McKinley T34 Syringe Driver for Adults in Palliative Care

Excellent care at the heart of the community 1

McKinley T34 Syringe Driver for Adults in Palliative Care

Standard Operating Procedure

Date (2016/18) V4 August 2016 This document remains valid whilst under review

TARGET AUDIENCE (including temporary staff)

People who need to know this document in detail

ALL Clinical healthcare workers including seconded, bank and agency staff involved in McKinley Syringe driver use

People who need to have a broad

understanding of this document

Managers of Clinical Staff

Service Managers

People who need to know that this document exists

All employees of SCFT

Author: End of Life Care Lead

Approved by: End of Life Care Steering Group Date: August 2016

Ratified by: Trust Wide Clinical Governance Group Date: September 2016

Date of next review:

August 2018


CONTENTS

Page

1. INTRODUCTION 3

1.1 Purpose 3

1.2 Scope 3

2. INSTRUCTIONS FOR USE 4

2.1 Equipment 4

2.2 Setting up the syringe driver 7

Monitoring checks 13

2.3 Problem Solving 15

2.4 Alarms/Alerts 18

2.5 Contents of syringe driver box in the community 19

3. KEY PERFORMANCE INDICATORS 21

4. RESPONSIBILITIES 21

5. ASSOCIATED DOCUMENTS AND REFERENCES 21

6. VERSION CONTROL 21

Equality and Human Rights Analysis (EHRA) 22

Ratification Checklist


1. INTRODUCTION 1.1 Purpose The nurse must obtain appropriate written instructions from the medical practitioner or independent prescriber. The prescription must be documented, by the prescriber, on a valid prescription/ instruction chart. This should include medicine, diluent, dose, route, and time in hours but NOT the volume (ml). The nurse is responsible for signing the administration chart after setting up the syringe driver to deliver the prescribed dose of medicine. Where there is uncertainty regarding compatibility and stability refer to www.palliativedrugs.com, local syringe driver guidelines, or telephone SCT Medicines Management Team, the hospital pharmacy or local Specialist Palliative Care Team. The nurse should discuss the rationale for syringe driver use with the patient and carer and obtain verbal consent before setting up the infusion. A copy of the Patient Information Leaflet for McKinley T34 Syringe Pump should be provided. Information should be provided in a format which meets the patient’s and carer’s individual needs. The nurse is responsible for monitoring the syringe driver: four-hourly in the inpatient setting, or at each clinical visit in the community, and documenting results on the Community Syringe Driver Administration chart. In the community setting it is recommended that a minimum of two syringe driver checks are undertaken by a Registered nurse each day. If patients are transferred from another care setting to SCFT with a syringe driver in situ, the syringe driver should be changed to a SCFT syringe driver as soon as is practically possible, and the original syringe driver returned without delay. If a patient is admitted to hospital with a SFCT syringe driver, send a self-addressed padded envelope for return of the syringe driver 1.2 Scope This document establishes the Standard operating procedure for the use of the McKinley Syringe Driver for Palliative Care in Adults aged 18 and over under the care of SCFT.


2. INSTRUCTIONS FOR USE 2.1 Equipment Standardization of the needle and infusion lines within organisations will help to minimise potential for error. The Saf-T-Intima™ SQ Infusion Set should be used as first line if placed by SCFT staff, however some subcutaneous infusion sets may have been placed by other organisations and may vary from the Saf-T set. Neria (Thalaset) or Sof -Set lines are used for patients who appear sensitive to nickel needles, as evidenced by frequent breakdown of insertion site, or when other measures have failed (extra dilution, change to less irritant medicines). McKinley, Neria and Sofset infusion sets have a lumen volume of less than 0.5ml which causes negligible change in medicine delivered on days when a new line requiring priming is used. In adults, it is recommended that only 20ml or 30ml Luer-lok syringes are used, for the following reasons (Dickman: 2005):

Reduction in adverse site reactions due to greater dilution of contents

Reduction in risk of incompatibility due to greater dilution of contents

Amount of medicine wasted in infusion line reduced. Syringes should be filled to the maximum volume possible. For BD syringes this is equal to 18ml in a 20ml syringe and 23ml in a 30ml syringe. NB different brands of syringe have different recommended maximum volumes. Therefore it is recommended that only BD Plastipak syringes are used in SCFT. 50ml syringes may be used in exceptional circumstances under Specialist Palliative Care guidance, if the clinical situation requires this. However the lockbox currently supplied with the McKinley T34 Syringe Pump cannot hold syringes larger than 30ml.

