According to the bioavailability of the drug, medical condition and individual preference, the route of administration should be considered for each drug prescribed. These include:

• Oral
• Sublingual
• Buccal
• Nasal
• Gastrostomy/ Jejumostomy / Nasogastric (NG)/ Nasojejunal (NJ)
• Centrally inserted venous catheters (CVAD) including:
  • Percutaneous Indwelling Continuous Catheter (PICC)
  • Port-a-cath (an implantable port device positioned under the skin inserted into the subclavian vein)
  • Hickman Line (tunneled beneath the skin to a large vein)
• Subcutaneous
• Transdermal
• Rectal
• Epidural

Continuous Subcutaneous Infusions (CSCI) using a syringe driver are commonly used towards the end of life. Children can often be well managed using the NG/NJ/buccal and transdermal routes. Avoid repeated subcutaneous or intramuscular injections.

See: syringe driver section in Adult Guidelines.

Indication for using a syringe driver

• Unable to tolerate common routes of paediatric drug administration such as NG/NJ, buccal or transdermal
• Difficultly swallowing
• Persistent Vomiting
• Bowel Obstruction
• Not fully conscious
• Unsatisfactory Response to Oral medications

Advantages of using this delivery system

• continuous blood levels of medication
• maintenance of mobility and independence
• the ability to deliver complex drug combinations safely in the community
• Improved certainty that the medication is reaching its target

Disadvantages of using a syringe driver

• removes locus of care away from parents to “professionals”
• another piece of medical equipment to distract from the child
• costly in terms of daily nurse contact
• technically challenging in neonate / malnourished child

Certain common combinations of drugs can be mixed together and given in the same syringe driver. Some drugs such as dexamethasone and other drugs in high concentrations will require the use of a separate syringe driver.

As a general rule it is advisable not to mix more than 3 drugs in any one driver though up to 5 have been used in particular circumstances. Check compatibility first.(see www.pallcare.info)

See:  Adult Section: Setting up a Syringe Driver