Document Title

Syringe Pump Management – McKinley T34

Policy
Document Description
Document Type Policy
Service Application Trust Wide
Version 4.0
Lead Author(s)
Name Job Title
Rachel Overfield Director of Nursing
Sharon Yates Palliative Care Education Coordinator, Walsall Healthcare
NHS Trust
(Completed the adult section)
Jola Forys Clinical Lead - Community Children’s Nurse – (Completed the
children’s section)
Sindy Dhallu Clinical Operations Manager, Specialist Palliative & End of
Life Care
Sue Crabtree Care Group Manager/ Professional Lead for Palliative & End
of Life Care
Executive Director / Director / Manager
If you are assured that the correct procedure has been followed for the consultation of this
policy, sign and date below:
Name Rachel Overfield Date 26.09.16

Signature

Change History
Version Date Comments
1.0 February 2012  Change in syringe pump from Graseby to
McKinley T34 syringe pump – policy for
Walsall Healthcare NHS Trust.
2.0 September 2012  Paediatric mode of configuration added
into appendices (Appendix 2).
 New reviewed and amended community
syringe pump directive added into
appendices (Appendix 8).
 Points relating to the community syringe
pump directive: valid for date and
professional registration number added
into the policy under section 4.8.

3.0 August 2014  Clearer information relating to battery use

included in section 4.1.
 Additional information relating to the pre-
load function added to section 4.1.
 Additional information added that relates to
resuming the infusion section 4.1.
  Maximum amount of fluid that can be
administered via a subcutaneous injection
added to appendix 6.
 New Acute syringe pump documentation
added to appendix 10.
 Point added regarding the check of pre-
emptive medication point 9.3.
 New community syringe pump directive
added to appendix 8
4.0 May 2016  Change in cannula model
 Additional information added that relates to
use of the BD Saf T Intima device
 Clearer headings related to Incident
Reporting; Syringe Pump Maintenance;
Cleaning & Decontamination
 Change in size of luer lock syringe to be
used
 New section added on Prescribing and
monitoring of medicines
 Section 4.7 replaced with new information
related to compatibility and stability of
subcutaneous infusions
 Section added on McKinley T34 Syringe
Pump Problem Solving

Links with External Standards

NSPA/2010/RRR019 NSPA December 2010
MDA/2016/002 MHRA March 2016
Key Dates DATE
Ratification Date Trust Clinical Executive – October 2016
Minute number: 56/16
Review Date October 2019

2
 Executive Summary Sheet
Document Title: Syringe Pump Management – McKinley T34 Syringe pump
Policy

Please Tick () This is a new document within the Trust

as appropriate This is a revised Document within the Trust 

What is the purpose of this document?

Provides guidance for clinical staff regarding the use of the McKinley T34 syringe pump
outlining the procedure for use and ensuring safe and consistent practice.

What key Issues does this document explore?

This policy covers a range of issues including
 The use of subcutaneous infusions
 The use of Syringe pumps
 Safety & Risk Management
 Prescribing and monitoring of medicines
 The procedure for commencing a McKinley T34 Syringe pump
 The procedure for administration of a subcutaneous bolus injection in adults
 The Syringe Pump Competency Framework
 Associated syringe pump documentation
 Syringe pump directive (adults)
 Associated Standard Operating Procedures for use of the Syringe Pump

Who is this document aimed at?

Nursing Staff/Clinical staff Trust wide

What other policies, guidance and directives should this document be read in
conjunction with?
Infection control policy
Consent policy
Medicines Policy
Central Venous Access policy
Decontamination of medical devices policy
West Midlands Palliative Care Guidelines (2012)
West Midlands Children’s and Young People’s Palliative Care Toolkit (2011)

How and when will this document be reviewed?

This policy will be reviewed after 2 years or earlier if changes identified. This review will
be undertaken by the Professional Lead for Palliative & End of Life Care.

3
CONTRIBUTION LIST
Key individuals involved in developing the document
Name Designation
Sharon Yates Palliative Care Education Coordinator
Jola Forys Clinical Lead - Community Children’s
Nurse
Sindy Dhallu Clinical Operations Manager,
Specialist Palliative & End of Life
Care

Circulated to the following for consultation

Name/Committee/Group/Designation
Divisional Directors of Nursing
Care Group Manager/Professional Lead for Palliative Care
Care Group Manger/Professional Lead Long Term Conditions
Clinical Operations Manager, Specialist Palliative & End of Life Care
Clinical Leads Community Nursing
Professional Development Nurse
Practice Development Nurse ICU
Practice Development Nurse Theatre
Infection Control Nurse
Clinical Lead AMU
Ward Manager Ward 10
Sister A & E
Quality and Risk Management Matron, Women’s Children’s and Clinical
Support Services Division
Nurse Team Lead Intermediate Care/Clinical intervention/Rapid Response
COPD Lead Nurse
Heart Failure CNS
Acute Oncology Nurse Consultant
Lead Chemotherapy Nurse
Community Oncology CNS
Medical Devices Trainer
Pharmacy
Divisional Quality Teams
Syringe Pump Working Group
Palliative and End of Life Strategic Delivery Group Meeting
Policies and Procedures Members

Version Control Summary

Significant or Substantive Changes from Previous Version
Version Date Comments on Changes Author
1 February New policy. Palliative Care
2012 Education Coordinator
2 September Alterations made to the syringe Palliative Care
2012 pump directive and paediatric mode Education Coordinator
of configuration.
3 August General review completed. See Palliative Care
2014 points on change history. Education Coordinator
4 May 2016 General review of policy; alterations Professional Lead for

4
 made in line with MHRA alert - Palliative & End of Life
MDA/2016/002 Care

Document Index Pg No
1.0 Introduction 7
2.0 Scope 7
3.0 Statement of intent 7
4.0 Principles 8
4.1 Using a McKinley T34 syringe pump 8
4.2 Palliative Care Guidelines 11
4.3 Subcutaneous site selection and indications for 11
resiting the giving set
4.4 Maintenance of central venous access site 12
4.5 Subcutaneous bolus injections 12
4.6 Site irritation 13
4.7 Mixing drugs 13
4.8 Documentation 14
5.0 Roles and responsibilities 15
5.1 Director of Nursing 15
5.2 Care Group Manager/Professional Lead for Palliative 15
Care
5.3 Heads of Service 15
5.4 Team Leader/Ward Managers 15
5.5 Clinical Staff 15
6.0 Monitoring 16
7.0 Training 16
7.1 Patient, family/carer education 16
8.0 Definitions 17
8.1 Palliative Care 17
8.2 Infusion Pumps 17
8.3 Volumetric Pumps 17
8.4 Syringe Pumps 17
8.5 PCA Pumps 17
8.6 Ambulatory Pumps 17
9.0 Legal & professional issues 17
9.1 Patient consent 17
9.2 Authorisation to proceed 19
9.3 Anticipatory medication 20
10.0 McKinley T34 Troubleshooting Guide 20
10.1 Syringe pump alarm conditions 20
11.0 Audit 21
12.0 References 21
13.0 Related Policies 22
Appendices Pg No
1 Adult configuration mode 23
2 Paediatric configuration mode 24
3 Adult LOCK ON procedure 26
4 Paediatric LOCK ON procedure 30
5 West Midlands Children & Young Peoples Palliative 38
Care Toolkit

5
6 Administration of adult subcutaneous bolus injection 39
procedure
7 Syringe pump care plan - Community 41
8 Community syringe pump directive 42
9 Community syringe pump documentation 44
10 Acute syringe pump documentation 47
11 Subcutaneous Therapy Workbook and 48
Competencies
12 Patient leaflet- McKinley T34 Syringe Pump 58
13 SOP – Completion and use of McKinley T34 Syringe 58
Pump Directive
14 SOP – Loaning of McKinley T34 Syringe Pump 58
within Community Setting
Syringe Pump Loan Form
15 Community Syringe Pump Pathway – Monday- 58
Friday 09.00 – 17.00hrs
16 Community Syringe Pump Pathway – Out of Hours, 58
weekends and bank holidays
17 Discharge of patient from Walsall Manor Hospital into 58
community setting
18 Transfer of patient within community providers 58

19 Checklist for the Review and Approval of Procedural 59

Document and Equality Impact Assessment Tool

6
1. Introduction

This guidance applies to the use of syringe pumps in adults via subcutaneous sites only and
the use of syringe pumps in children via subcutaneous and central venous access routes.

This guidance has been produced to assist professionals to maintain their knowledge and
competence in administering drugs via an ambulatory syringe pump and aims to promote
procedural uniformity amongst those professionals, be it in the Hospital or Community setting
across Walsall Healthcare NHS Trust.

To meet with the Medicines & Healthcare Regulatory Agency (MHRA) requirements for
infusion devices Walsall Healthcare NHS changed to the McKinley T34 syringe pump in 2013.
A McKinley T34 syringe pump is a portable battery operated syringe pump and is seen as
being a more advanced delivery system than the Trusts pre-existing preference of syringe
pump.

2. Scope

The purpose of this guidance is to:-

 Outline Trust procedure for the use of a McKinley T34 syringe pump

 Ensure that all employees have appropriate guidance to support them when completing
this procedure in clinical practice

3. Statement of Intent

A unified procedure is required in order to ensure safe and effective practice throughout
Walsall Healthcare NHS Trust. Syringe pumps provide the opportunity to deliver a constant,
managed infusion of medication which offers distinct advantages for certain medications in
terms of safety and efficacy.

Syringe pumps are predominantly used in Palliative and End of Life Care common indications
for the use of syringe pumps include the following:

 Inability to tolerate oral medication for whatever reason for example: persistent nausea
or vomiting, dysphagia, intestinal obstruction, local disease
 Falling level of consciousness, coma or there may be a risk of aspiration if medication
is given orally
 Profound weakness/cachexia
 Severe stomatitis
 Administration of drugs that cannot be given by non-parental routes
 Malabsorption / when the rectal route is inappropriate / when the need for sufficient
quantities of oral medication is difficult / when a continuous dose of medication is
required
 Patient compliance (also consider transdermal route for analgesia)

7
4. Principles

4.1 Using a McKinley T34 Syringe Pump

 The McKinley T34 pump can be configured for adult or paediatric use, for specific drug
delivery route and for any of the three modes of operation which include: Lock ON
mode, Lock OFF mode and RATE mode. All of the T34 pumps used in Walsall
Healthcare NHS Trust are set in LOCK ON mode utilising a prime and load procedure.
Lock on mode means the syringe pump contents will be delivered by continuous
infusion over a pre-set time scale, for the majority of syringe pumps this will be over a
24 hour period. Designated staffs in specialist areas (Palliative Care Clinical Nurse
Specialists and Community Children’s Nurses) will have access to syringe pumps
configured to run over shorter periods of time. The LOCK OFF and the RATE mode will
not be used within Walsall Health Care NHS Trust. The configuration mode for adults
can be viewed on appendix 1 and the configuration mode for paediatrics can be viewed
on appendix 2.
 Within adults the McKinley T34 pump can only be used to administer medication via the
subcutaneous route.
 Within paediatric care a syringe pump can be used to administer medication via either
the subcutaneous or central venous access route dependant on authorisation.
 The full standard operating procedures for the McKinley T34 syringe pump for adults
and paediatrics can be viewed in the appendices:

 LOCK ON adult procedure can be viewed on appendix 3

 LOCK ON paediatric procedure can be viewed on appendix 4

 Although the McKinley T34 syringe pump automatically calculates the rate of the
infusion; staff must check that this is correct. In order to check that the correct rate has
been calculated correctly staff should divide the volume of the infusion by the delivery
time this will give the hourly rate, for example 10mls divided by 24 hours = 0.42
ml/hour.
 In paediatric care if the syringe pump is being administered via the subcutaneous route
then a thalaset neria G27, 8mm, 110 cm infusion set product code 78-060-2738 should
be used to administer the infusion.
 Within adults the BD Saf-T-Intima cannula without Y adaptor is used, 24g – product
code FSP 3559 and connected to the CME administration set with anti-siphon valve -
product code: FKA 400.
 Within adults when administering a subcutaneous bolus injection the BD Saf-T-Intima
cannula , 24g, as above , is to be selected – product code FSP 3559.
 Within Walsall Healthcare NHS Trust, only the McKinley T34 syringe pump is used. If a
patient is transferred into the organisation with a different model/make of syringe pump
insitu the syringe containing the prescribed medication should be replenished as per
the authorisation and the syringe pump changed to a McKinley T34 syringe pump as
soon as possible. The pump should also be taken out of the care setting in order to
minimise confusion and returned to the original care provider via EBME.
 Do not infuse contents of the syringe pump over a period longer than 24 hours.

