Commonly used palliative care medications can either be given as a continuous infusion over 24 hours or as-needed using subcutaneous injections.
Continuous medication(s) refers to the giving of medications that enter the bloodstream slowly and continuously throughout the day. Continuous medication(s) are usually given via a syringe driver or pump, which is a portable, battery-operated machine (See figure 4).
The syringe driver or pump may be attached to a subcutaneous cannula. Once the cannula has been inserted the person should not experience any discomfort from it.
A nurse will reload the syringe driver or pump regularly and may sometimes change the combination of drugs or the dose of medications in the syringe, after discussion with the prescriber. This may need to occur if the person is experiencing ongoing and increasingly unpleasant symptoms, has required an increase in the number of breakthrough medications daily or has been generally unsettled. It sometimes takes a few days to get the right dose(s) and combination of medication(s).
‘As-needed medication(s)’ refers to medication given occasionally through the day. Intermittent medication(s) can be given by subcutaneous injection either for one-off symptom management or for more regular breakthrough symptom management. So breakthrough medication is a type of intermittent medication, and, as mentioned earlier is used to control a symptom that has re-occurred in spite of regular medication.
There are a number of options for how to give the no-needle injections. Which technique you need to use will depend on the as-needed medication that you are giving and the type of container the medication is stored in. Your nurse will give you personalised training so that you know how to give the as- needed no-needle injections that have been prescribed for the person you are caring for. There are step-by-step guides which give detailed information for each of these different techniques and you should refer to these each time you give a no-needle injection.
The nurse will show you how to prepare the no-needle injection by drawing up the medication. The carer diary will tell you how much liquid (the volume) you will need to draw up into the syringe for the correct dose. This may be different for different medications so check the personalised information in your carer diary carefully.
There are two options available when giving an injection into a subcutaneous cannula; your nurse will explain which one you will use.
Firstly, remove the blunt drawing up needle from the syringe. Then give the injection by connecting the syringe to the port on the Y-arm using a twisting or screwing motion until the syringe is securely attached, as shown in figure 5. Then slowly push the plunger to give the medication. Once the medication has been given you can remove the syringe by unscrewing the syringe in the opposite direction.
The other side of the Y-arm, which has a white rim or similar (your nurse will advise you), is topped with a special membrane with a slit in it so you can choose to inject the medication straight into this opening without removing the cap using a short blunt needle (see figure 6). Then slowly push the plunger to give the medication.
For further instructions contact your healthcare team or refer to the step-by-step guides in your training pack.