Syringe drivers in palliative care

The syringe driver is a small, portable battery-driver infusion pump, used to give medication subcutaneously via a syringe usually over 24 hours. It can be used when other routes (e.g. oral, buccal, rectal, transdermal) are unsuitable.

The most commonly used syringe driver in the UK is the T34 ambulatory syringe pump, set up according to volume of fluid

Indications include:

• nausea and vomiting
• dysphagia
• intestinal obstruction
• other inability to swallow or absorb drugs
• rectal route inappropriate
• semi-comatose/comatose patient
• acute pain
• patient convenience (eg massive doses of morphine)
• terminal stage debility

Choice of infusion sites: (2)

Sites of choice include:

• anterior chest wall
• lateral upper arms
• anterior abdominal wall
• anterior outer thigh
• area over scapula (in confused or disorientated patient)

Avoid areas of inflammation, oedema, broken skin, bony prominences, recently irradiated areas, sites of tumour, sites of infection, skin folds or lymphoedema

Prescribing for the syringe driver:

• the dose of each drug to be given by infusion over a specified time period (usually 24 hours) should be clearly written

Note that it is important to seek expert advice before initiating a syringe driver. Also check local guidelines as to the appropriate use of syringe drivers.

Reference:

1. Palliative Care Pain & Symptom Control Guidelines for Adults and Staff Providing Generalist Palliative Care. GMMMG. November 2019, reviewed November 2022
2. West Midlands Palliative Care. Syringe Driver Pump Use. December 2025 (online)