Alfentanil is a controlled drug that comes in several strengths. Dose see opioid conversion table overleaf subcut in 24 hr syringe driver. Opioid dose conversion chart, syringe driver doses, rescueprn. Is this prescription dosage within this maximum dosage. If the patient is in pain, vomiting or very agitated, give a stat sc injection of appropriate medication while setting up the syringe driver. Syringe driver operates rate calculator azcalculator. Iv infusion rate cchr dose mcgkgmin x weight kg x 60 minhr.
How to solve drug calculations identify what type of drug calculation and as a first step, use common sense to estimate a rough answer. If the patients pain is not well managed, consider giving a breakthrough dose of morphine dose before commencing the syringe driver because morphine from the syringe driver may take up to four. Starting dose range over 24 hours in syringe driver subcutaneous maximum dose over 24 hours 1. This book saved me when it came to taking those med tests. The concentration is the mass of medicine contained in a volume of liquid. Advanced medicines calculations infusion rates and. Use of alfentanil in renal failure in palliative care in. It is not something that is used by every patient in palliative care, but it can be. The label on the medicine bottle states the concentration of the medicine. Drug calculations for nurses by kerri wright companion. Dosage is the prescribed amount of drug in mg per kg of body weight.
Example calculations from total daily dose of 80mg oral morphine daily dose of morphine mg calculation to alternative drug suggested prescribed dose of alternative drug 80 fentanyl patch. Your patient has a prescription for methyphenidate hydrochloride 1. Opioid conversion ratios guide to palliative care practice. This article is for information only and should not be used for the. A syringe driver is a small portable battery operated pump that administers drugs subcutaneously by continuous infusion. In many cases, drawing a picture that visually represents the. Guidelines for syringe driver management in palliative. Opioid conversion ratios guide to palliative care practice 2016 352016 2016. However, it needs the continued multidisciplinary approach of nurses, doctors and.
Calculate the total dose of drug required in 24 hours and then divide volume of solution by 24, to give a rate per hour. Only use drugs that are known to be effective via the sc route. Dose microgramskgmin x weight kg x volume ml x 60 rate mlhour amount of medication micrograms applying this formula to this calculation. Syringe drivers are often required to provide medicines for symptom.
Guidelines for syringe driver management in palliative care in new. Calculating subcutaneous morphine to subcutaneous diamorphine. Therefore the calculation shows that, to give 30mg per hour, the infusion pump rate. When and how to use a syringe driver in palliative care. It is an extract from the nursing times learning unit drug calculations in practice, which. However, if the infusion required that 600 micrograms were to be infused each hour instead, this would first need to be converted into mg before the infusion rate was calculated, that is, 600. Setting up a t34 syringe driver lock on prime and load when setting up a syringe driver or renewing the next 24 hour syringe, two qualified nurses. Guidelines for syringe driver management in palliative care. During office hours contact pharmacy or the palliative care team for advice.
Calculate syringe driver operates rate using simple dosage calculator. The emr pcc grants permission to reproduce parts of this publication for clinical and educational use only, provided. This calculation is straightforward when the rate you want 30mghour and. The change to mlh syringe drivers is a step in the right direction to improving the safety of syringe drivers. A syringe driver takes 34 hours to establish a steady state drug level in plasma.
Ensure that drug calculations are checked according to legislative requirements and organisational policy and protocols when the syringe driver is setup17. If you want to calculate the dose of a medication, you need to use the following equation. Therefore the calculation shows that, to give 30mg per hour, the infusion pump rate would need to be set at 6ml per hour. Guidance for syringe driver prescribing st lukes hospice plymouth. This article provides essential information on how to calculate drug doses and infusion rates. Refer to relevant guidelines to obtain usual dose range for each medication.
The prn dose of opioid should be calculated from the dose of. Measure from the shoulder of the syringe to the first visible seal of the plunger see fig 1. The use of a subcutaneous or intravenous infusion using a syringe driver to deliver medications has certain advantages. The most appropriate for use in palliative care is 2ml ampoules of alfentanil 500microgramml. Prescribing in palliative care medicines guidance bnf. Nomogram for dvtpe, the infusion dose should be increased by 2 unitskghour. Subcutaneous ketamine infusion in a syringe pump two drug combinations. Any change in the syringe driver dose should take account of the number of sc prn doses given over the last 24 hours. Diazepam, chlorpromazine and prochlorperazine are too. This conversion tool estimates a reasonable equipotent dose between two benzodiazepines. The prescription states only the type and volume of fluid. Your patient is currently receiving an infusion based on 18unitskghour. Painbreathlessness nb if already on oral opioids, see below for conversion. Medication management medical assistant math practice practice safe medication management, medical assistant math practice in usa are highly trained, dedicated and caring.
Weight is the patients weight, expressed in kg or lb. Smith wants a dopamine drip started at 20mcgkgmin on john doe in bed 7. It is very important that you input an accurate result. If severe renal impairment, seek specialist advice morphine 2. A syringe driver is a small, portable, battery operated device that administers medicines subcutaneously over a selected time period, usually 24 hours. The figures in these tables are not clinical doses to prescribe. Smith has ordered a heparin infusion of unitshour for john doe in bed 7. Calculated by dividing 24 hour oral morphine dose by 30. Increase the dose of midazolam accordingly up to 30mg in syringe driver over 24 hours. Unlike opioid equipotent dosing, benzodiazepine equivalence is much less.
Whilst the preferred route of medication administration in paediatric palliative care is the oral one, there may be occasions when this is impractical or. Whilst the preferred route of medication administration in paediatric palliative care is the oral one, there may be occasions when this is impractical or undesirable. Subcutaneous ketamine infusion in a syringe pump 2 drug combinations. The following are problems that may be encountered with syringe drivers and the action that should be taken. For information on the usual doses of drugs used in a syringe driver see inside of back cover. For the majority of patients in the last days of life. This calculation is straightforward when the rate you want 30mghour and the amount of the drug in the bag 250mg are both in the same units mg. Actually this is the same formula used in the po dosage calculator. Drug calculations for nurses infusion pump calculations.
Calculator drug additive label alcohol wipe small tegaderm syringe driver check list and community subcutaneous medications record sheet community or syringe driver observation chart. Medication management medical assistant math practice. When and how to use a syringe driver in palliative. Starting setting up a syringe driver mckinley t34 if symptomatic give stat dose as syringe driver takes 2 4 hours from setting up to achieve effect. Drug calculations for nurses made easy nursing times. This is because the niki t34 syringe driver simplifies administration by detecting the syringe size and volume of medicine, and sets the rate to deliver the infusion over the required time period, e. Thcontinue with prn midazolam calculate dose as 16 of syringe driver dose. Helps you calculate the rate in whole drops per minute when administering iv bags of fluid. Nursing competence in drug calculations has been a cause for concern. Syringe drivers are often used at the end of life because they are the easiest way to give someone the medicines they need to feel comfortable at that time.
Which application rate is needed for the patient getting the designated drug dosage. If the patient is in pain, vomiting or very agitated, give a stat sc injection of appropriate medication while. If you change the syringe driver dose remember to also change the 4 hourly prn. The answer is the syringe driver needs to be set to 3. See conversion table for calculating doses, changing from oral to sd use and using other opioids e. Double this measurement to calculate the rate in mm per 12 hours ie, twice as fast. How to calculate drug doses and infusion rates accurately. Dose mghr x volume in syringe ml amount in syringe mg. Oxycodone in doses above 100 mg given via a syringe driver may. He wants an 800mg vial of dopamine mixed in 500 ml of d 5 w. This is from a previous post that i had responded to. Clinical protocol for the use of syringe drivers in.
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