Synopsis
Use a continuous subcutaneous infusion only for a clear route or symptom indication, calculate each 24-hour dose from assessed need, verify compatibility and device programming, and monitor the patient, site, pump and breakthrough response through every handover.
- Use a continuous subcutaneous infusion when oral or transdermal delivery is unreliable and a reasonably stable 24-hour medicine requirement exists.
- First-line preparation reconciles the last 24 hours of scheduled and rescue medicines, symptoms, renal and hepatic function, allergies and current route.
- Calculate the infusion from actual effective need and route conversion; do not place all anticipatory medicines into the pump simply because they are available.
- The prescription states each generic medicine and total dose over 24 hours, diluent, total volume, subcutaneous route, duration, device and separate breakthrough doses.
- Local formularies and specialist pharmacy compatibility data govern mixtures and concentration; visual clarity does not prove chemical stability.
- An independent trained check should verify patient, calculation, units, medicines, ampoules, diluent, syringe, device program and line before connection.
- Choose a healthy site, secure and label the line and keep it separate from intravenous access; never flush the subcutaneous line as an unscheduled bolus.
- The gold-standard review assesses symptom response, rescue use, sedation, breathing, site, syringe, battery, remaining volume, rate and prescription at least daily and after every change.
- Explain to patients and families that a pump supplies steady medicine through a route and does not itself accelerate dying.
Key red flags
A syringe pump is a route, not a diagnosis, sedation order or automatic indication that death is imminent.
Never copy a standard mixture: every drug, total 24-hour dose and indication must derive from the individual assessment and prior exposure.
Do not mix medicines without checking concentration-specific compatibility, diluent, device and stability in the current local palliative source or with pharmacy.
Microgram-to-milligram errors, wrong syringe size, wrong duration or confusing millilitres per hour with total volume can cause fatal exposure.
The pump does not give immediate rescue; severe symptoms need a separately prescribed and administered breakthrough dose while the infusion is reviewed.
Site redness, swelling, pain, leakage, crystallisation, cloudiness or precipitation can interrupt delivery and requires immediate assessment.
An unexplained change in arousal, breathing, myoclonus or hallucinations requires dose, renal function, drug interaction and pump checks before continuation.
New sedation, respiratory slowing, hallucination or myoclonus after starting or changing a pump requires immediate dose and device review.
Investigation priorities
Confirm the indication, symptom mechanism, oral or patch failure, expected duration and whether needs are stable enough for continuous delivery.
Management branches
An established symptom medicine is needed continuously and the oral route is no longer reliable.
- Assess symptoms and route, reconcile actual 24-hour exposure, check organ function and calculate each medicine and rescue through the local palliative protocol.
- Verify compatibility, diluent and concentration with an approved source or pharmacy and complete an independent prescription and device check.
- Connect at a suitable labelled site, explain purpose and alarms, document start and arrange patient, site, pump and symptom review within the required interval.