McKinley T34 Syringe Pumps are used in LOCK-ON Mode within SCFT. This means the medication will be delivered over 24 hours and cannot be changed by the user.


Inserting the Butterfly Needle

Figure 1

Preparation Hold as shown (Fig. 1) and rotate the white safety shield to loosen the needle. (Fig. 1). Priming The prime procedure is possible by removing the filter plug and connecting the IV Set and allowing catheter priming. After insertion, just by opening and controlling the flow of the IV Set, the infusion can be started.

Actuator

Infusion status indicator light (GREEN = RUNNING

Power: ON/OFF

Actuator movement: FF/Back

Plunger Sensor

Syringe flange collar sensor

Barrel clamp arm & sensor

Info

Scroll UP/DOWN

YES/START NO/STOP


Figure 2 Figure 3

Insertion Grasp the textured sides of wings and bring them together, pinching firmly. (Fig 2). Using thumb and index finger gently pinch the skin around selected site to identify the subcutaneous tissue. (Fig. 3). Insert the full length of the catheter and needle through the skin at a 30°- 45° angle. (Fig 3). Other administration sets such as Neria (Thalaset) or SofSet may be chosen for patients who have problems at the needle site which have not been resolved by choosing an alternative infusion site. The nurse should refer to the manufacturer’s guidelines for insertion The angle of insertion will depend on the needle type, length and the amount of subcutaneous tissue. Needle Removal Lay the wings flat on the skin surface and pull the white safety shield in a straight, continuous motion until the safety shield separates from the safety system. Discard the needle immediately in a puncture resistant, leak-proof sharps container. Stabilisation Secure the catheter and apply a sterile dressing.

For more detailed instructions on how to use the Saf-T-Intima SQ infusion set please refer to the instructional video on the Pulse under End of Life Care Training.


2.2 Setting up the syringe driver STEP 1 – Preparing the syringe It is good practice to make the solution as dilute as possible to minimise the risk of incompatibility and skin site reactions.

1. Select the appropriate size syringe and establish the final volume. 2. Complete all relevant documentation including a label. 3. Wash hands according to Standard infection control procedures 4. Check the prescription chart/ medicines instruction chart and medicines to be

used as per Medicines Management policy 5. Check compatibility of medicines. 6. Draw up prescribed medicine and diluent into the syringe (see ‘Filling the

Syringe’ box). Dilute to maximum volume. 7. Attach the completed medication label, taking care not to place it over the

scale or where it would impede the syringe sensor in the barrel clamp arm. 8. If a new infusion set is required attach a McKinley anti-siphon infusion set and

prime the line with the contents of the syringe (0.5ml). 9. If the existing infusion set is to be used, complete Steps 2 – 4 (until Start

Infusion? message) before connecting the syringe to the line. 10. If any part of the prescription is changed – A new syringe and line MUST be

used

Filling the Syringe Using a BD Luer-lok syringe (minimum 20ml syringes are recommended), draw up all medicines required in the following way:

Dissolve powdered medicines e.g. diamorphine (if being used) in a small amount of diluent to be used.

Leave the dissolved medicines in the ampoule(s) at this stage.

Draw up any other medicines into the syringe.

Add the dissolved medicines (if being used) to the contents of the syringe.

Use diluent to make the total contents up to the maximum volume for the syringe (18ml in a 20ml BD syringe; 23ml in a 30ml BD syringe).

Mix the contents thoroughly and remove air bubbles. Minute air bubbles should not cause a problem.

Complete the medicine label.

