In palliative care, continuous subcutaneous infusions (CSCI) have become the standard of care and the Syringe Driver has become
an essential piece of equipment. This little book sets out to tell you all you need to know about using syringe drivers for CSCI.
The first chapter describes clearly how to operate a SIMS Graseby syringe driver, including the reasons one should not use
the boost button. Chapter 2 provides information about each of the drugs that can be given by CSCI, including a sentence or two on which other drugs each is compatible with. Chapter 3 describes
the use of CSCI for the treatment of various clinical situations - pain, nausea and vomiting, restlessness and agitation, and respiratory tract secretions.
Chapter 4, comprising more than half the book, is a compilation of 153 compatibility tables for mixtures of 2-, 3-, 4- and
5-drugs. Given that polypharmacy is the rule rather than the exception in palliative care, the information in these tables is very welcome. I wondered whether even more information might not
be available from the manufacturers, a source that does not seem to have been tapped. The tables are very well set out and drug incompatibilities clearly marked, including those where the incompatibility
is dose-dependant. Unfortunately, these tables are not referenced and the reader has to refer back to the text in chapter 2.
This book contains a wealth of information but it is not always that easy to access it. When I looked up hydromorphone, the
text in chapter 2 said that it was compatible with a variety of drugs but there were no listings for hydromorphone in the 2-drug compatibility tables. Perhaps the hydromorphone page in chapter
2 should include a table summarizing the information available elsewhere in the book so that one doesn’t have to scrutinize the tables of contents in chapter 4 or look at all the pages listed
in the index. My other quibble is that the equianalgesic dose table for opioid drugs is based on diamorphine, which is appropriate for the UK, but makes the table more difficult to use in the
rest of the world where diamorphine is not available. And whilst we are on the rest of the world, opioid drugs used elsewhere (e.g., morphine tartrate, levorphanol) are not included.
This book is a valuable resource providing a wealth of information about the use of syringe drivers and CSCIs in palliative
care and should be readily available wherever syringe drivers are used. One can only imagine the trouble experienced by the authors in researching, collating and presenting all the data, but
I know the second edition will be even better.
Roger Woodruff
Past Chairman, International Association for Hospice and Palliative Care (IAHPC)
Director of Palliative Care, Austin & Repatriation Medical Centre, Melbourne, Australia
April 2002
Author Information
Andrew Dickman is Specialist Principal Pharmacist, Palliative Care Team, Whiston Hospital, Prescot, Merseyside, UK