8
4.1.1 Syringe pump maintenance
 The maintenance of the McKinley T34 syringe pump and related equipment is the
responsibility of each nursing team/ward in collaboration with the Trusts EBME
department. Each Syringe pump and lock box will be identified by an individual number
and must be returned to the EMBE department annually for servicing.
 Syringe pumps should be sent to EBME for checking if they are known to have been
dropped, submerged in the bath/shower, of if there is any other doubt to their functional
operation.
 Each community practice based team should maintain a register of each syringe pump
assigned to them.
 Each ward/community practice based nursing team has a responsibility to return the
T34 Syringe Pump to either the EBME department after use (if in the hospital) or to the
named team as identified by the EBME label.
 When the syringe pump detects a problem, four things occur:
 the infusion stops
 an audible alarm is activated
 a message appears on the display screen indicating the cause of the alarm
 the LED indicator turns red.

4.1.2 Cleaning and Decontamination

 The T34 infusion pump must be cleaned in between patient use, and it is the
responsibility of staff within each service areas to ensure that this is carried out. Please
refer to the Trusts Decontamination of Medical Devices Policy.

4.1.3 Clinical Incident reporting

 In the event of an incident involving the McKinley syringe pump, the event log within the
syringe pump can be downloaded, the event log will record the last 512 pump events
along with a record of pump status (volume infused, rate, etc.) at the time of the event.
The event log can be downloaded by the EBME department at the Manor Hospital.
 The syringe and subcutaneous infusion line should remain intact within the pump, with
only the battery removed to prevent inadvertent use of the pump. Full details of the
infusion and supporting documentation should be provided to EBME. Senior nurse/
manager should be informed of the incident immediately.
 Examples of specific incidents include (this list is not exhaustive):
 Administration of incorrect medication, dose and/or diluent
 Delays in acquiring medications
 Infusions completing ahead of time
 Infusion continuing beyond intended time of completion
 Incorrect use of specified equipment as signified in this policy

4.1.4 Safeguarding

 Consider the safe storage of medication in a patient’s home with known drug users.
 Consider recording of the risk on local risk register.

4.1.5 Equipment

 The McKinley T34 syringe pump may be used with most brand syringes. Sizes ranging
from 2ml to 50ml can be used with the McKinley T34 syringe pump, within Walsall
Healthcare NHS Trust it is recommended that a 20ml or 30ml BD Plastipak syringe is
used where possible. If a larger syringe is required eg. 50ml BD Plastipak luer lock and
lock box, seek advice from the Specialist Palliative Care Team. Please note that the

9
 syringe must be luer lock in order to avoid leakage or accidental disconnection.
 A Duracell Procell Energizer Industrial Alkaline 9V battery code 6LR61 should always
be used. The battery level should be checked at each use. Within the hospital setting
the battery can be used fully, please note that the syringe pump will start to alarm when
battery power is getting low this is normally 15-30minutes prior to the end of the battery.
Within the community setting the battery must be discarded if there is less than 40%
life remaining. It is imperative that the battery is changed as this will prevent
discontinuation of the delivery of the infusion. The average battery life starting at 100%
lasts approximately 3-4 days dependent on use.
 It is important to encourage the use of a holster (single use) especially for mobile
patients

4.1.6 Choice of subcutaneous cannula

The BD Saf-T-Intima cannula without a Y-adaptor - product code FSP 3559 is the
choice of cannula for subcutaneous drugs across Walsall Healthcare NHS Trust.
 To reduce needle stick injuries to staff and patients
 Site reactions are less common
 Insertion is less traumatic
 To reduce the risk of incorrect administration of drugs through a separate port

The BD Saf-T-Intima cannula has a dead space of 0.2ml. It is not primed before or after
insertion. If a patient is started on a continuous subcutaneous infusion, it is important to
site a separate BD Saf-T-Intima cannula for bolus drugs.

Figure 1 example of 24g BD Saf-T-Intima cannula without a Y-adaptor

4.1.7 Activate & De-activate the syringe pump

 Please be aware that when you switch the syringe pump on fingers can get trapped by
the actuator as this automatically moves to reset itself. Keep fingers away from the
actuator during this part of the preloading procedure. The preloading procedure should
not be interrupted please ensure that this is completed when commencing or
replenishing the syringe pump (when replenishing the syringe pump this means that the
syringe pump should be turned off and back on again).
 When in use the McKinley syringe pump key pad should always be locked, to activate
the key pad lock the information button should be pressed until the bar moves from left
to right, the key should be held down until the bar has moved completely across the
screen, and a beep will be heard to confirm the lock has been activated. The syringe
pump should then be placed in a lock box; universal keys will be supplied to all clinics
and ward areas. Within the community setting each syringe driver box will be issued
with a key safe, the key for the lock box will be stored here.

10
  To deactivate the key pad lock the information key should be pressed until the progress
bar moves from right to left, the key should be held down until the bar has moved
completely across the screen, a beep will be heard to confirm the lock has been
deactivated.
 It is possible to stop the infusion whilst in the lock box as the key pad is accessible.
 If the battery fails whilst the infusion is in the progress, the battery can be changed and
the infusion resumed. The syringe pump will recommence its delivery from the point it
stopped - YES to RESUME the infusion should always be entered. Please note that
staffs have a 1 hour window in which to resume the infusion after this time the syringe
pump cannot be resumed and must be replenished.

4.1.8 What to do if a patient dies whilst the syringe pump is running

 Stop the syringe pump by pressing the STOP button

 Press the ‘INFO’ button and record the date, time and amount of solution
remaining to be infused in the syringe (ml).
 If there are any doubts about the circumstances of the death, leave the syringe
pump in place and contact the senior manager for support and guidance
including completion of a clinical incident via Safeguard System.
 In an expected death, remove the syringe from the pump , destroy the contents
and record the signature(s) of person(s) destroying the remaining solution
 Remove the battery from the syringe pump
 Remove the cannulae as soon as possible.
 Ensure the syringe pump is cleaned and decontaminated before returning into
main stock

4.2 Palliative Care Guidelines

When delivering Palliative or End of Life Care within Walsall Healthcare NHS Trust the
following guidelines are recommended as useful reference material:

 Adult services - the “West Midlands Palliative Care Guidelines” (2012)

 Adult Services – WHT End of Life Care Guidelines
 Paediatric Services - the “West Midlands Children and Young People’s
Palliative Care Toolkit” (2011) (Appendix 5).

4.3 Subcutaneous Site Selection and Indications for Resiting the Giving Set

 Areas suitable for subcutaneous infusion include those with a good depth of
subcutaneous fat, away from joints. Areas to be avoided include lymphoedematous
areas, areas of broken skin, recently irritated skin sites, sites of infection, bony
prominences, sites over tumour, skin folds and areas of inflammation.
 Sites of choice for the syringe pump include anterior chest wall, lateral upper arms,
anterior abdominal wall, anterior outer thigh and area over the scapula (in confused or
disorientated patient).
 When reloading the syringe pump always check the site for signs of inflammation,
swelling and infection. If the site remains in good condition reload the syringe as per the
directive/drug chart. The giving set remains insitu and does not need resiting; this can
remain insitu for a maximum of 3 - 5 days; however clinical judgement is required if
the patient has poor skin integrity and resiting the cannula may cause further
discomfort and distress.

11
  If the site appears red, swollen, inflamed or if leakage is apparent then the syringe
pump will need to be resited, please note that a new giving set is required and that the
needle- free/cannula device should be sited in a different location.
 If medication changes or if drug doses within the infusion are increased then the
syringe and the giving set will need changing and resiting.

4.3.1 To avoid the risk of siphonage:

 Ensure the syringe pump is placed at the same level as or lower than the infusion site
 If an infusion is stopped before the syringe is empty, disconnect the syringe from the
patient and apply a sterile universal bung.
 Do not remove a syringe that is not empty from the syringe pump, whilst connected to
the patient.

4.4 Maintenance of Central Venous Sites

 The McKinley T34 syringe pump can be administered via a central venous access in
PAEDIATRICS ONLY.
 There should be clear authorisation outlining the route of administration.
 For maintenance of the central venous site refer to Trust central venous access policy.

4.5 Adult Subcutaneous Bolus Injections

 It is recommended that subcutaneous bolus injections are administered via BD Saf-T-

Intima needle free/cannula device, 24g or if this is unavailable an orange
needle/syringe can be used, as outlined in the above section.
 Anticipatory’ medication(s) should be prescribed subcutaneously, stating clearly the
drug name, dose range, and indications.
 If a bolus dose of medication is required, this bolus dose should be given through a
separate cannula, as outlined above, secured by a dressing. The drug should be
flushed with at least 0.2ml Water for injection to accommodate the dead space after
administration of the drug.
 The principles for site selection should be followed as outlined above.
 If a subcutaneous bolus injection giving set is insitu the site should be monitored for
signs of inflammation, swelling, leakage and infection. If the site remains in good
condition administer subcutaneous injection as per the directive/drug chart. The giving
set remains insitu and does not need re-siting; this can remain in situ for a maximum of
3- 5 days; however clinical judgement is required if the patient has poor skin integrity
and re-siting the cannula may cause further discomfort and distress.
 If the site appears red, swollen, inflamed or if leakage is apparent then the giving set
will need to be re-sited, please note that a new giving set is required and that the
needle should be sited in a different location.
 If 3 boluses have been required in 24 hours – consider a Continuous Subcutaneous
Infusion (CSCI) via the T34 McKinley Syringe Pump. If unsure, please discuss with the
Specialist Palliative Care Team.

