What Is a Syringe Driver? T34 Guide for Care Teams

A syringe driver is a small, battery-powered pump that gives medicine through a fine tube just under the skin, at a steady rate, usually over 24 hours. It's mostly used in palliative and end of life care when someone can't swallow tablets or keep them down, so their symptoms stay controlled without repeated injections. In the UK, the T34 is one of the models generally used.

What is a syringe driver used for?

A syringe driver (also called a syringe pump; giving medicine this way is called a continuous subcutaneous infusion) keeps a steady level of medicine in the body. According to Marie Curie's guidance for professionals, it's often used when a person:

• can't swallow, or is less conscious
• is being sick often, or has a bowel obstruction or poor absorption from the gut
• would otherwise need frequent injections
• has symptoms that aren't controlled by other routes

The medicines usually treat symptoms such as pain, nausea and vomiting, and breathlessness. More than one medicine can go in the same syringe. If symptoms break through, extra doses can still be given another way, as prescribed.

NICE's guideline on care of dying adults in the last days of life (NG31, 2015) says to consider a syringe pump for continuous symptom control if a person has needed more than two or three doses of any "as required" medicine in 24 hours.

Syringe drivers at the end of life: what they do and don't mean

Families often see a syringe driver and assume the end is very close. It's worth your team knowing the facts, because they'll be asked.

• It isn't only for the last days. Syringe drivers can be used at any stage of an illness for symptom control, and some people go back to tablets, liquids or patches when they can swallow again.
• It doesn't speed up death. Marie Curie calls this a common misunderstanding and says there's no evidence for it.
• It can be stopped. With the guidance of doctors and nurses, a syringe driver can be stopped and medicines given another way.

Staff shouldn't guess how long someone has left. If a relative asks, a calm "that's a good question for the nurse or doctor, shall I ask them to talk to you?" is better than a guess.

The T34 syringe driver: what you'll see

Marie Curie says the models generally used in the UK are the T34 and the BD BodyGuard T. You'll usually see:

• the pump itself, with a small screen and keypad
• a syringe holding the prescribed medicines
• a thin line running to a soft needle or cannula under the skin
• a clear, lockable box around the pump and syringe, so the keypad can't be pressed and the syringe can't be moved

A light that flashes now and then, with an occasional whirring sound, usually means the pump is working. The pump isn't waterproof, and NHS patient leaflets advise keeping it away from heat pads, hot water bottles, electric blankets and direct sunlight.

Today's pumps replaced older designs. In 2010 the National Patient Safety Agency told providers to move away from the Graseby MS16A and MS26 drivers, which had been linked to confusion over rate setting, to drivers with extra safety features. A 2018 Department of Health and Social Care review looked back at that change.

How it's set up and checked

This is a high-level picture, not a procedure. Setting up a syringe driver needs specific training, and the detail comes from your local policy and the person's care plan.

• Prescribing: a doctor or other prescriber decides the medicines and doses. Nobody else changes them.
• Setting up: a trained health professional, usually a nurse, prepares the syringe to the prescription, primes the line, chooses and checks the site, and starts the pump.
• Renewing: the syringe is usually renewed every 24 hours. Marie Curie says the line and needle are usually changed every three to seven days.
• Checking: at the intervals your policy sets, the nurse checks the rate on the screen matches the prescription, how much is left, the battery, the line and the site, and looks for anything wrong in the syringe such as cloudiness or crystals. Each check is recorded.

What care staff and families should look out for

Care staff are often the ones in the room when something changes. Tell the nurse responsible straight away if you notice:

• An alarm or bleeping. Don't switch it off, press keys or try to silence it. Call the nurse. Alarms can mean a low battery, a blocked or kinked line, or the syringe nearly empty.
• Changes at the site: redness, swelling, pain or leaking, or a dressing that's wet or lifting. On darker skin, redness can be harder to see, so look for any colour change.
• Symptoms not controlled, or new symptoms such as more pain, sickness or agitation.
• A line that's been lain on or pulled. Lying on the tubing can block it, so take care during personal care and repositioning.
• The pump wet, dropped or damaged, or the lock box cracked.
• Cloudy contents or sediment in the syringe.

Write down what you saw and when, in the person's records, and keep the out-of-hours number for the nursing team where every shift can find it.

Who is responsible?

Responsibility is shared, and everyone needs to know where their part stops.

• The prescriber decides the medicines and doses and reviews them.
• Registered nurses set up, renew and monitor the syringe driver, following the prescription, local policy and pharmacy advice. If your service doesn't employ nurses, the person's community nursing team usually does this.
• Senior care staff or nursing associates may take on parts of the task in some organisations, if local policy allows it. Under the NMC Code, a nurse who passes a task to someone else stays accountable for that decision, must make sure they're supervised and supported, and must check the outcome. That only works with training and a sign-off in practice.
• Care staff observe, report, record and keep the person comfortable. They don't adjust the pump.
• You, as the manager, set the policy, decide who's trained for what, and make sure staff know who to call, day and night.

How Kasorb can help

Our T34 syringe driver training is for nurses and senior care staff. It runs on site for up to 10 staff, and covers what a syringe driver is for, the T34's parts, batteries, lock box and settings, preparing and loading the syringe and priming the line, choosing and inspecting the site, starting, pausing and stopping an infusion, routine monitoring and records, alarms and troubleshooting, site reactions and when to escalate, and working within your policy, the prescription and pharmacy advice. Staff work through set-up, monitoring and alarm scenarios with feedback from the trainer, then your own supervised sign-off confirms each person in practice. It's quoted for your team, and certificates are emailed the next day.

For the wider picture, see our palliative care and end of life care courses, and verification of expected death for registered nurses.

FAQs

What is a syringe driver used for?

A syringe driver gives a steady dose of medicine under the skin, usually over 24 hours. It's used to control symptoms such as pain, sickness and breathlessness when someone can't swallow or keep tablets down, or would otherwise need frequent injections.

Does a syringe driver mean someone is dying?

Not necessarily. Syringe drivers are used at any stage of an illness for symptom control, and some people go back to tablets later. They're common at the end of life, but they don't speed up death.

How often is a syringe driver changed?

The syringe is usually renewed every 24 hours, and the line and needle are usually changed every three to seven days, or sooner if there's a problem with the site. Your local policy sets the detail.

Can care staff set up a syringe driver?

It's usually a registered nurse's job. Some organisations allow trained senior care staff to carry out parts of the task under local policy, with nurse supervision and a sign-off in practice. Care staff without that training observe and report, and never adjust the pump.

What is a T34 syringe driver?

The T34 is a portable, battery-powered syringe pump widely used in UK palliative care. It sits in a clear lockable box, runs a prescribed infusion under the skin, and alarms if there's a blockage, a low battery or the syringe is nearly empty.