A small observational study of the longevity of syringe driver sites in palliative care

Although the use of portable syringe drivers is common in palliative care, problems do occur. A small observational study of local practice was undertaken to establish the rate of syringe driver reactions and duration of sites; to determine whether a predictable relationship existed between the number of days on a syringe driver and the number of sites used consecutively; and to discover whether the location of a syringe driver site influenced the site longevity. Eighty-six syringe driver sites were established in 27 patients during the 3-month study period. Site duration ranged between 1 hour and 9 days (mean 2 days). An association was found between the number of days on a syringe driver and the number of sites used. However, this relationship is not close enough to predict when a site may be discontinued. Thirty-eight syringe drivers (44%) were discontinued because of site reactions. The location of a syringe driver site appeared to be an important factor influencing the site longevity, with cannula dislodgment three times more prevalent from the chest wall than the upper arm (P=0.05). However, the findings suggest that if it is possible to prevent dislodgement from the chest wall, then this site can be used for significantly longer before a site reaction develops (P=0.02). In view of the unpredictability of site reactions, it is concluded that sites must be assessed regularly and changed as soon as problems develop. As this was a small study in one unit without standardization of site reaction assessment, the results should be interpreted with caution. However, given the lack of published work in this area, this study contributes to the evidence base and raises important questions for both clinical practice and future research.