4.5.1 Use of loading/bolus doses

When a CSCI of drugs is commenced, there is a significant time lag before therapeutic
levels are achieved. The need for a separate subcutaneous loading dose of drugs(s)
should therefore be discussed with the prescriber or in their absence with the Specialist
Palliative Care Team. A loading dose, to be administered via subcutaneous route, is
indicated if the patient has uncontrolled symptoms at the time of initiating a syringe

12
 pump.

The prescribing of separate ‘anticipatory’ subcutaneous bolus drugs is recommended

whenever a syringe pump is in use for palliative or patients approaching end of life.
(NHS Scotland for Education, 2011)

NB. Never use the syringe pump to administer a loading or bolus dose of drug.

The full procedure for administration of a subcutaneous bolus injection can be viewed on
Appendix 6.

4.6 Site Irritation

 Site reactions are more likely to occur if the infusion contains cyclizine or high doses of
diamorphine or levomepromazine (Dickman et al 2009). It is therefore recommended
that the solution should be diluted as much as practical and a 20ml BD Plastipak luer
lock syringe is recommended. Please note that a 30ml BD Plastipak luer lock syringe
can also be used; if a larger syringe is required e.g. 50ml BD Plastipak luer lock, seek
advice from the Specialist Palliative Care Team.
 If site irritation occurs alternative options may need to be considered for example the
drug combination may need to be reviewed, please contact the Specialist Palliative
Care Team for advice as required.

4.7 Mixing Drugs

 Some drug mixtures may be sensitive to light, accelerating changes in colour or

chemical makeup. For this reason the syringe pump should be protected from light.
 The more drugs that are mixed together, the greater the risk of precipitation or reduced
efficacy of the drugs being used. Therefore where possible no more than two drugs
should be added, but it is often common to see three drugs mixed together in the same
infusion. Where more than two drugs are required:
 Liaise with the pharmacy department for advice
 for adults refer to the West Midlands Palliative Care Guidelines
(2012)
 for children refer to the West Midlands Children and Young
Peoples Palliative Care Toolkit (2011)
 It is difficult to establish minimum dilution volumes, it is therefore recommended that
infusions that contain a combination of drugs should be diluted as much as is practical,
ideally to 17mls in a 20ml syringe or to a greater volume in a 30ml syringe if required.
Please note that the maximum volume that can be loaded into the syringe pump in a
BD Plastipak is as follows: a 20ml syringe can be filled to 17mls and a 30 ml syringe
can be filled to 23 mls (Dickman et al , 2009)
 Dexamethasone compatibility is unpredictable and is best given in a separate syringe
pump or as a bolus subcutaneous single dose once daily.
 Seek advice from the Specialist Palliative Care teams if indicated.
 Refer to the compatibility chart within the West Midlands Palliative Care Guidelines
(2012) or the Palliative Care Formulary (PCF 5).

13
4.8 Documentation

When commencing a syringe pump in practice clear documentation regarding its use should
be completed. A care plan regarding the syringe pump (Appendix 7) should be in place.
Evaluation of the plan of care should take place at every review of the infusion. In order to
assist with the tracking and location of equipment the syringe pump asset code should be
documented on the syringe pump administration checklist form.

When administering ‘anticipatory’ drugs:

 Record Name and dose of medication
 Route of administration
 Record the symptom(s) for which one or more of the drug(s) have been
administered
 Record the effectiveness of the drug on the symptom(s) identified (NICE,2015)

Paediatrics
Within the Community setting the ‘Drug Administration Document for Babies, Children and
Young People Requiring Symptom Management’ (p.17) should be used (Appendix 5).

Community Setting
Within the Community setting the syringe pump directive and documentation should be utilised
(Appendix 8 & 9). Please note that syringe pump directives are issued with a valid for date, if
this date has expired the syringe pump directive should be reviewed and re-written, it is
therefore the responsibility of individual nurses to review and action this well in advance of the
expiry date. It is recommended best practice that the syringe pump directive includes the
prescribers professional registration number, for medical practitioners this will be their General
Medical Council (GMC) number and for Non-Medical Prescribers this will be their Nursing
Midwifery Council (NMC) number, if this information is excluded then the directive will need to
be reviewed and re-written as soon as practicable. Superseded syringe pump directives
should be crossed through, signed and dated. They should then be removed from the patient’s
home and filed within the patient’s clinic notes.

Hospital Setting
Within the acute setting the syringe pump monitoring form (Appendix 10) should be utilised,
the syringe pump should be checked 2 hourly. On discharge from hospital patients with a
syringe pump should be issued with a syringe pump directive (Appendix 8), both the directive
and the patients electronic discharge summary need to go to pharmacy before medication is
dispensed, this is to ensure that the information on the two documents match.

Labelling
Ensure the label does not interfere with the mechanism of the syringe pump i.e. where there is
contact with the barrel clamp arm – no part of the label should be underneath the barrel clamp
arm. When attaching the label, ensure that it does not obscure the visual scales on the
syringe, which may require to be viewed during the infusion. Complete all areas of the label.
(NHS, Scotland for Education 2011)

14
5. Roles & Responsibilities

5.1 Director of Nursing

It is the responsibility of the Director of Nursing to: -

 Ensure that Ward Managers / Team Leaders release staff to access syringe pump
training.
 Escalate and report issues around syringe pump management to board level.

5.2 Care Group Manager/Professional Lead for Palliative Care

It is the responsibility of the Care Group Manager/Professional Lead for Palliative Care to:-
 Identify and guide best practice within Palliative and End of Life Care
 Facilitate guideline development and supporting procedures.

5.3 Heads of Service

It is the responsibility of Heads of Service to:-

 Ensure that all their clinical areas have the appropriate equipment to perform syringe
pump management.
 Ensure that systems and processes are in place for the checking, storage, servicing
and maintenance of the McKinley T34 syringe pump.
 Ensure that all employees attend annual training on syringe pump management,
ensuring that courses are recorded on ESR.

5.4 Team Leaders/Ward Managers

It is the responsibility of Clinical Team Leaders / Ward Managers to:-

 Ensure that all employees on the teams’ training needs analysis attends training on
syringe pump management as required.
 Ensure that all McKinley T34 syringe pumps are placed on the team’s medical device
inventory.
 Any faults identified with the McKinley T34 syringe pump must be reported immediately
to EBME.

5.5 Clinical Staff

It is the responsibility of clinical staff to:-

 Undertake annual Syringe pump training if appropriate to their role.
 Ensure that the directions set out in this policy are adhered to and implemented in
practice
 Any faults identified with the McKinley syringe pump must be reported immediately to
EBME
 Incidents involving equipment should be reported in line with Trust policy.

15
6. Monitoring

Monitoring Process Requirements

Who Clinical Lead, Team Leader, Ward Manager
Standards Monitored Attendance at theoretical training and completion of
practical competencies
When To be monitored as part of the annual appraisal process
How Attendance on training will be monitored on Trust data
base ESR/OLM, Clinical Lead, Team Leaders and Ward
Managers are responsible for ensuring that staff
competencies are achieved
Presented to Quality Team meetings, Palliative and End of Life
Strategic Delivery Group Meeting
Monitored by Clinical Lead, Team Leader, Ward Manager
Completion/Exception Quality Team meetings, Palliative and End of Life
reported to Strategic Delivery Group Meeting

7. Training

 Walsall Healthcare NHS Trust recommends that theoretical training on syringe pump
management is attended by relevant staff on an annual basis. Following completion of
the theoretical training staff also need to complete practical competencies (Appendix
11) in the clinical setting. It is recommended that practical competencies are achieved
within six months post completion of the theoretical training. If the practical
competencies are not achieved within the six month time scale then the theoretical
training will need to be re-attended.
 Staff should attend session 1 : Using the T34 McKinley Syringe Pump followed by
Session 2: Syringe Pump Management whilst completing the competency document.
 The staff members Line Manager should nominate the assessor to complete the
syringe pump competency document
 If the person to sign off your competencies is not the staff member’s line manager, then
remedial action is required; an action plan should be devised for discussion with the
signatory and the staff member’s line manager.
 Record of completion of the competency document should be forwarded to ESR, for
recording on the training log. A copy should also be retained in the staff member’s
personnel file.
 The procedures outlined in this policy must only be undertaken by a registered nurse
who has successfully completed the theoretical training and associated practical
competencies.
 Nurses must feel competent and confident that their skills and knowledge are
maintained within their code of practice (NMC 2008).

7.1 Patient, family/carer education

Any patient requiring drugs via a syringe pump should be given verbal and written explanation
of the following:

 Reason for using subcutaneous route

 Information on care of the pump
 Any safety monitoring of pump
 What to do in case an alarm sounds or the light stops flashing

16
  Advice on showering and bathing
 Patient leaflet with the above advice (Appendix 12)

If patient lacks capacity, the above information must be relayed to the nominated person and
documented.

8. Definitions

8.1 Palliative care

Palliative care is the active holistic care of patients with advanced progressive illness.
Management of pain and other symptoms and provision of psychological, social and spiritual
support is paramount. The goal of palliative care is the achievement of the best quality of life
for patients and their families (NICE 2004).

8.2 Infusion pumps

These pumps use an active method to overcome resistance to flow by increased delivery
pressure. Volumetric or syringe pumps are the most common.

8.3 Volumetric pumps

These pumps are the preferred choice for medium and high flow rate and large volume
intravenous or enteral infusions.

8.4 Syringe pumps

These pumps are the preferred choice for lower volume and low flow rate infusions.
Syringe pumps drive the plunger of a syringe forward at a controlled rate to deliver the
substance to the patient. The McKinley T34 syringe pump is a small, portable, battery driven
pump, which continuously administers medication via a butterfly infusion set into a
subcutaneous site over a given length of time.

8.5 PCA Pumps

Unlike a general-purpose infusion pump, a PCA pump has the facility for patients to deliver a
bolus dose themselves. This is achieved by operating a switch or pressure pad connected by
a cord to the pump.

8.6 Ambulatory pumps

Ambulatory pumps have been designed to allow patients to continue receiving treatment or
therapy away from a hospital, thereby leading a normal life during treatment. The size and
design of these pumps means patients can carry them around in a form of holster.

9. Legal & Professional Issues

9.1 Patient Consent

When commencing a syringe pump, patient consent should be obtained. Every adult has the
right to make his or her own decisions and must be assumed to have capacity to do so unless
it is proved otherwise (MCA 2005). Informed consent must be obtained before any procedure
is undertaken. The DoH (2009) state “it is a general legal and ethical principle that valid
consent must be obtained”.

Consent is concerned with the patient having capacity, being given voluntarily and receiving
sufficient information (DoH 2009). This means the patient must be

17
  Able to comprehend and retain information and the consequences of not having the
intervention
 That there is no pressure or undue influence to accept or refuse
 That they understand the nature and purpose of the intervention.

In the case of patients who are unable to give consent, the General Practitioner/consultant
can make a decision regarding the course of action to be taken in the best interests of the
patient. The decision must be supported by a holistic patient assessment, discussed fully with
the patient’s nominated other and documented in full within the patient’s notes.