The syringe must be attached to the pump before being connected to the patient

The maximum volume that can be used in a syringe is as follows;

BD 20 ml syringe 18ml

BD 30ml syringe 23ml

Different brands of syringe have different recommended maximum volumes. It is recommended that only BD Plastipak luer-lok syringes are used. Press and hold the BACK button to move the actuator to its full extent to accommodate large syringes. A beep will sound. Insert the syringe carefully to avoid depressing the plunger (a small drop may appear at the tip of the syringe). The display may read up to 0.4ml less than the amount visually drawn up. This is acceptable (less than 2% discrepancy).


DO NOT:

Allow the syringe to be in direct sunlight.

Mix more than three medicines in one syringe, unless on the advice of a palliative care specialist team.

Use if there are any signs of cloudiness or crystallisation

Infuse the contents of the syringe over a period longer than 24hours. Step 2 – Prepare the McKinley T34 Syringe Pump Pre-loading 1. Before placing the syringe into the pump, ensure the barrel clamp arm is

down then press and hold the ON/OFF key until the pump identification screen appears. The identification screen briefly shows the pump model and software version.

2. The LCD display will indicate Pre-Loading and the actuator will start to move. Wait until it stops moving and the syringe sensor detection screen (syringe graphic) appears. 3. During Pre-Loading the actuator will return to the start position of the last infusion programmed. If the actuator is not in the correct position to accommodate the syringe, leave the barrel clamp arm down and use the FF or BACK keys on the keypad to move the actuator. Forward movement of the actuator is limited, for safety reasons; therefore repeated depressions of the FF key may be required when moving the actuator forward. Backwards movement is not restricted. Step 3 – Fitting the syringe to the Syringe Pump When fitting the syringe to the syringe pump – the screen displays Load Syringe:

The syringe graphic on the screen ceases to flash when the syringe is correctly fitted at all 3 points.

1. Check the patient’s name (and wristband if used) against the prescription, according to the medicine administration procedure. 2. Lift the barrel clamp arm, turn it and seat the filled syringe collar and plunger so the back of the collar sits in the central slot. The syringe collar should be vertical with the scale on the syringe barrel facing forward. 3. Lift, twist and lower the barrel clamp arm. 4. Click the syringe plunger into the actuator. This may require some pressure.


The syringe graphic on the screen ceases to flash when the syringe is correctly seated at all three points.

5. The syringe size and brand option will then be displayed. 6. If the syringe size and brand match the screen message, press the YES key

to confirm. 7. If the syringe size and/or brand do not match, scroll with UP or DOWN keys until the correct selection appears, then press the YES key to confirm. Step 4 - Starting the infusion 1. After confirming the syringe type, the next screen message displays the total volume, duration (24hrs) and rate calculated by the pump in ml/hr. 2. Check this information – compare volume displayed with that in the syringe and check the rate displayed equals syringe volume divided by duration:

If it is correct press the YES key to confirm

If it is incorrect press the ON/OFF key to return to syringe options. Select correct syringe and press the YES key to confirm

3. The screen message will display Start Infusion?

4. If using a new line insert the needle into the infusion site and cover with an IV3000 dressing (or equivalent); if using an existing line disconnect the old syringe from the line and reconnect the line to the new syringe in the pump. 5. Press YES to start the infusion. When the syringe pump is running:

the green LED indicator (above the ON/OFF switch) flashes (approx. every 30 seconds)

the bottom line of the screen displays Pump Delivering alternating with the make and size of syringe

For example:


If the infusion has not been started and a button has not been pressed for more than two minutes, an alarm will sound. The message Pump Paused Too Long Confirm, Press YES will show on the LCD display. To stop the alarm, press YES and continue programming the infusion.

Step 5 – Lock the keypad The McKinley T34 Syringe Pump allows users to lock the operation of the keypad during infusion. The function should be routinely used to prevent tampering with the device.

To activate the keypad lock, press and hold the INFO key until the screen displays a progress bar moving from left to right.

Hold the key until the bar has moved completely across the screen and a beep is heard to confirm the lock has been activated.

