Drug Recommended Dose Comments Hyoscine Butylbromide Do not confuse with Hyoscine Hydrobromide Available as: - 20mg / ml ampoules For colic: 60mg – 120mg / 24 hours (higher doses sometimes used) Usual starting dose 60mg For respiratory secretions: 20mg – 60mg / 24 hours Useful for spasm of smooth muscle (gastro-intestinal and ureteric colic) Used to dry up noisy respiratory secretions Less likely to cause CNS effects (including sedation) than Hyoscine Hydrobromide Acceptable combinations in syringe based on laboratory data and clinical practice at recommended doses and concentrations: 3 Drugs Hyoscine Butylbromide + Diamorphine + Levomepromazine or + Midazolam 2 Drugs Hyoscine Butylbromide + Diamorphine or + Haloperidol + Midazolam 7.9
10. Skin site selection and skin care 10.1 Skin For Subcutaneous Infusion The best sites to use for continuous infusion of drugs are: - (Cooper and Mitten 2000; Danne et al 2000; Dickman et al 2002; Johnson 1998; Macmillan et al 1994) 10.2 Sites Which Should Not Be Used For Cannula Placements Are: Lymphoedematous limbs. The rate of absorption from the site would be adversely affected and infection could also occur. Sites over a bony prominence: the amount of subcutaneous tissue would be diminished impairing the rate of drug absorption. Previously irradiated skin area. Radiotherapy can cause sclerosis of small blood vessels, thus reducing skin perfusion. Sites near a joint, excessive movement may cause cannula displacement and patient discomfort. Broken skin. Localised areas of disease e.g. chest wall with breast cancer. Affected limb following lymph node dissection. Patients may decide (in partnership with the nurse responsible for their care) for themselves, after consultation, a suitable site that will interfere as little as possible with their lifestyle (Cooper and Mitten 2000; Danne et al 2000; Dickman et al 2002; Johnson 1998 ) 10.3 Care Of the Skin Site and Checks Hospital, Hospice and Nursing Home Check 4 hourly. Check position of needle Condition of site Volume infused (mls) Check symptom control Record above details on syringe driver observation chart Community Patient/carer may be taught how to assess if appropriate. The District Nurse or Community Nurse will check the site at each visit.
Infusion won’t start Battery inserted incorrectly Battery exhausted Start button not depressed sufficiently Correct as appropriate Medication crystallises Incompatibility of drugs or diluent in syringe STOP - seek urgent medical and pharmaceutical advice. Ensure that the patient is comfortable Alarm – battery is depleted Battery needs replacing Replace battery Infusion motor running Light still flashing Periodic click Syringe plunger mechanism has worn out Use another syringe driver Unit to be returned to Medical Electronics Department Syringe pumps should be serviced annually according to organisational policy. 12. SPECIALIST advice 12.1 Contact Numbers for specialist palliative care advice Site Contact Contact number St Andrews Hospice Senior Nurse on duty (01472) 350908 Lindsey Lodge Hospice Senior Nurse on duty (01724) 270835 Scunthorpe & Goole Hospitals Macmillan Nurses – Palliative Care (01724) 387709 Diana Princess of Wales Hospital Macmillan Nurses – Palliative Care or Macmillan End of Life Clinical Care (01472) 874111 Ext 3596 or (01472) 874111 Ext 3595