This should be considered in line with the organisations Consent policy.

Parental responsibility

If a child who is under 16 does not have the capacity to consent, someone with parental
responsibility can consent for them. The person with parental responsibility must have the
capacity to give consent

9.2 Authorisation to Proceed

Written medical authorisation in the form of a medication chart / syringe pump directive
must be obtained (Paediatrics appendix 5) (Community setting appendix 8) including:
 Date
 Patients name and date of birth
 Any known allergies
 Name and dose of medication
 Route of administration and duration
 Details of any recommended dose changes
 Details of any breakthrough medication to be administered
 Date and signature of medical officer/Non-medical prescriber
 Special directions
Sections on the syringe pump directive not being used should be clearly crossed through
signed and dated. Only the active medical authorisation should remain within the patient
notes. Any superseded medical authorisations should be crossed through, removed and filed
within the patient’s clinical / medical notes.

The person preparing the medication should check the following:

 Prescription
 Compatibility of medicines prescribed
 Diluent
 Infusion volume required
 Size of syringe required

Where drugs are prescribed to be delivered over 24 hours via a T34 McKinley Syringe Pump,
additional ‘anticipatory’ subcutaneous bolus drugs should always be prescribed and available
for administration when required. ‘As required’ drugs should not be crossed out because the
drugs are now being delivered over 24 hours via the syringe pump.

18
9.2.1 Starting syringe pumps in relation to stopping opioids by other routes of
administration

Patients on Fentanyl Patches

Seek advice from pharmacy/Specialist Palliative Care Team

Patients on modified release oral opioid preparation e.g. Zomorph

A decision on an appropriate time should be based on the clinical status of each individual
patient. If assistance is required, please seek advice from pharmacy /Specialist Palliative Care
Team.

When oral treatment is to be re-started

If an oral modified release preparation is being commenced, the continuous subcutaneous
infusion should be stopped when the first dose of modified release oral opioid is administered.
The patient may require breakthrough medication more frequently until therapeutic levels are
reached. If further advice is required, seek guidance Specialist Palliative Care
Team/pharmacy. (NHS, Education for Scotland 2011).

9.3 Anticipatory medication

Within the community setting if anticipatory medication is issued this should be checked and
recorded on the medication stock balance form. Nurses have a responsibility to check this
stock at subsequent visits to ensure that it is still in date and suitable for use if required, it is
recommended that this takes place as a minimum on a weekly basis. At this time the directive
should also be checked to ensure that this is still valid.

10. McKinley T34 Trouble Shooting Guide

Fault Possible cause Action

The pump will not No battery present
start Battery inserted incorrectly
Cap on battery terminal
Battery is depleted/very low
Pump is faulty
Infusion ended Drug incompatibility or site
early/late problems
Memory not cleared prior to
replenishment of syringe
Fit a battery
Re-align battery terminals
Remove cap
Fit a new battery
Contact EBME for servicing of pump
Assess patient and discuss with
pharmacy/palliative care team.
If ended late, check if ‘bolus
medication’ is required to control
symptoms.
If the pump is continuing to infuse
beyond the prescribed time –
infusion. Assess why and resolve
cause. Set up a new infusion if
required.
Send the syringe pump in use to
EBME to check pump history
Assess patient and discuss
management with pharmacy/palliative
care team.
Report as a clinical incident via
Safeguard System.

19
 Wrong syringe brand
confirmed during set up/
incorrect volume measured
by syringe pump
Syringe pump placed
>75cm above infusion site.
This can lead to siphon age
if the syringe is not secured.
Air is present in the syringe
The syringe pump is faulty.
Infusion is running The syringe pump may have
slow stopped.
Cannula site requires to be
changed.
Pressure/kinking on the SC
infusion line or cannula.
Disconnection of syringe,
line or cannula.
The syringe pump is faulty.
Cannula sites Irritation from prescribed
require frequent medication
changes
Cannula insertion technique
The pump has Exhausted battery
stopped before
syringe has emptied
The syringe pump is faulty.
Set up as new infusion
If user error – seek assistance from
EBME
Check syringe barrel to see if it is
cracked. A cracked syringe can lead
to siphon age.
Send syringe pump to EBME for
servicing.
Check if the infusion has stopped at
any point.
Assess patient and discuss
management with pharmacy/palliative
care team.
If ended late, check if patient needs
‘as required’ bolus medication.
Report as a clinical incident via
Safeguard System.
Set up a new infusion.
Check placement of the syringe, SC
infusion line and cannula.
If user error – seek assistance from
EBME.
Send syringe pump to EBME for
servicing.
Use a larger syringe and a more
dilute solution of drug. Check diluent
and potential alternatives for
prescribing with pharmacist/palliative
care team.
User error- seek training
Fit new batter, turn syringe pump on,
confirm syringe size and brand and
then resume infusion.
Send syringe pump to EBME for
servicing.

10.1 Syringe pump alarm conditions

When the syringe pump alarm sounds, the syringe pump will automatically stop infusing and
continue to alarm until the problem is resolved. It is important to inform patients/carers of this
and who to contact in the event of this occurring. In the community, the nursing teams should
leave their contact details on the ‘McKinley T34 Syringe Pump’ patient leaflet.

10.1.1 Precipitation, cloudiness or colour change in syringe contents or line

If this should occur, STOP the infusion and inform the prescriber/pharmacist. Discuss:

20
  Compatibility information – West Midlands Palliative Care Guidelines (2012)
 Dilute the drugs in a larger volume
 Separate the drugs into 2 separate syringe pumps

 Consider giving one drug as a subcutaneous bolus dose
 Keep the syringe pump away from sunlight and heat

Once satisfied with the above, commence a new infusion at a different site with a new cannula
and new infusion line.

11. Audit criteria

 Correct completion of documentation
 Completion of all documentation including prescriptions/directive
 Syringe pump monitoring documentation
 Use of correct equipment
 Information guide given to Patients and Carers

12. References

Department of Health. (2009) Reference Guide to Consent for Examination or Treatment.

London: Department of Health.

Department of Health. (2005) The Mental Capacity Act. DOH.

Dickman, A. Schneider, J. Varga, A. (2009) The Syringe Driver: Continuous Subcutaneous

Infusions in Palliative Care. Oxford: Oxford University Press.

Hirsch, C. Boulstridge, L. Morrison H. (2012) West Midlands Palliative Care Physicians

Palliative Care Guidelines for the use of Drugs in Symptom Control. Birmingham: University
Hospital Birmingham NHS Foundation Trust.

National Institute of Clinical Excellence. (2004) Improving Supportive and Palliative Care for
Adults with Cancer. NICE.

National Institute of Clinical Excellence (2015) Care of the Dying Adults in the Last Days of
life. NICE Guideline. London: NICE

NHS Education for Scotland (2011) Guidelines for the use of the CME McKinley T34 Syringe
Pump for Adults in Palliative Care. Glasgow: NHS Education for Scotland

NMC. (2008) The Code. The Nursing Midwifery Council.

West Midlands Paediatric Palliative Care Network (2011) West Midlands Palliative Care
Toolkit

21
13. Related Policies

 Consent to examination or treatment policy

 Decontamination of medical devices policy
 Medicines Management policy
 Central venous catheter policy
 Relevant Policies within the West Midlands Palliative Care Toolkit

22
Appendix 1

Set Up Configuration
for CME Medical T34 Adults

Change Set up
Menu

Default Custom
Menu Option Setting range Setting Setting
FF Key Operation 0 - 10mm 5mm 5mm
Backlight Duration 0 - 60s 5s 10s
Info Duration 1 - 20s 5s 10s
disable, 2, 4, 8, 16, 32 or
Operation LED 64s 32s 32s
Titration Option* Enabled or Disabled Disabled Disabled
Default Duration** 0:00 to 99:00hrs 24hrs 24hrs
Occlusion Pressure 100 - 1500mHg 720mmHg 720mmHg
KVO Rate* 0 - 2mL/hr 0mL/hr 0ml/hr
Program Lock Enabled or Disabled Enabled Enabled

Technician Menu

Default Custom
Menu Option Setting range Setting Setting
Service Interval 0 (off) - 50000hrs 0hrs 0hrs
Service Interval Months 0 months 12 months
Purge 0 - 0.5mL 0.2mL 0.2ml
Maximum Rate 0 - 650mL/hr 5mL/hr 5ml/hr
Syringe Individual
Pump ID 17 Characters to ID pump Pump serial no.
Tech Code Access code for Tech Menu *** ***
Level 1 Code Level 1 Access code *** ***

Notes
* These setting can only be set if the Program lock is Disabled
** The default Duration can only be 0hrs if program Lock is
Disabled
The minimum setting with Lock Enabled is 0:01hrs.
*** Technician codes have been removed. These
codes are given to engineers only ***

Approved
Date

23
Appendix 2

Set Up Configuration
for CME Medical T34
Paediatrics
(Sai Medical Centre)
3 pumps. All lock on.
1 pump configured to deliver over 1 hour.
2 pumps configured to deliver over 24 hours.

Change Set up
Menu

Default Custom
Menu Option Setting range Setting Setting
FF Key Operation 0 - 10mm 5mm 5mm
Backlight Duration 0 - 60s 5s 10s
Info Duration 1 - 20s 5s 10s
disable, 2, 4, 8, 16, 32 or
Operation LED 64s 32s 32s
Titration Option* Enabled or Disabled Disabled Disabled
2 pumps @
24hrs
1 pump @ 1
Default Duration** 0:00 to 99:00hrs 24hrs hour
Occlusion Pressure 100 - 1500mHg 720mmHg 300mmHg
KVO Rate* 0 - 2mL/hr 0mL/hr 0ml/hr
Program Lock Enabled or Disabled Enabled Enabled

Technician Menu

Default Custom
Menu Option Setting range Setting Setting
Service Interval 0 (off) - 50000hrs 0hrs 0hrs
Service Interval Months 0 months 12 months
Purge 0 - 0.5mL 0.2mL 0.2ml
5ml/hr for the
2 pumps @
24hrs

20ml/hr for
the 1 pump
@ 1 hour
Maximum Rate 0 - 650mL/hr 5mL/hr
Syringe Individual
Pump ID 17 Characters to ID pump Pump serial no.
Tech Code Access code for Tech Menu *** ***
Level 1 Code Level 1 Access code *** ***

24
Notes
* These setting can only be set if the Program lock is Disabled
** The default Duration can only be 0hrs if program Lock is
Disabled
The minimum setting with Lock Enabled is 0:01hrs.
*** Technician codes have been removed. These
codes are given to engineers only ***

Approved
Date

25
Appendix 3
ADULT LOCK ON PROCEDURE
How to load and start an infusion using the McKinley syringe pump, utilising the LOCK
ON safety feature

Equipment required
 McKinley T34 syringe pump
 A Duracell Procell Energizer Industrial Alkaline 9V battery code 6LR61
 Appropriate size syringe i.e. BD Plastipak 20ml, 30ml, 50ml luer lock
 24 gauge BD Saf-T-Intima cannula
 CME administration set with anti-siphon valve
 70% isopropyl alcohol swab (steret)
 Clear semi-permeable dressing (IV3000)
 Infusion pump documentation
 Lock box, key, within the community setting key safe
 Medication and diluent as prescribed with completed authorisation (Drug chart / syringe
pump directive)
Element Procedure Rationale
1. Read the patient notes and check To ensure you have the authorisation to
medical authorisation (Syringe commence the syringe pump on the right
pump directive/drug chart). patient.
2. Ensure correct drugs and diluent In order to proceed with setting up the
are present. Within the infusion pump and maintain accurate
Community setting complete documentation.
medication stock details using
appropriate documentation.
3. Explain the procedure to the To ensure the patient and family are happy
patient and family and obtain for the procedure to go ahead, prepared
informed consent. for the procedure and feel supported.
4. Wash hands and put on apron. To maintain good hygiene and minimise
infection.
5. Ensure the patient is comfortable To maintain patient comfort and check for
and expose chosen site for any abnormalities.
infusion. If reloading the syringe
pump check the current site is in
good condition.
6. Prepare equipment into clinical To minimise infection and maintain
procedure sheet. organisation.

