Before setting up an infusion

The Bodyguard T syringe pump is a portable, battery operated device for delivering medicine by continuous subcutaneous infusion (CSCI) over a 24-hour period. Syringe pumps provide an alternative route for pain and symptom management in palliative care.

Component parts of the BD Bodyguard T syringe pump

Key pad features:

	key: shows infusion summary, battery status, event log and key pad lock/unlock feature
	Up and Down keys enable scrolling up and down the menu
	confirms selection and starts the infusion
	responds to no to selection and stops infusion
	key moves the actuator to the right
	key moves actuator back to the left
	infusion light flashes GREEN when infusion running and RED when stopped
	switches pump on and off

The use of a syringe pump can sometimes be associated with end of life care. Before setting up the syringe pump, it is important to discuss the reasons for use with the patient, family and carer. The discussion should include an explanation of how the pump works and how to respond to any incidents which may occur.

An information leaflet is available for patients, families and carers: see the appendices. This should be offered across all care settings.

Most common reasons for use:

Oral route compromised:

• Difficulty swallowing
• General condition deteriorating

Oral route less effective:

• Intractable nausea and vomiting
• Gastro-intestinal malabsorption
• Gastro-intestinal obstruction

Other less common situations may arise, when using a syringe pump could be beneficial, but the decision should be discussed and agreed between the patient, the wider multi-professional team and other colleagues e.g. Specialist Palliative Care, Pharmacy.

Advantages include:

• the delivery of therapeutic medicine levels over a 24-hour period
• may reduce need for regular subcutaneous bolus injections

Disadvantages include:

• access to subcutaneous sites may be limited as a result of long term infusions
• site reactions e.g. redness, bleeding, leakage, inflammation, blanching and infection
• patient may find the pump restrictive e.g. unable to move freely, daily refill required

Where possible, involve the patient in the choice of suitable site(s). Ensure the area chosen has loose, subcutaneous tissue.

Acceptable subcutaneous sites: Outer arm Upper thigh Abdomen Chest wall Scapula (for someone who is confused or delirious) Sites to avoid: Oedematous / lymphoedematous sites/ abdominal ascites Bony prominences/ areas at risk of displacement e.g. waistband, near joints/skin folds Irradiated areas /broken skin

To minimise the risk of occlusion and site complications, it is essential that the subcutaneous device is inserted correctly: BD video for insertion of a subcutaneous infusion device (Saf T Intima). The cannula can remain in place for up to 7 days. The date of insertion should be written on the site dressing and on the recording chart. In some circumstances, it may be appropriate to leave the cannula in place longer provided the integrity of the site remains e.g. limited options for new sites.

Decisions regarding the subcutaneous device should be risk assessed and the rationale recorded on the recording chart. If the cannula is unused for 24 hours, check the patency by flushing with a compatible solution e.g. 0.9% Sodium Chloride or Water for Injections. Remove the cannula when no longer required.

Key Point: A single port, subcutaneous infusion device should be used for the administration of medicines via a syringe pump. An additional device should be inserted for the administration of bolus subcutaneous medications. This helps to ensure the syringe pump delivers the prescribed medicines over a 24hour period without interruptions

The groups of medicines listed below are commonly prescribed for use in syringe pumps to help
manage a range of symptoms.

• analgesics
• anti-emetics
• sedatives
• anti-secretory

Occasionally medicines may be used out with a manufacturers licence or ‘off-label’ in palliative care
e.g. via the subcutaneous route. This practice carries additional responsibilities for prescribers,
pharmacists and nurses: see section ‘off label and unlicensed prescribing’ on Scottish Palliative Care
Guidelines.

Key Point: The preferred route for the administration of medicines remains oral (where possible).

All medicines administered via the syringe pump should be clearly and correctly prescribed in accordance with local policy and procedures. Further information and prescribing advice can be accessed on the Scottish Palliative Care Guidelines: Scottish Palliative Care Guideline.