Changes in practice in the use of subcutaneous diamorphine via syringe driver.

A study was undertaken in 1988 to examine various aspects of administering diamorphine subcutaneously by syringe driver at the time when its use had recently been introduced into the community. The results of this study and of a comparative study undertaken in 1994 are reported. It was found that in both studies the syringe driver was used mainly for patients who were unable to take oral medication or who were vomiting. However, in the first study, subcutaneous diamorphine was used in 31% of patients with no absorption problems, to improve pain control in those whose pain was poorly controlled on oral medication. In the second study, the syringe driver was used in only 8% of patients for this purpose. In both studies the use of the driver was continued until death in 37 of the 39 patients (95%) in each group. The syringe driver was used for longer than 14 days in most patients (56%) in the first study and the dose of diamorphine was increased in 54% of patients. In the second study, the driver was used mainly in the last week of life (69%) and the dose was more stable, remaining unchanged in 69% of patients. The incidence of site complications (5%) was the same in both groups, but other problems occurred with the use of the driver in the first group.