When the keypad is activated the INFO, YES/START and NO/STOP buttons are still active.

To deactivate the keypad lock (pump must be infusing) repeat the above procedure. The progress bar will now move from right (lock on) to left (lock off) and a beep will be heard.

Step 6 – Place the pump in the lockbox and lock the box Do not place the syringe pump higher than the patient’s body (e.g. on locker) to avoid siphonage of the contents under gravity with lines having no anti-siphon device. Connecting a new syringe to the SC infusion line when re-siting of line is not required When an SC infusion line is already in situ and re-siting is not required:

1. Fill and label a new syringe. 2. Disconnect the SC infusion line from the empty syringe before removing the

syringe from the pump. This ensures that the patient does not receive an inadvertent bolus dose if the syringe is not completely empty when it is removed.

3. Remove the empty syringe from the pump and return the barrel clamp arm to the down position.

4. Press STOP then press ON/OFF to switch the pump off. Switch the pump back on and observe the preload sequence (Step 2).


5. Load the new syringe and programme the infusion pump (steps 1 & 3). 6. Check the SC infusion line is full of fluid and connect it to the new syringe

ensuring the Luer-Lok is fully tightened. Start the infusion (Step 4). 7. If there is a delay in re-attaching the syringe to the SC infusion line, the line

should be capped or covered using a Luer-Lok cap. Changing the SC infusion line when the patient’s medication has been changed

It is considered good practice to change the SC infusion line and use a new site when the patient’s prescribed medication has been changed. The need to change the SC infusion line depends on the change in prescription e.g. when a different combination of medicines is prescribed then a new SC infusion line should be used.

Follow the procedure - Setting up the McKinley T34 Syringe Pump

In exceptional circumstances e.g. in cachetic patients or when a syringe driver has been in use over a long period and alternative sites are very limited, if the existing site is viable and the medicines are compatible, continued use of the existing line and site may be in the patient’s best interest.

Connecting a new SC infusion line to the syringe when a new SC infusion line is required during an infusion

If a new line is required during an infusion, e.g. due to site irritation, it is best practice to discard the syringe and its contents and start a new syringe with the new line.

If exceptional circumstances dictate that this course of action is not possible (e.g. due to insufficient medicine availability at a weekend) follow the steps below, documenting your rationale in the patient’s notes :

1. Unlock the keypad. 2. Press NO/Stop key to temporarily stop (pause) the infusion. 3. Disconnect the syringe from the old line and cap the syringe. 4. Remove the needle from the patient. 5. Remove the syringe from the pump, attach the new SC infusion line to the

syringe and ensure the luer-lok is fully tightened. 6. Prime tubing with the syringe contents until the fluid just shows at the needle tip. 7. Reposition the syringe in the pump (with barrel arm down first adjust the actuator

using FF key to new syringe length). 8. Press YES to confirm syringe make and size. 9. Press YES to RESUME existing programme. 10. Check the display and press YES to confirm. 11. Insert the new needle into the new skin site. 12. Press YES to start the infusion.

This requires the line to be primed from the existing contents of the syringe, resulting in the infusion ending before the full 24 hour period. Document the time the SC infusion line is changed on the community administration chart, or in the patient’s notes, and the new finish time for the

infusion.


13. Document the new finish time for the infusion (see Duration on screen) on the community administration chart and in the notes.

Step 6 - Monitoring the Syringe Pump in Use It is good practice to check the pump during the first 15 minutes of operation. The monitoring checks should be carried out and recorded on the daily administration chart :

One hour after setting up the infusion and then every four hours (inpatient clinical setting).

At set-up/ syringe change and at least once more during the 24 hour period (community)

The following information should be recorded:

The location of the infusion site when the syringe pump is set up and when the line is changed (this reduces disturbance to the patient during monitoring). When the infusion site is changed, record the reason in the notes.

If an infusion is discontinued before it is complete e.g. because of a change in dose or medicine, document the amount of solution remaining and destroyed (ml) in the notes.