7. Place opened sharps box to side To ensure safe disposal of sharps and
of field. minimise risk of sharps injury.
8. Insert the battery into the syringe To power the infusion.
pump.

26
9. Ensure the barrel clamp is down. ----------------
10. Press the on button This allows the rate of the infusion to be
Allow the pre-loading function to set.
take place, the actuator will move
to the position that was in place at
the start of the previous infusion.
DO NOT INTERUPT THIS
FUNCTION
When replenishing the syringe
pump ensure that the syringe
pump is switched off and back on
again to allow the pre-load
function to be completed.
Check the configuration of the
pump on the display screen.
11. Check the battery life by pressing To ensure that there is enough battery life
the information button, the screen to deliver the infusion.
will then state battery level, press
the green YES key to show the
current battery level. Please note
that within the community the
battery will need to be changed
WHEN IT REACHES 40%.
12. The display screen states to load This is to ensure that practice is
syringe, within Walsall Healthcare standardised and risks are minimised
NHS Trust only BD PLASTIPAK
LUER LOCK syringes should be
used. Dependent on the volume
and combination of medication in
the infusion select the appropriate
size syringe.

13. Draw up drugs and diluent as To ensure adequate dilution of medication.

prescribed.
14. Attach the filled syringe to the To ensure all air is expelled.
giving set and gently depress the
plunger until the infusion tubing is
primed to the needle end
Omit this part of the procedure
when reloading the syringe
pump.
15. Attach label to syringe stating the To ensure syringe is clearly labelled in
patient’s name, date of birth, order to prevent drug errors and identify
drugs, dosage, batch numbers faulty batches.
and diluent used.

16. Align the syringe and use the To ensure the syringe runs to time.
FF/BACK keys to move the
actuator for syringe placement.
17. Lift the barrel clamp arm and To ensure that the syringe runs to time.
insert the loaded syringe, ensure
that the plunger clips into the

27
 actuator.
18. The display will state the syringe To ensure that the correct rate of infusion
size and brand, if this matches is selected.
the one used, confirm by pressing
yes. Please note that if the correct
brand syringe is not displayed this
indicates a problem with the
loading of the syringe within the
pump.
19. The infusion summary will display To ensure the correct rate of infusion is
the volume, duration and rate of selected.
the infusion. *check this
manually*
If correct press yes to confirm.
20. Before continuing the infusion BD
Saf-T-Intima needs to be sited in
the patient.
21. Clean the chosen site with a 70% Minimise risk of infection.
isopropyl alcohol swab (steret) –
in line with local policy.
22. Grasp the chosen site firmly and To ensure the cannula is inserted at the
insert the cannula at 45 degrees, correct angle promoting better drug
with the bubble surface of the absorption.
‘wings’ face down. Release the
grasped skin.
Omit this part of the procedure
when reloading the syringe driver.
23. Secure with a semi-permeable To ensure the needle remains in position
transparent dressing (IV 3000). and the site can be observed.
24. Pull the needle safe system down
in one smooth single movement.
25. Dispose of the needle in the To prevent a sharps injury to patient or
sharps container as per WHT member of staff.
Policy.
26. Remove and dispose of the clamp To avoid accidental occlusion.
on the BD Saf-T-Intima
27. Attach the primed extension set to In preparation to start the infusion.
the BD Saf-T-Intima cannula in
the patient.
28. The display will state start the To start the infusion.
infusion, press yes when ready to
commence the infusion.
29. The display then shows the Confirms the infusion has commenced.
infusion running time, rate and
syringe size. The green light also
flashes every 32 seconds to
indicate infusion delivery.
30. The key pad should then be This prevents the key pad from being
locked to lock the key pad the tampered with whilst the infusion is
information button should be running.
pressed until the bar moves from
left to right, the key should be
held down until the bar has

28
 moved completely across the
screen, and a beep will be heard
to confirm the lock has been
activated.
31. The syringe pump should then be This prevents the loaded syringe from
placed into a lock box. Universal being tampered with whilst the infusion is
keys are available for clinical running.
staff. Within the community
setting Keys should then be
locked in the key safe in the
syringe driver box
32. Please note that if the infusion is stopped at any point, the display will
state:
Press YES to resume, NO for new programme
If you wish to restart the existing infusion then YES to resume the
infusion should be pressed, if in error NO is pressed the syringe pump
will recalculate the rate of the remaining medication to run over 24 hours,
if this occurs the infusion should be discontinued and syringe reloaded.
33. Record the above actions into the nursing documentation.

29
Appendix 4
PAEDIATRIC LOCK ON PROCEDURE
How to load and start an infusion using the McKinley syringe pump, utilising the LOCK
ON safety feature

Equipment required

 McKinley T34 pump

 9V alkaline battery
 Luer lock syringe, minimum 10 – 20 mls BD (Becton Dickinson) Plastipak Luer Lock
 Subcutaneous administration device e.g. thalaset neria G27, 8mm, 110 cm (or similar)
if required
 Transparent adhesive dressing e.g. IV3000 clear semi-permeable dressing/tegaderm
 West Midlands Drug Administration Document
 Drug labels
 Lock box and key
 Prescribed medicines/diluents
 Dressing pack which include gloves and apron
 White or injectable bungs
 Clinell wipes
 Filter needles
 Green needles
 IV infusion connector set
 Sharps box
 Hand decontamination equipment
 Clinical waste facilities

Element Procedure for preparing the Rationale

infusion

1 Obtain valid consent by Obtain valid consent for the procedure

discussing the procedure
specific to the needs of baby,
child/young person taking into
consideration their cognitive
development.
respecting the baby, child/young
person’s and family’s rights and wishes.
DOH 2001a

2 Read the patient notes and
check ‘Drug Administration
Document for Babies, Children
and Young People Requiring
Symptom Management’
To ensure you have the authorisation to
commence the syringe pump on the
right patient

30
3 Ensure correct drugs and
diluent are present and
compatible.
4 Record medication stock
details using ‘Drug
Administration Document for
Babies, Children and Young
People Requiring Symptom
Management’
5 Hand decontamination to be
carried out, according to
Policy, prior to carrying out
any procedure
6 Prepare equipment onto
opened dressing pack
7 Place opened sharps box to
side of field
8 Use a luer lock syringe.
Use size 10ml - 20ml To standardise syringe size. Consider
whenever possible
In a 20 ml syringe 17mls total
volume
In a 50ml syringe 35mls total
volume
9 Draw up and check prescribed
medication
10 Use diluent as per patient
prescription to make up
required amount for infusion.
Invert syringe several times
11 Prime the line
Omit this part of the
procedure when reloading
the syringe pump
12 Label the syringe (name of
patient, date and time of
preparation, name of all drugs
and diluent, total volume of the
contents to be infused, initials
of person(s) preparing infusion
13 Attach label to syringe
ensuring it does not obscure
In order to proceed with setting up the
infusion pump and ensure accurate and
safe delivery of the medication.
To ensure adequate stock and to keep
track of medications
To minimise cross infection and
promote health
To minimise infection and maintain
organisation
To ensure safe disposal of sharps and
minimise risk of sharps injury
A luer lock ensures that the infusion
does not disconnect
smaller syringe with, for example
neonates.
The pump will not allow delivery of
more than this amount in this sized
syringe
To continue with the procedure and
maintain patient safety
Larger dilution will reduce the risk of
adverse site reactions and
incompatibility.
To ensure medication mixes thoroughly
with diluent
To ensure all air is expelled
Replacing syringe with same dose of
medication enables reuse of same
giving set.
To identify medication being used and
promote safety of the baby child/young
person, and to comply with NMC record
keeping directives
To identify medication being used and
promote safety of the baby child/young
31
 visual scales or interfere with person
the mechanism of the infusion
device i.e. where there is
contact with the barrel clamp
14 Insert battery into syringe To power the pump
pump

15 Ensure barrel clamp is down To enable the pump to be programmed

16 Switch pump on and allow the To enable the previous settings to be

preloading programme to deleted
complete do not interrupt
movement of the actuator.
17 Check battery level - Flashing To ensure sufficient battery power until
syringe icon will appear on the next check.
screen, to check the battery
level Press the INFO key once;
followed by a single press of
YES key, battery level will
appear on the display after a
few seconds. Verify that there
is sufficient battery power for
the programme (note a fully
charged battery lasts
approximately 3 – 4 days) in
the community should the
battery life read 40% or less
at the start of a 24 hour
infusion, change the battery.

18 If the actuator is not in the To ensure syringe can be loaded

correct position to correctly
accommodate the syringe
leave the barrel clamp arm
down and use the FF or BACK
buttons on the keypad to move
the actuator to align the
syringe

19 Lift the barrel clamp arm. To ensure syringe is loaded correctly

Seat the filled syringe collar
and plunger so the back of the
collar sits against the back of
the central slot. The syringe
collar should be vertical.
Lower the barrel clamp arm.

20 Confirm the syringe size and To ensure correct placement of syringe

brand by pressing the YES in pump to safely deliver infusion.
button if the incorrect syringe is
displayed use the up/down
arrows to scroll through the
other options for brand/size
and press YES

32
21 The volume in the syringe will To ensure correct placement of syringe
be displayed, press YES to in pump to safely deliver infusion.
confirm.
To reset the pump
If the volume displayed does
not match the volume in the
syringe (allow 0.5 ml for
system accuracy) remove the
syringe and start again.

22 The infusion summary will

display the volume, duration
and rate of infusion.

If correct press YES to confirm

23 The display will now state To start the infusion
‘START THE INFUSION?’

Press YES when ready to start

the infusion

NB: if pump is paused too long

it will bleep, press YES this will
take you to the ‘Start Infusion?’
screen.

The pump will run, the green

LED indicator will flash every
30 seconds.

Place the pump in the lock box.

