Dosage calculations on a drug round, you may be given the total dose a patient is to receive. Find additional exercises and information to accompany kerri wrights innovative textbook on drug calculations on this companion website. Lets say you only happen to have a 20 ml syringe at hand. Label the syringe with drug names and dosage and patient name.
Whilst the preferred route of medication administration in paediatric palliative care is the oral one, there may be occasions when this is impractical or undesirable. This package is designed to provide selfdirected learning. My classmates are also confused because we havent been taught this material yet. Guidelines for syringe driver management in palliative care. Syringe pumps also known as syringe drivers are commonly used for people living with a terminal illness. The graseby ms16a syringe driver is a portable, batteryoperated.
Slide 1 sc administration of medications using a syringe. It is most frequently used in palliative care particularly cancer care, bypassing problems such as. Dose mghr x volume in syringe ml amount in syringe mg infusion rate. Designing a simple help card for use with a syringe driver.
Jul 27, 2008 i am having trouble with dosage calculations and knowing which syringe to use when im solving a problem. Drug calculations for nurses made easy nursing times. Used in syringe drivers to set the rate of the pump for, say, insulin sliding scales. Guidelines for subcutaneous infusion device management in. Medication management medical assistant math practice practice safe medication management, medical assistant math practice in usa are highly trained, dedicated and caring. Zomorph 60mg 12 hourly 120 mg 120mg2 60mg dose of morphine subcutaneously via syringe driver over 24 hours 60mg key. The change to mlh syringe drivers is a step in the right direction to improving the safety of syringe drivers. You might have been given a syringe driver, to help control pain, sickness, agitation or fits.
A critically ill patient who weighs 75 kg is prescribed noradrenaline. With the use of any information on this site, the user shall assumetake sole responsibility for any consequences or damages. Single drugs used in a subcutaneous infusion over 24 hours in palliative care tables 1a to 1f diluent. In this video we look at how to solve some common problems when using a syringe driver. Calculate conversions from oral opioids to subcutaneous opioids.
Not all types of medication can be used in a subcutaneous infusion. The patient may require a dose of immediate release medication prior to commencement of the syringe driver, as medication from a syringe driver may take up to four hours to reach the desired blood level. It can also recalculate the dosage expressed in mgkg into doses of liquid medication. Generally the more dilute the contents are, the lower the risk of compatibility problems and injection site reactions. Ensure that drug calculations are checked according to best practice, legislative. Prescribe the medications for subcutaneous infusion and the diluent, calculating. An audit of subcutaneous syringe drivers in a nonspecialist hospital. Welcome to the syringe driver survey database sdsd the sdsd is a database of the visual appearance of drug combinations reported in prospective international multicentre surveys and also from individual reporting.