The following precautions will minimise the risk of problems of incompatibility and instability:
- A maximum of 3 compatible drugs in any one syringe driver/pump is recommended.
- Do not leave drugs in a syringe driver/pump for more than 24 hours.
- Seek advice from the Specialist Palliative Care Team if necessary.
The book called The Syringe Driver: Continuous subcutaneous infusions in palliative care (by Andrew Dickman and Jennifer Schneider) serves as a valuable reference source, providing comprehensive review of syringe driver use and administration of drugs by CSCI. It contains an extensive, referenced list of compatibility and stability data relating to drug combinations administered by CSCI.
Another resource is the SDSD (Syringe Driver Survey Database), it is a database of the visual appearance of drug combinations reported in palliativedrugs.com from prospective international multicentre surveys and also from individual reporting. There are currently over 2350 entries. This data is categorised as ‘observational data’, and a description of ‘appeared compatible’ has been assigned if there was no obvious physical change in appearance of the combination in use, e.g. discoloration, clouding, or the precipitation of particles/crystals.
Although subcutaneous administration of these drugs is common and accepted good practice in palliative care, the use of this route lies outside the product license for most of these preparations.