The individual carrying out the monitoring checks should document and sign the relevant sections of the monitoring chart. If any checks are not carried out e.g. site check to prevent disturbing the patient whilst asleep, record this and the reason on the monitoring chart.

If any checks indicate a problem the appropriate action must be taken and documented in the patient notes.

• When the STOP key is pressed, the LED light changes from green to red and the screen displays Pump Paused Press YES to Start

• If the pump is paused for more than two minutes, an alarm will sound and the screen will display Pump Stopped Too Long. Press YES to restart or

NO to continue pause.

• It is important to select the correct option at point 9,(see above) YES will resume current infusion (same patient, same syringe, same infusion) . NO

deletes the current programme – it cannot be retrieved. Should the NO button be pressed in error at point 9, the syringe will need to be removed from the pump and discarded. A new syringe will need to be filled and the process

commenced again, beginning at Step1


Check that the infusion running screen displays: Line 1- infusion time remaining Line 2 – infusion rate in ml/hr Line 3 – alternates between syringe brand and size and Pump Delivering

If no display ensure pump has been switched on

If pump is malfunctioning remove from use and return to EME for servicing

Document the flow rate (ml/hr) and your observations as appropriate

If there is a significant discrepancy (>5%) between the actual and expected infusion rate refer to Problem Solving Chart

Check the LED light is flashing green (approx. every 30 seconds)

Check the volume infused (VI) and volume to be infused (VTBI)

Press the INFO key once to display this information

VI on monitoring chart

Check the battery life Press the INFO key twice to display this information

If less than 40% remaining, insert a new 9v6LR61 battery.

Check that there are no signs of crystallisation in the syringe/line.

Crystallisation may appear as cloudiness or slid particles in the solution (these may be transient), or an inability to move the syringe plunger.

If crystallisation has occurred, this may be due o exposure to direct sunlight or incompatibility of medicines.

Refer to Problem Solving Chart and complete an incident form.

Check for signs of local reaction at the needle site.

If there is any soreness, redness or swelling, refer to Problem Solving Chart

Check that the line remains primed with fluid, is securely attached and is not kinked.

If this is not the case, refer to the Problem Solving Chart

Check how effective the medicine has been over the past 24 hours.

If symptoms have not been controlled review medicines and seek advice from your local Specialist Palliative Care Team.

MONITORING CHECKS


Care During the Infusion 1. In the community setting, the patient and/or carer must be given clear guidance

on what to do, and who to contact, in the event of a problem arising. Their involvement should be assessed according to individual needs, as not all are able/wish to be involved.

2. Whilst the syringe pump is in use, the patient and relative/carer should be aware of:

how to take care of the syringe pump e.g. avoid spillages of liquids or dropping the pump and to report if the green light stops flashing or the alarm sounds

if the pump is dropped in water immediately remove the battery

how to change the battery (if appropriate)

avoiding the use of a mobile telephone within one metre of the syringe pump.

ensuring the syringe pump is well supported when the patient is mobile e.g. placed in a pocket or holster

who to contact when a problem occurs

Prior to each episode of use (after preloading), check the pump and battery as follows:

Visual inspection for defects and cleanliness

Check battery life – press INFO key, press YES to select Battery Level.

Document level on Daily Administration Record.

Step 7 - Stopping the Infusion and Removing the Syringe Pump

When the infusion is nearing completion, a warning will be shown on the display screen 15-30 minutes before the end of the infusion.

When the infusion is complete and the syringe is empty the pump will stop automatically and an alarm will sound.

If the syringe pump is no longer required for the patient press YES to confirm the end of the infusion, disable the keypad lock and press and hold the ON/OFF switch to power off the pump.

If the infusion is to be stopped before the syringe is empty it should be disconnected or clamped from the patient first for safety.

Ensure the guidance following Death is observed correctly where applicable Step 8 - Following Death Verification of Expected Death It is the responsibility of the nursing team to ensure colleagues and carers are aware of the following points:

Verification of expected death must be carried out by an appropriately trained health professional.


Document the volume of medicine remaining in the syringe (volume to be infused -VTBI) at time of death (press INFO key once to view this information).