The battery and the keypad

can still be accessed

24 Prepare the baby, child/young To reassure the baby, child/young

person and parent/carer for the person and parent. Reduce anxiety.
procedure; allow child/young
person any distraction if
required.
25 Make sure that the baby, To maintain the baby’s, child’s/young
child/young person is person’s privacy and dignity.
comfortably positioned in a
safe area
26 Check insertion site and To maintain safe practice and fulfil legal
document in ‘Drug requirements
Administration Document for
Babies, Children and Young
People Requiring Symptom
Management’
27 If a baby, child/young person To minimise trauma of having to use
has a central venous access other methods of administering

33
 device it is appropriate to use it medication.
to administer medication via
the T34. To minimise any discomfort felt by the
insertion of a needle
If a central venous line is not
available then a thalaset or In order to deliver the medication
other subcutaneous infusion
set should be used
Appendix : Administration of Subcutaneous Infusion
1 Clean site with 70% Isopropyl Minimise risk of infection
alcohol swab in line with local
policy
2 Insert the administration device To promote comfort and have the
into the subcutaneous tissue at needle in a position to facilitate drug
the selected site at a 90% delivery
angle

Secure with a semi-permeable To allow observation of the site

transparent dressing, unless
contraindicated.

Include a loop of the infusion To avoid direct pull on the

set under the dressing administration

3 The pump will still be To start the infusion

displaying ‘START
INFUSION’? Press YES

NB: if pump is paused too long

it will bleep, press YES this will
take you to the ‘Start Infusion?’
screen.

The pump will run, the green

LED indicator will flash every
30 seconds.

Place the pump in the lock box.

4 The T34 allows all users to To prevent tampering with the device
lock the operation of the and any accidental change in infusion
keypad during the infusion. rates

The nurse must lock the pump

as follows:

Press and hold the blue ‘INFO’

key, the screen will display a
progress bar in the image of a
syringe. Keep the button
depressed until you hear a
beep then you will have
completed the operation.

34
 The ‘YES/START
‘NO/STOP
‘INFO’
Are all still operational

To deactivate repeat the

procedure until a beep is
heard.

NB Do not confuse ‘Lock On’

mode with locking the infusion.

‘Lock On’ is the device being

locked on to a 24 hour infusion.

Locking the infusion is when

you lock the infusion that is
running so that the rates and
doses cannot be changed

5 Infusion complete
As the pump nears the end of
the infusion it will alarm
intermittently to alert that it is
almost complete.
When infusion complete and
syringe is empty the pump will
stop automatically and the
alarm will sound. If syringe
pump is no longer required
press ‘OFF’ then disconnect
the infusion from the patient. To ensure the equipment is free from
Remove battery from the contamination and ready and available
syringe pump. Clean the pump for next use.
and lock box, do not immerse
in water, in accordance with
manufacturers’ guidelines.

If the baby, child/young person

requires further infusion switch
pump off remove syringe and
repeat clinical procedure.
NB you must ensure the
actuator goes all the way back
until you hear a bleep, this will
erase the previous
programmed information and
prevent errors when re-
commencing infusion.

When the baby, child/young To demonstrate a clear audit trail of

person no longer requires the medication
syringe driver a final reading of

35
 the remaining volume in the
syringe is documented on p17
of the drug administration
documentation (Drug
Administration for Babies,
Children and Young People
requiring Symptom
Management (2011)
6 Document all care given in To maintain best practice regarding
patient notes record keeping (NMC 2008)

Administration of infusion using Central Venous Access

1 Attach syringe extension to the To minimise trauma of having to use

central venous device other methods of administering
medication.
2 The pump will still be displaying
‘START INFUSION’ ? Press
YES (if pump is paused too long
it will bleep, press YES) this will
take you to the ‘Start Infusion?’
screen.

The pump will run, the green Indicates pump is delivering infusion
LED indicator will flash every 30
seconds.

Place the pump in the lock box.
3 The T34 allows all users to lock
the operation of the keypad
during the infusion.
To protect the syringe driver and the
integrity of the infusion
To prevent tampering with the device
and any accidental change in infusion
rates

The nurse must lock the pump

as follows:

Press and hold the blue ‘INFO’

key, the screen will display a
progress bar in the image of a
syringe. Keep the button
depressed until you hear a beep
then you will have completed
the operation.
The ‘YES/START
‘NO/STOP
‘INFO’
Are all still operational

To deactivate repeat the

procedure until a beep is heard.

NB Do not confuse ‘Lock On’

mode with locking the infusion.

36
 ‘Lock On’ is the device being
locked on to a 24 hour infusion.

Locking the infusion is when

you lock the infusion that is
running so that the rates and
doses cannot be changed
4 Infusion complete
As the pump nears the end of
the infusion it will alarm
intermittently to alert that it is
almost complete.
When infusion complete and
syringe is empty the pump will
stop automatically and the
alarm will sound. If syringe
pump is no longer required
press ‘OFF’ then disconnect the
infusion from the patient.
Remove battery from the To ensure the equipment is free from
syringe pump. Clean the pump contamination and ready and available
and lock box, do not immerse in for next use.
water, in accordance with
manufacturers’ guidelines.

If the baby, child/young person

requires further infusion switch
pump off remove syringe and
repeat clinical procedure.
NB you must ensure the
actuator goes all the way back
until you hear a bleep, this will
erase the previous programmed
information and prevent errors
when re-commencing infusion.

When the baby, child/young

person no longer requires the
syringe driver a final reading of
the remaining volume in the
syringe is documented on p17 To demonstrate a clear audit trail of
of the drug administration medication
documentation (Drug
Administration for Babies,
Children and Young People
requiring Symptom
Management (2011)
5 Document all care given in To maintain best practice regarding
patient notes record keeping (NMC 2008)

37
Appendix 5
West Midlands Children & Young Peoples Palliative Care Tool kit

F:\McKinley syringe
driver work\Drug_Administration_Document.pdf

38
Appendix 6
ADULT PROCEDURE - Administration of adult subcutaneous bolus injection
Element Procedure
1. Read patient notes and check
medical authorisation letter
(syringe pump directive).
2. Ensure correct drugs and diluent
are present and record
medication stock details using
appropriate documentation.
Please note that a maximum of
2mls can be administered per
subcutaneous injection.
3. Explain the procedure to the
patient and family and obtain
informed consent.
4. Wash hands and put on apron.
5. Ensure the patient is comfortable
and expose site for Saf-T-Intima
cannula.
6. Prepare equipment into clinical
procedure sheet.
7. Place unopened sharps box to
side of field.
8. In syringe 1 draw up the
prescribed drug with appropriate
diluent as required.
9. In syringe 2 draw up 1ml of
sterile water for injection for
flushing post administration of
drug.
10. Ensure the chosen site is
cleaned with a 70% isopropyl
alcohol swab (steret) in line with
local policy.
11. Grasp the chosen site firmly and
insert the cannula at 45 degrees,
with the bubble surface of the
‘wings’ face down. Release the
grasped skin.
12. Apply a semi permeable dressing To ensure the cannula remains in
preferably IV 3000. position and the site can be
observed.
Rationale
To ensure you have the
authorisation to proceed.
In order to proceed with the bolus
injection administration and ensure
accurate documentation is
maintained.
To ensure the patient and family are
happy for the procedure to go
ahead and feel supported.
To maintain good hygiene and
minimise infection.
To maintain patient comfort and
check skin site for any
abnormalities.
To minimise infection and maintain
organisation.
To ensure safe disposal of sharps
and minimise risk of sharps injury.
To ensure drugs are diluted if
needed and ready for
administration.
To flush line with.
To minimise infection.
To ensure the cannula is inserted at
the correct angle promoting better
drug absorption.
39
13. Pull the needle safe system
down in one smooth single
movement.

14. DO NOT dispose of the clamp on Required to close of the line after
the BD Saf-T-Intima flush administered.
15. Administer drug slowly form the To allow absorption of the drug and
attached syringe, massage the provide reassurance for the patient.
area gently and inform the
patient that they may experience
some pain at the site of
administration.
16. Remove the syringe and flush
gently with appropriate amount of
sterile water for injection.
17. Apply the clamp.
18. Replace the bung
19. Ensure safe disposal of sharps To minimise sharps injury.
and other materials used.
20. Wash hands and remove apron.
21. Complete documentation.

40
Appendix 7 – Syringe Pump Care Plan - Community
Patient Name: NHS No:

Date Client Problems/Needs Goal Nursing Intervention Self/Relative Care

Time and
Signature
_____________ To attempt to prevent, 1. Reassess symptoms on each visit.
requires
administration of detect and minimise 2. Ensure appropriate consent is obtained from ___________
medication(s) via a complications of the or Next of Kin/Lasting Power of Attorney/Patient
syringe pump to control infusion. Representative prior to commencing syringe pump.
___________________. 3. Explain all interventions to _____________ prior to
To attempt to ensure commencing/reloading the syringe pump.
effective symptom 4. Reassess infusion site on each visit and re-site butterfly if
control is maintained. clinically indicated, or after 5 days as appropriate in line
with
local policy.
To attempt to maintain 5. Reload syringe pump with prescribed drugs and doses as
patient comfort. per signed directive in line with local policy.
6. Complete all relevant documentation in line with local
policy.
7. Reassure _____________ and their family/carers on each
visit.
8. Liaise with GP/Specialist Palliative Care CNS for advice
re: symptom control and management as necessary.
9. Maintain _____________ comfort and dignity at all times.

41
 Appendix 8
COMMUNITY NURSING SYRINGE PUMP DIRECTIVE & INSTRUCTION TO GIVE BOLUS DOSE
Current Medication Record
Name of Patient: verified. SIGN
Source (please circle):
NHS Number: DOB: GP Practice Records;
Nursing/Care Home;
*
Health Care Professional;
EDS; Carers.
Address : Allergies / Sensitivities:

If more than one syringe pump is in use; please use a separate drug directive for each pump.
Clearly label the pump and chart.
This chart is for syringe pump (1,2 or 3 ) Total number of pumps in use

TO CONTROL PAIN VIA SYRINGE PUMP:

Drug Name: Dose via syringe pump Sign
over 24 hours: (initials)
If pain is not controlled this may be increased daily by:

To a maximum dose of :

TO CONTROL VOMITING VIA SYRINGE PUMP:

Drug Name: Dose via syringe pump Sign
over 24 hours: (initials)
If vomiting is not controlled this may be increased by:

To a maximum dose of :

TO CONTROL OTHER SYMPTOMS VIA SYRINGE PUMP::

Drug Name: Dose via syringe pump Sign
over 24 hours: (initials)
If symptom control of : is not controlled this may be increased by:-

To a maximum dose of :

Intermittent Bolus Injection

Additional drugs may be prescribed below for control of additional symptoms i.e. initial bolus dose and other stat medication.
Date Drug Dose Dose frequency (if prn to Route Max. total dose in 24 hours Sign
include minimal dose including drug(s) in syringe (initials)
interval) pump

Doctor/ Non-Medical *
Prescriber Name Signature:
(Print):
GMC/NMC Number: Date of Valid for 28 days only
Issue:
NB: Where a new directive/error is made please cross through with a pen, sign, date & file in patient’s notes.

