Drugs and syringe drivers: a survey of adult specialist palliative care practice in the United Kingdom and Eire

Subcutaneous delivery of drugs using a syringe driver is common practice wi thin specialist palliative care units. There is, however little documented information regarding clinical practice. A survey performed in 1992 reporte d that at least 28 drugs were used in combination with others in a single s yringe driver. The aim of the present study was to reassess practice in thi s field and to enquire more specifically about newer drugs. Postal question naires were sent to all adult specialist palliative care in-patient units i n the UK and fire (n=208). One hundred and sixty-five units (79%) responded . The most common syringe driver in use was the Graseby 26 (61% of respondi ng units). Most units delivered the contents of the syringe over 24 h, and water was usually used as the diluent in 90% of cases. The maximum number o f drugs that respondents were prepared to mix in a single syringe was usual ly three (51%) or four (35%). In the UK, all units used diamorphine in dose s from 2.5 mg/24 h upwards. All respondents also used haloperidol, in doses from 0.5 to 60 mg/24 h. A total of 28 different drugs were used in syringe drivers. The most common combinations were diamorphine and midazolam (37%) , diamorphine and levomepromazine (35%), diamorphine and haloperidol (33%), and diamorphine and cyclizine (31%). In conclusion, there is much in commo n with regard to the way in which drugs are delivered in syringe drivers. H owever, a wide variety of drugs and drug combinations are still in use.