Stop the infusion: remove the keypad lock (press and hold INFO key), press STOP, press and hold the ON/OFF key until the graphic fills completely black, a beep is heard and the pump switches off.

Remove the battery.

In palliative care, following verification of expected death, a health professional

should remove the butterfly/ cannula, line and syringe from the patient and dispose of it according to SCFT Waste Management policy.

Disconnect the syringe from the syringe driver, decontaminate and return the syringe driver to the box

Following Unexpected Death

Following unexpected death, which cannot be verified by a registered nurse, liaise with the patient’s GP or duty medical practitioner. Stop the infusion (see above) but do not remove syringe driver, and leave the cannula, line and syringe in place.

Document actions undertaken and volume of medicine remaining in the syringe (VTBI –see above).

2.3 Problem Solving

FAULT POSSIBLE CAUSE ACTION

The pump will not start.

No battery present. Battery inserted incorrectly.

Battery is depleted/very low

Pump is faulty.

Fit a battery.

Re-align battery terminals.

Fit a new battery

Service required

Infusion ended early/going too quickly

Wrong syringe brand confirmed during set up/incorrect volume measured by pump.

Pump faulty or incorrectly calibrated

Stop infusion and discuss with doctor. Set up a fresh infusion

Ensure correct understanding of user/educate.

Service calibration required

The pump has stopped before emptying syringe.

Exhausted Battery.

Faulty Pump

Fit new battery, turn pump on, confirm syringe size and brand

select to resume infusion.

Return for service


Site reaction - cannula required changing

See Problem Solving- Site Irritation

Pump running - occlusion alarm (may take more than 2 hours to alarm)

Pump will stop automatically and alarm will sound.

Press “YES” to silence alarm. Identify cause of blockage and clear it.

DO NOT remove syringe from pump. Restart infusion.

Syringe renewal – cannula and line intact

Switch of pump using the ON/OFF button and remove old syringe.

Make up new syringe and load pump as described previously in steps 1 to 6 without priming extension line as it is still intact

Change of prescription

Switch of pump using the ON/OFF button

Disconnect extension line from cannula, remove syringe from pump and discard remaining volume, documenting amount on SC infusion chart.

Make up new syringe and load pump as detailed in steps1 to 6 using a new extension line.

Pump running fast (i.e. more than 1 hour ahead of expected time

Stop infusion, check condition of patient and seek medical advice. Report as a medication incident.

Check for disconnection of line or cannula.

Check the correct syringe brand or size has been selected.

Check syringe securely attached to pump.

Check no air present in syringe (solution will siphon in if barrel cracked).

Change the entire syringe pump for a new one and send original for servicing.

Check the pump has not been placed above the height of the patient (siphonage could have occurred).

Pump running slow (i.e. running more than 1 hour behind expected time

Check the syringe pump light is GREEN and flashing.

Check the battery level.

Check the correct (luer lock) syringe brand or size has been selected.

Check that syringe is inserted correctly into syringe pump (actuator is

still against plunger).

Ascertain if syringe pump has been stopped and restarted for any

reason.

Check contents of syringe and line – is there any evidence of

crystallisation/kinking of tubing?


Check cannula site – is this red/hard/lumpy/sore?

Change cannula site if necessary

Consider further dilution of drugs to minimise irritation by setting up a

fresh syringe.

Consider metal allergy if using nickel needle.

Report as an incident

Site Irritation

Change site (use a new winged infusion set/extension line when changing site).

Discuss possible change of drugs with doctor (cyclizine and levomepromazine = most common cause).

Dilute drugs to a larger volume in new syringe.

Consider separating into 2 syringe pumps.

Consider infection.

Consider other possible route of drug administration e.g. rectal.

For severe site reactions which persist despite usual measures such as increased dilution of drug(s), consult palliative care specialist for advice on treatment options.

Precipitation, cloudiness or change in syringe contents

Check compatibility information.

Diluent (seek advice from a pharmacist as to when saline might be appropriate).