42
Version 5 October 2014 Catalogue number ND PC 1

Syringe Pump Directive Flow Chart

As part of a holistic assessment any registered Health Care / Allied Health Care Professional may
identify that a patient requires a syringe pump to administer their medication’
If a patient only requires subcutaneous bolus injections then the top part of the syringe pump directive –
“Please infuse subcutaneously via syringe pump over 24 hours” SHOULD BE CROSSED THROUGH

FOR
EXAMPLE
ONLY

Sign here only

only the bottom section of the syringe pump directive “Intermittent bolus injection”
should be completed and the GP/NMP signs each entry and at the bottom of the form

FOR Sign here

EXAMPLE
ONLY

If analgesics have been prescribed to control pain the syringe pump directive
includes a daily increment dose. This should usually be half – to a third of the total
Best Practice
dose prescribed. For example Morphine 60mgs = 20mgs – 30mgs daily increment The syringe pump directive ideally
dose. It is important to highlight that drug doses should only be increased if the
patient has needed breakthrough analgesia. should be typed so that it is clear
and legible to all
When prescribing analgesics as a subcutaneous bolus injection this should be a sixth Please refer to West Midlands
of the total dose prescribed. For example Morphine 60mgs being infused over 24
hours via a syringe driver = 10mgs subcutaneous bolus injection.
Palliative Care Guidelines (2012)

Community Specialist Care CNS Team Contact Details

Monday – Friday 09.00 – 16.30 01922 602620 based at Walsall Palliative Care Centre
Evening on call after 5pm inc. weekends & bank holidays evenings: Please ring switchboard at Walsall Manor Hospital:
01922 721172 (for telephone advice for Health Care Professionals ONLY)
Weekends & Bank Holidays 09.00 -16.30: Please ring 01922 602620 (answer phone available) in the first instance
or ring switchboard at Walsall Manor Hospital or the weekend mobile
Walsall Manor Hospital Specialist Palliative Care CNS Team Contact Details
Monday – Friday 0900 – 1700 Weekends & Bank Holidays 09.00 -17.00
Ext:7111 or bleep via switchboard at Walsall Manor Hospital

Please note that the Specialist Palliative Care Team is available for advice as required and the West Midlands
Palliative Care Guidelines (2012) are also recommended as essential reference material. 43
Appendix 9 - ADULT Community syringe pump documentation
SYRINGE PUMP ADMINISTRATION & CHECKLIST
Patient Name:

Address:

DOB: NHS No:

Date & Time Date & Time Date & Time Date & Time

Syringe pump asset code Syringe pump asset code Syringe pump asset code Syringe pump asset code

Medication, batch No & Medication, batch No & Medication, batch No & Medication, batch No &
expiry date expiry date expiry date expiry date

Diluent, amount (mls) & Diluent, amount (mls) & Diluent, amount (mls) & Diluent, amount (mls) &
expiry date expiry date expiry date expiry date

Hourly Rate Hourly Rate Hourly Rate Hourly Rate

Clarity of solution Clarity of solution Clarity of solution Clarity of solution

Duration of cannulae Duration of cannulae Duration of cannulae Duration of cannulae

Infusion site position Infusion site position Infusion site position Infusion site position

Appearance of infusion site Appearance of infusion site Appearance of infusion site Appearance of infusion site

Battery light flashing Battery light flashing Battery light flashing Battery light flashing
Yes / No Yes / No Yes / No Yes / No

Battery life: Battery life: Battery life: Battery life:

Connections intact
Yes / No
Key pad locked Yes / No
Analgesic patch insitu
Yes / No
Connections intact
Yes / No
Key pad locked Yes / No
Analgesic patch insitu
Yes / No
Connections intact
Yes / No
Key pad locked Yes / No
Analgesic patch insitu
Yes / No
Connections intact
Yes / No
Key pad locked Yes / No
Analgesic patch insitu
Yes / No

Name of patch Name of patch Name of patch Name of patch

Dose of patch Dose of patch Dose of patch Dose of patch

Name: Name: Name: Name:

Signature: Signature: Signature: Signature:

44
BOLUS DOSE ADMINISTRATION & CHECKLIST
Patient
Name:
Address:

DOB: NHS
No:
Date & Time Date & Time Date & Time Date & Time

Medication Administered Medication Administered Medication Administered Medication Administered

via bolus injection, batch via bolus injection, batch via bolus injection, batch via bolus injection, batch
No & expiry date No & expiry date No & expiry date No & expiry date

Diluent & expiry date Diluent & expiry date Diluent & expiry date Diluent & expiry date

Flush, amount & expiry Flush, amount & expiry Flush, amount & expiry Flush, amount & expiry
date date date date

Position of Site Position of Site Position of Site Position of Site

Duration of cannula Duration of cannula Duration of cannula Duration of cannula

Appearance of site Appearance of site Appearance of site Appearance of site

Cannula secure Cannula secure Cannula secure Cannula secure

Yes / No Yes / No Yes / No Yes / No

Re-siting indicated Re-siting indicated Re-siting indicated Re-siting indicated

Yes / No Yes / No Yes / No Yes / No

Name: Name: Name: Name:

Signature: Signature: Signature: Signature:

45
SYRINGE PUMP & SUBCUTANEOUS BOLUS INJECTION DOCUMENTATION
Name Additional Instructions: e.g. The patient has commenced the Individualised End of Life Care Plan
DOB
NHS No
Address Drug Allergies/Sensitivity:

MEDICATION STOCK BALANCE

Please note that only one drug is to be entered per line and the medication stock balance should be recalculated on each drug administration
Date Time Medication Ampoule Opening Ampoules Ampoules Dose Amount Stock Signature
Strength Stock added to used Given Wasted Balance
stock

46
LABEL
NAME:………………………………………
DOB:………………………………………...
HOSPITAL NO.:……………………………
NHS NO.:…………………………………... Appendix - 10 ADULT Acute Trust syringe pump documentation

SYRINGE PUMP ASSET CODE……………………………………………………… The syringe pump should be checked 2 hourly

Date & Time Hourly Clarity of Mls Infusion Appearance Battery Connections Key Pad Signature
Rate Syringe & Remaining in Site of infusion Light flashing Intact Locked
Giving Set Syringe Position Site

Version 1 March 2013 Catalogue number NCP 28

47
Walsall Healthcare NHS Trust T34 McKinley Syringe Pump Competency Framework for Palliative Care in
Adults

Appendix 11
48
REGISTERED NURSE

NAME

BASE

DESIGNATION

SYRINGE PUMP TRAINING DATE

SESSION
DRUG MANAGEMENT
STUDY SESSION DATE

ASSESSOR

NAME

BASE

DESIGNATION

LINE MANAGER SIGN OFF DATE: SIGNATURE

49
LEGISLATION
COMPETENCY
Knowledge Area
The Registered Nurse is able to
locate and have working knowledge
of the current Walsall Healthcare
NHS Trust Guidelines for the use of
the T34 Ambulatory Syringe Pump by
CME Medical for adults in palliative
care
The Registered Nurse understands:
1. The Walsall Healthcare NHS
Trust professional standards
for record keeping.
NMC: Standards for
Medicines management
(2010)
NMC: The Code (2015)
Professional Standards of
Practice and Behaviour for
Nurses and Midwives.
Caldicott Principles (2013)
2. Walsall Healthcare NHS Trust
Incident Reporting Policy and
use of Safeguard Incident
reporting system
3. The Walsall Healthcare NHS
Trust Infection Prevention
and Control Policy and Waste
Management Policies
OUTCOME/ EXPECTATION DATE REGISTERED NURSE and
ASSESSORS SIGNATURES
Is able to refer to Walsall Healthcare NHS Trust
Guidelines and Policies. Has clear understanding of
Walsall Healthcare NHS Trust’s policy on administering
medication and use of syringe pumps including
safeguarding with understanding of mental capacity
and consent to ensure safe and effective person
centred care.
Demonstrate appropriate record
keeping and completion of syringe
pump documentation.
Demonstrate knowledge and
understanding for personal
professional accountability and
standards to be maintained
Awareness and understanding of
Caldicott Principles and the
importance of safe clear
documentation
Safe effective practice with access to
incident reporting systems
Awareness and Understanding of
policies and has previously
undertaken the appropriate training
on these subjects
50
PROFESSIONALISM/ ACCOUNTABILITY
COMPETENCY
Knowledge Area
Reflection on own practice and
maintaining clinical skills.
COMMUNICATION, CLINICAL SKILLS AND MEDICATION KNOWLEDGE
COMPETENCY
Knowledge Area
1.
The Registered Nurse:
Understands the influence of
culture, ethnicity, race and faith
on patient and family decision
making
2. Communicates effectively with
the patient /carer and family.
Provides clear information
regarding the use of the T34
Syringe Pump, taking into
account patient/carer family
concerns and reservations.
Gains and records verbal
consent from patient/carer prior
to setting up syringe pump.
Provides written guidance on
the Syringe Pump.
3. Have knowledge and
understanding of appropriate
OUTCOME/ EXPECTATION DATE REGISTERED NURSE and
ASSESSORS SIGNATURES
Ability to recognise own learning needs and
identify how to meet these.
Takes responsibility for completing mandatory
training and maintaining current knowledge and
skills regarding the CME T34 Syringe Pump
REGISTERED NURSE and
OUTCOME/ EXPECTATION DATE ASSESSORS SIGNATURES
Ability to recognise own learning needs and
identify how to meet these.
Takes responsibility for completing mandatory
training and maintaining current knowledge and
skills regarding the CME T34 Syringe Pump
Creates awareness of the purpose of the CME
T34 syringe pump and medication with clear
explanation to patient/carer and family,
addressing concerns and reservations (risks and
benefits)
Verbal consent obtained to commence CME T34
syringe pump.
Understands the importance of providing written
information to patient/ carer and family regarding
CME T34 Syringe Pump.
Demonstrate awareness of where to access the
Patient Information Leaflet.
51
 equipment required e.g.
appropriate cannula for s/c
medications, correct syringe
make and size, infusion line
and needle free device and that
these are appropriate and
compatible with the CME T34
Syringe Pump and the drugs
prescribed
4. Demonstrate required safety
checks, ensuring that the CME
T34 Syringe Pump is clean,
visually intact, in working order
and that it is asset tagged and
has been serviced in the last
year
5. Demonstrate that the current
prescription is both legal and
clinically appropriate and on the
Syringe Pump Directive Form.
6. Sourcing Knowledge for
medication advice
7. Select and safely insert needle
free cannula
On-going maintenance of site
8. Demonstrate knowledge,
understanding and skill in the
preparation, setting up,
Demonstrate knowledge of the Walsall Healthcare
T34 Syringe Pump Policy and Guidance relating
to the selection of equipment required to deliver a
s/c infusion via the CME T34 Syringe Pump,
ensuring safe care.
Demonstrate knowledge of safety checks required
to safely set up the CME T34 Syringe Pump.
Ensure safe, consistent practice
Demonstrates knowledge of safe prescribing
especially pertaining to controlled drugs and
correct completion of Syringe Pump Directive
Form and Infusion Monitoring Form.
Understanding of bolus and “prn” drug delivery.
Confirms that dose conversions are appropriate
and has recognised compatibilities and diluents
Advises colleagues, notes and reports any errors.
Demonstrates knowledge of opioid conversions
Demonstrates knowledge of available resources.
Can state from whom and where to seek further
advice
Demonstrates knowledge of:
 Selection of appropriate comfortable site
 Correct insertion and securing of s/c
cannula, infusion line and needle free
device as per Walsall Healthcare NHS
Trust Guidelines.
 Is able to utilise clinical judgement and
justify decision-making when appropriate.
Successfully demonstrate the procedure to set up
a CME T34 Syringe Pump under supervision on
three separate occasions in clinical practice or at
52
 monitoring and closing down of
the CME T34 Syringe Pump
Demonstrate safe use of lock
box for CME T34 Syringe Pump
9. Disposal of sharps and clinical
waste following Walsall
Healthcare NHS Trust policy
10. Maintaining accurate
documentation
11. Storage and decontamination
of used equipment
CLINICAL JUDGEMENT
COMPETENCY
Knowledge Area
The Registered Nurse has
knowledge of symptom assessment
and management and is able to:
1. Monitor continuous
subcutaneous infusion for
any malfunction which may
affect symptom
nursing base.
Will be able to provide evidence using the
procedure to set up T34 Syringe Pump
documentation signed off and dated by
designated assessor for each occasion.
Demonstrate knowledge of the policies and
procedures relating to the safe handling and
disposal of sharps and clinical waste.
Evidences the correct documentation has been
completed accurately.
Able to state procedure for local area:
 Removing from stock
 Returning to stock
 Lending out CME T34 Syringe Pump
 Returning CME T34 Syringe Pump to
rightful owner
 Sending CME T34 Syringe Pump to EBME
 Decontamination before returning to stock
OUTCOME/ EXPECTATION DATE REGISTERED NURSE and
ASSESSORS SIGNATURES
Demonstrate the ability to assess and monitor
symptoms and plan for appropriate interventions
Able to give rationale for carrying out the checks.
Able to say how frequently these checks should
be carried out
53
 management

