Subcutaneous infusion pump (know how and when to prescribe)

What it is

A subcutaneous infusion pump (syringe driver) delivers continuous subcutaneous medication over 24 hours - the standard method for maintaining symptom control once oral medication is no longer reliable (reduced consciousness, dysphagia, GI obstruction, or persistent vomiting)
Widely used in the terminal phase of illness and increasingly also for symptom control earlier in a palliative trajectory when oral administration becomes unreliable for any reason

Continuous subcutaneous infusion avoids the peaks and troughs of intermittent dosing, maintains steady plasma drug levels, and does not require IV access - well suited to community/home settings as well as inpatient care

Multiple drugs are commonly combined in a single syringe (e.g. an opioid, an antiemetic, and an anxiolytic/antisecretory agent together) - compatibility must be checked before combining drugs in the same syringe, since some combinations precipitate or otherwise become physically/chemically incompatible
Site selection (commonly upper arm, abdomen, or thigh) and site rotation reduce local irritation; the site should be checked regularly for signs of inflammation, which can impair absorption if not addressed

Calculate the total 24-hour dose based on the patient's prior opioid/other drug requirements (converting from oral/other routes as needed - see opioid conversion) and set the pump rate accordingly
Breakthrough medication (a separate PRN subcutaneous dose, not simply increasing the pump rate) remains necessary alongside the continuous infusion for episodic symptom exacerbation
Regular review and dose titration as symptoms and the clinical picture evolve, particularly in a rapidly changing terminal phase

Drug compatibility in combined syringes, site reactions, opioid dose conversion calculations, breakthrough dosing alongside continuous infusion

A syringe driver is a delivery method, not a different treatment philosophy - families sometimes perceive its introduction as signalling imminent death specifically, and clear explanation that it is simply a more reliable route of administration, used whenever oral dosing is no longer feasible, can reduce unnecessary distress

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