Setting up a syringe pump

Bodyguard T syringe pump (or equivalent)

• Luer lock syringe
• Extension line (with integrated anti-syphon valve)
• Needleless connection system
• Good quality 9 volt (6LR61) alkaline battery
• Transparent adhesive dressing
• Smaller syringes and needles to prepare the medicine(s)
• Sharps bin
• Personal Protective Equipment (as required)

The size of syringe selected to prepare the medicine(s) will depend on the volume of the medicines prescribed including diluent. The total volume generated will determine the size of the syringe.

The volumes below provide an average maximum volume.

• 20ml – maximum volume 17mls
• 30ml – maximum volume 22mls
• 50ml – maximum volume 34mls (*risk assess prior to use)

*Please note a 50ml syringe cannot be accommodated by the majority of lockboxes.

Lockbox / Cover

The Bodyguard T syringe pump may be set up with either a lockbox or non-locking cover. Please refer to local policy and procedures.

Battery

BD recommend only using 9V 6LR61 non-rechargeable batteries. Before using the pump, the following actions should be taken.

• Always check the battery power before commencing an infusion
• Press the key until the battery level option appears on the screen and then press  to confirm
• The average battery life, when commenced at 100%, is approximately 2-3 days but varies depending on use
• In the community setting, if the battery power has less than 50% life remaining at the start of an infusion, then a new battery should be installed
• Report any problems with battery connections to your local Medical Physics department.

BD recommends leaving the battery in the Bodyguard T pump however please check local policy and procedures. If the battery has been removed from the syringe pump, please check the date and time are accurate on set up. Guidance on resetting the time & date: see in the appendices

Key Point: The battery level can reduce significantly when alarm conditions are activated during the infusion.

Key Point: The low battery alarm provides warning at least 30 minutes before the battery ends. If the battery is not replaced, a backup buzzer will sound for 3 minutes and the pump will then shut down.

Key Point: Please consider the environment where the syringe pump is being managed and how the nursing team can respond to the need for a battery change. For example, community settings should confirm the battery level is sufficient to complete the delivery of the full infusion.

The following documents are used to support the administration of medicines via a syringe pump:

• Continuous subcutaneous infusion ‘Prescription Chart’
• Continuous subcutaneous infusion ‘Recording Chart’
• Medicine additive label

For the purposes of this guideline, the term ‘recording chart’ has been used to refer to the document used to prepare, monitor and record continuous subcutaneous infusions however this varies across different organisations. All sections should be completed in accordance with local policy and procedures.

Syringe pumps are commonly used to deliver one, two or three medicines over a 24 hour period. Some health boards accept the delivery of more than three medicines in one syringe pump however this is often under the advice from specialist or pharmacy services. Please refer to local policy and guidance. The mixing of medicines in this manner is unlicensed but is supported by practice. Medicines should only be mixed if known to be compatible. The diluent must also be compatible with the medicines prescribed.

Key Point: If dexamethasone or cyclizine are prescribed, these should be added once all other medicines are diluted. These medicines are the most common causes of incompatability.

Further information and advice is available via compatibility and stability tables for subcutaneous infusion and Medicines Complete - Drug Compatibility Checker

Mixing syringe contents:

• Select and check compatibility of prescribed medicines and diluent
• Draw up first medicine into Luer-Lok syringe
• Then, dilute to an appropriate volume i.e. the final intended volume less the volume of subsequent medicine(s). This ensures that the additional medicines will be added to an already dilute solution to reduce the risk of incompatibility
• Draw up additional medicine(s) into a separate syringes and leave needle attached
• Pull back plunger on first syringe to beyond final intended volume and add additional medicine(s), one at a time, carefully through the luer end
• Draw a little air into the syringe, invert it gently several times to mix the solution, then expel air taking care not to expel any of the contents.
• Attach the completed drug additive label taking care not to obscure the syringe markings or
  interfere with the mechanism of the syringe pump e.g. barrel clamp arm

The following points should also be considered:

• Avoid mixing medicines if compatibility data is not available. Consider using an additional pump or an alternative route of administration or seek advice.
• Do not mix more than three medicines without seeking advice from specialist palliative care and / or pharmacy unless this has already been agreed by your health board.
• Protect the infusion from direct sunlight or excessive heat to prevent degradation of medicines and reduced efficacy.
• The contents of the syringe should be clear. If any crystallisation/precipitation occurs, consider using an additional pump or an alternative route of administration.

Key Point: To minimise skin irritation, and reduce problems with compatibility, the prescribed medicine(s) should be diluted to the maximum volume.

• prime the line manually with contents of the syringe
• attach the line to the syringe tip and ensure the connection is secure

The evidence base regarding the duration of extension lines for continuous subcutaneous infusions in palliative care is limited. Some companies recommend that the syringe extension line change interval is every 72 hours, see references and resources for information: BD syringe pump directions for use. However the extension line might need changed sooner if there are any issues with the site or drug compatibilities. The date of any line change should be documented on the recording chart.

Key Point: If a new site is required, due to local infection, inflammation and/or irritation: consider renewing the syringe contents, extension line and subcutaneous infusion device.

Key point: if a new site is required due to other reasons, such as site displacement or leakage, it may be possible to use the existing syringe contents but this will reduce the expected time of completion.

The Bodyguard T syringe pump allows users to minimise operation of the keypad during an infusion.

To activate the keypad lock:

• press and hold the  key until a ‘progress’ bar moving from left (lock off) to right (lock on) is
  shown
• hold the key until the bar has moved completely across the screen
• a beep will be heard to confirm the lock has been activated

To deactivate the keypad lock:

• can only be performed when the pump is operating / infusing
• repeat the above procedure and the ‘progress’ bar will now move from in the opposite
  direction from right (lock on) to left (lock off).

Please note, only specific keys are accessible when the keypad lock is activated – see diagram below

Detailed product information by the manufacturer on how the pump operates can be found here in the resources and references section and also here: BD BodyGuard T Syringe Pump Directions for Use

Key Point: The patient/family/carer should be discouraged from interacting with the pump and advised to contact the nursing team caring for them if any issues occur.