2. Monitor for any change in Demonstrates knowledge of individual patient’s

patient’s symptom control.
Determine appropriate
intervention and administer
breakthrough medication
as prescribed, when
necessary
3. Monitor for side effects of
medication and undertake
appropriate responsive
action. This includes
seeking advice from
medical and MDT
colleagues
symptoms and their management.
Effective symptom management as per West
Midlands Palliative Care Guidelines 2012
Demonstrates early recognition of potential
adverse effects of medication administered via
s/c infusion.
Patient’s safety and comfort maintained and
symptom management optimised

PROCEDURE TO SET UP A CME T34 SYRINGE PUMP

DATE/COMMENT DATE/COMMENT DATE/COMMENT

COMPTENCY LEVEL REACHED ASSESSOR’S ASSESSOR’S ASSESSOR’S
SIGNATURE SIGNATURE SIGNATURE
Able to demonstrate procedure for identification of correct patient
and gain verbal consent from the patient or, if necessary, from
carer/family

Demonstrate ability to select correct equipment to undertake the

procedure

Demonstrate how to load a battery.

54
Demonstrates correct procedure for insertion of the appropriate
cannula for s/c medications and needle free device and able to
state frequency of when to renew

Able to identify correct size, leur lock and brand 30ml syringe
required and understand the importance of correct identification
during the set up process

Demonstrates ability to select and use CME T34 Infusion line

Demonstrates knowledge of where to find advice on medicine

compatibilities

Demonstrates ability to prepare medication safely and correctly,

including the maximum volume of fluid for syringe using 30ml
syringes

Demonstrates how to correctly complete and secure the yellow

additive medication label for syringe

Demonstrate knowledge and skills to load the syringe correctly

Demonstrate when and why new infusion site may be required

Demonstrates how to start the infusion.

Demonstrate knowledge and understanding of siphonage

Demonstrates how to lock key pad and check battery

Correct disposal of sharps

55
KNOWLEDGE OF COMPLICATIONS

DATE/COMMENT DATE/COMMENT DATE/COMMENT

COMPTENCY LEVEL REACHED ASSESSOR’S ASSESSOR’S ASSESSOR’S
SIGNATURE SIGNATURE SIGNATURE
Demonstrate knowledge and understanding of the different
alarms and how to correctly deal with them

Demonstrate knowledge of what to do should an error alarm

show or the device appears to malfunction.

Demonstrates correct procedure for insertion of the appropriate

cannula for s/c medications and needle free device and able to
state frequency of when to renew

DOCUMENTATION

DATE/COMMENT DATE/COMMENT DATE/COMMENT

COMPTENCY LEVEL REACHED ASSESSOR’S ASSESSOR’S ASSESSOR’S
SIGNATURE SIGNATURE SIGNATURE
Demonstrates knowledge of and understands the importance of
correct documentation

Able to correctly complete the Walsall Healthcare NHS Trust

Subcutaneous Infusion Monitoring Chart. Give clear knowledge
and understanding of Syringe Pump Directive Form and stock
management procedures.

Describe what procedures are in place for lending out and

returning a CME T34 Syringe Pump

Demonstrates knowledge of how/ where to obtain further

supplies of CME T34 Syringe Pump consumables and
documentation

56
 FINAL SIGN- OFF

This confirms that reflective discussion has taken place and (Name)……………………………………………………….

has been deemed competent / not competent to set up a CME T34 Syringe Pump independently. This follows one

theoretical and three observed practice sessions.

If not deemed competent, further education and support will be required and agreed by your Line Manager.

REGISTERED NURSE

NAME

SIGNATURE

DATE

ASSESSOR

NAME

SIGNATURE

DATE

Acknowledgement to Greater Glasgow and Clyde NHS Trust

57
Appendix 12 - Patient Leaflet –McKinley T34 Syringe Pump

Patient leaflet -
McKinley T34 Syringe Pump.docx

Appendix 13 – SOP for Completion of a community Syringe Pump Directive

SOP completion of
syringe pump directive (2).doc

Appendix 14- SOP for Loaning of Syringe Pump

SOP Loaning of
McKinley Syringe Driver (community).doc

Syringe Pump Loans

Form.doc

Appendix 15 – SOP for syringe pump pathway Monday – Friday 9am -5pm

SOP Syringe pump

pathway Mon-Fri 9-5 (2).docx

Appendix 16 – SOP for Syringe Pump Pathway Out of Hours

SOP Syringe pump

pathway OOH.docx

Appendix 17 – SOP for Syringe Pump following discharge from Walsall Manor
Hospital

SOP Syringe Pump

pathway Discharge of Patient from Walsall Manor Hospital.docx

Appendix 18 – SOP for transfer of patient within Community

SOP Transfer of
Patient within Community.docx

58
 Appendix 19

Checklist for the Review and Approval of Procedural Document

To be completed and attached to any procedural document that requires ratification

Title of document being reviewed: Yes/No Comments

1. Title
Is the title clear and unambiguous? It
Yes
should not start with the word policy.
Is it clear whether the document is a
Yes
guideline, policy, protocol or standard?
2. Rationale

Are reasons for development of the

document stated? This should be in the Yes
purpose section.
3. Development Process
Is the method described in brief? This
Yes
should be in the introduction or purpose.

Are people involved in the development

Yes
identified?

Do you feel a reasonable attempt has been

made to ensure relevant expertise has Yes
been used?

Is there evidence of consultation with

Yes
stakeholders and users?
4. Content
Is the objective of the document clear? Yes

Is the target population clear and

Yes
unambiguous?

Are the intended outcomes described? Yes

Are the statements clear and
Yes
unambiguous?
5. Evidence Base

Is the type of evidence to support the

Yes
document identified explicitly?
Are key references cited? Yes
Are the references cited in full? Yes
Are supporting documents referenced? Yes
6. Approval

Does the document identify which

Yes
committee/group will approve it?
If appropriate have the joint Human NA
Resources/staff side committee (or

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 Title of document being reviewed: Yes/No Comments
equivalent) approved the document?
7. Dissemination and Implementation
Is there an outline/plan to identify how this
Yes
will be done?
Does the plan include the necessary
Yes
training/support to ensure compliance?
8. Document Control
Does the document identify where it will be
held?
Have archiving arrangements for
Yes
superseded documents been addressed?
Process to Monitor Compliance and
9.
Effectiveness

Are there measurable standards or KPIs to

support the monitoring of compliance with Yes
and effectiveness of the document?
Is there a plan to review or audit
Yes
compliance with the document?
10. Review Date

Is the review date identified? Yes

Is the frequency of review identified? If so
Yes
is it acceptable?
11. Overall Responsibility for the Document

Is it clear who will be responsible for co-

ordinating the dissemination,
Yes
implementation and review of the
documentation?

Lead Director

If you are assured that the correct procedure has been followed for the consultation of this policy, sign and date
it and forward to the chair of the committee for ratification.
Name Date

Signature Approving
Committee
Ratification Committee Approval

If the committee is in agreement to ratify this document, can the Chair sign and date it and forward to the Risk &
Assurance Team
Name Date

Signature

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 Equality Impact Assessment Tool
To be completed and attached to any procedural document when submitted to the
appropriate committee for consideration and approval.
Title of the policy/guidance: Syringe Driver Management – McKinley T34
Policy & Procedure

Yes/No Comments
1. Does the policy/guidance affect one
group less or more favourably than another
on the basis of:
Race No
Ethnic origins (including gypsies and travellers) No
Nationality No
Gender No
Culture No
Religion or belief No
Sexual orientation including lesbian, gay and No
bisexual people
Age No
Disability - learning disabilities, physical No
disability, sensory impairment and mental
health problems
2. Is there any evidence that some groups No
are affected differently?
3. If you have identified potential N/A
discrimination, are any exceptions valid,
legal and/or justifiable?
4. Is the impact of the policy/guidance likely No
to be negative? (If no, please go to
question 5.)
If so can the impact be avoided?
What alternatives are there to achieving the
policy/guidance without the impact?
Can we reduce the impact by taking different
action?
5. Health inequalities No
6. Please consider the following questions
relating to Human Rights Act:
Will it affect a person’s right to life? No
Will someone be deprived of their liberty or No
have their security threatened?
Could this result in a person being treated in a No
degrading or inhuman manner?
Is there a possibility that a person will be No
prevented from exercising their beliefs?
Will anyone’s private and family life be No
interfered with?

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If you have identified a potential discriminatory impact of this procedural document,
please complete Impact Assessment Action Plan identifying the action required to
avoid/reduce this impact.

For advice in respect of answering the above questions, please contact the Equality
and Diversity Manager.

Is further detailed impact assessment required? No

If yes, please detail how this is to be processed and by whom

Details (names and roles) of staff involved in this impact assessment

Name Role Date completed Outcome
Sharon Yates Palliative Care 01/08/2014 Equality impact
Education assessment tool
Coordinator completed no issues
identified
Sindy Dhallu Clinical 18/07/16 Equality impact
Operations assessment tool
Manager- Spec completed no issues
Palliative & EoL identified
Care

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