Dilute to a larger volume

Consider separating into 2 syringe pumps of give one drug as a subcutaneous bolus infection.

Keep away from sunlight and heat

Advise patient on keeping syringe pump away from hot pack/heat pad of hot water bottle

Commence new infusion at a different site with new cannula and extension line/winged infusion set.

Breakthrough pain/symptoms

Separate subcutaneous injections should be prescribed for breakthrough symptoms. Regular use of breakthrough medication indicates a need for reassessment of patient.


2.4 Alarms/Alerts When an ALERT is activated:

The infusion continues

2/3 beeps are heard approximately every 3 to 4 minutes

A screen message indicating the cause of the alert displays intermittently with the infusion running screen When an ALARM is activated:

The infusion stops

A continuous audible alarm activates (this will continue until either the YES key is pressed to mute or the problem is rectified)

A screen message displays to indicate the cause of the alarm

The infusion status indicator (LED) turns red

Screen Display Sound Possible Causes Action

Occlusion Check line & syringe

Alarm Patient access device is blocked, occluded, clamped or kinked.

Remove occlusion and restart

Flush/change cannula

Syringe displaced

Alarm

Syringe has been removed or displaced, one or more of the syringe detection sensors is not detecting

Check and Confirm

syringe seated correctly

Syringe flanges need to

be in the vertical position at all

times.

Pump paused too long

Alarm

Pump has been left in STOP mode (on hold) for 2 minutes

Either start the infusion, continue pause or turn the pump off

Program nearly complete

Alert

15 minutes to end of Infusion

Prepare to change syringe or turn pump off

End program

Alarm

Infusion complete

Close down or start new infusion

Low battery

Alert Battery is almost

depleted (30 minutes left) Prepare to change battery

End battery

Alarm

Battery is depleted

Change battery


2.5 Contents of Syringe Driver box in the community SCFT McKinley T34 Syringe Pump Guidelines and SOP McKinley T34 Syringe Pump* Plastic Lock Box* 9 volt alkaline 6LR61 battery for current use (e.g. Duracell MN1604 or Procell) Four spare batteries Syringes 10 x 20ml BD Plastipak Luer –Lok syringes 3 x 30ml BD Plastipak Luer-Lok syringes 5 x 2ml syringes (for pm doses if needed) 7 x 1ml syringes (for accurately drawing up doses of medicines below 1ml in volume) Infusion Lines 10 Saf-T-Intima™ subcutaneous infusion set. (Oracle order code FSP324) 10 Saf-T-Intima™ extension lines (Oracle order code FSB648) 10 Luer-Lok bungs Needles 10 blue 23g needles – for drawing up medicines 10 orange 25g needles – for pm doses Diluents 1 box of 10 ampoules of 10ml Water for injections 1 box of 10 ampoules of 10ml sodium chloride 0.9% (NaCI) Needle Site Dressings 10 x IV 3000 dressings (or equivalent) 3 Packs Gauze Swabs 1 Roll of Permeable Tape (eg. Micropore) Documentation 10 Medicines Labels 10 McKinley T34 Syringe Driver Administration Charts Syringe Driver: record of maintenance check sheet *Replacement available from CME McKinley, customer services 01253 894646



3. KEY PERFORMANCE INDICATORS (KPIS) / MONITORING COMPLIANCE None

4. RESPONSIBILITIES Senior Managers must authorise deviation from any policy and procedure and ensure that the reasons have been clearly documented. All Staff must seek senior management approval before deviating from any procedure or guideline; AND clearly document the reasons that the procedure or guideline was not followed.

5. ASSOCIATED DOCUMENTS AND REFERENCES McKinley Syringe Driver policy for Adults in Palliative Care Care Plan for the dying person

6. VERSION CONTROL

Record of Changes

Date Version Changes / Comments

01/01/2012 1.0 Minor Amendments following consultation

01/05/2013 2.0 Minor Amendments following operational feedback

16/08/2016 3.0 Minor Amendments following consultation

Documents

McKinley T34 Syringe Driver for Adults in Palliative Care