Pain relief
The most common and effective painkillers used in palliative care are opioid medications. These can include morphine, oxycodone and fentanyl. These types of medications come in the form of tablets, patches applied directly to the skin or as injections. Opioid medications can cause drowsiness, short-lived nausea and constipation. Your expert healthcare team will choose the most appropriate medication, dose and preparation for you. The dose, effectiveness and side effects of this medication will be reviewed on a regular basis and only changed (dose increased or decreased) if required.
Relaxants
Benzodiazepines are valuable medications that are used in palliative care for a variety of physical and psychological issues. These can include lorazepam, clonazepam and midazolam. You may be prescribed these medications to help with pain, breathlessness and anxiety. Sometimes they can cause drowsiness, so again you will be closely monitored in order to ensure the correct medication and dose are being used.
Anti-sickness
A variety of anti-sickness medications are available and the choice of medication will vary according to the likely cause of your sickness. We commonly use medications such as anti-psychotics (used to treat mental health problems) for sickness as there is good evidence that these medications work for nausea and vomiting. If you have any concerns about this, please speak with your healthcare team.
Anti-secretory
As you become less well, you may lack the strength to cough and spit out secretions that can pool at the back of the throat. This will not cause you to drown nor have problems with your breathing, but these secretions can sometimes be noisy and distressing to your loved ones. In this instance, you may be prescribed some antisecretory medications to try and “dry-up” these secretions. These medicines are only available as injections, therefore can only be given by a trained nurse (either in the hospice or at home by the community nurses) Sometimes these medicines make your mouth feel dry. Alongside regular sipping of fluids as you are able, your healthcare team or family will be trained to provide mouthcare to ensure your mouth remains as moist as possible.
What is a syringe pump?
Sometimes, it can be necessary to use injectable medications to manage your symptoms. This is achieved by using a small, portable machine called a syringe pump. A syringe pump is a portable device that administers medications constantly over a 24 hour period using a small tube inserted under the skin (in the subcutaneous tissue) This means the medicines are absorbed directly into your system.
A syringe pump can administer medications to help manage symptoms such as pain, nausea, vomiting, breathlessness, secretions and anxiety.
Why do I need a syringe pump?
- If you are finding it difficult to swallow tablet or liquid medicines
- If you are feeling sick or are vomiting
- If your bowel is not working properly
- If your healthcare team are concerned that you are not absorbing medications via your stomach
- If you are sleeping for long periods of time and not awake enough to take your tablet/liquid medicines
How does the syringe pump work?
Your healthcare team will discuss which injectable medications will be included in the syringe pump and a prescription issued by your GP or other members of your healthcare team. A trained nurse (either in the hospice or at home by the community nurses) will insert a small needle under the skin, usually in your upper arm, tummy or upper thigh. The needle is then removed and a fine plastic tube remains in place (secured with a dressing) This plastic tube is connected to the syringe containing the medication by an infusion line (a thin, long piece of flexible plastic) and is placed in the battery operated syringe pump. The pump then slowly pushes the syringe plunger to deliver the medicines over a 24 hour period.
Trained nurses re-fill the syringe every day, changing the medicines in the syringe if needed and inspecting the plastic tube site on your skin to ensure there is no redness etc.
How will I know that the syringe pump is working properly?
The syringe pump itself is relatively small (fits in the top pocket of a shirt) and lightweight. It should make very little noise when running properly. The syringe pump does have an alarm which will sound as the medication in the syringe is about to finish or if there is a problem with the pump. When in the hospice, the nurses will check on the pump regularly and respond to any alarm. If you are at home and the alarm sounds, please contact the community nursing team as soon as possible.
Simple do’s and don’ts
Please do:
- Tell the hospice or community nurse if your skin is sore or red where the plastic tube is placed
- Tell the hospice or community nurse if the plastic tube comes out or if the alarm is sounding
- Ask a member of your healthcare team if you have any worries or concerns about the syringe pump or medicines
- Tell the hospice or community nurse straight away if you have accidentally dropped the syringe pump
- Keep the syringe pump on a flat surface when sitting or in bed (e.g. a table or bedside cabinet)
- Keep medication in a safe place when at home (out of the reach of children or vulnerable adults)
Please don’t:
- Get the syringe pump wet. It may be possible to disconnect the pump for a short period of time when it is due to be changed to allow you to bathe or shower. If the pump gets accidentally wet, please inform the hospice or community nurse immediately
- Attempt to adjust the syringe or syringe pump
- Press any buttons (including the silence alarm button) – contact the community nursing team immediately if alarm is sounding
- Expose the syringe pump to bright sunlight or heat
It is potentially dangerous for you or your family to interfere with the syringe pump in any way. It will impact the effectiveness of the medications being given and may cause you significant harm. If you have any questions or concerns about this, please discuss this with a member of your healthcare team.
Contact the community nursing team if:
- You are worried that the syringe pump is alarming, not working properly or damaged
- The colour of the medicines in the syringe has changed or become cloudy
- The skin around the plastic tube insertion site is red or discoloured, hot, painful or swollen
- You have any other concerns
If you need advice about any issues relating to medication, call the Clinical Advice Line on 01245 455478 between 08.00 and 20.00 hours, 7 days a week.