Document Type:
PROCEDURE
Title:
Use of the CME T34 Syringe Pump for Adult Patients
Unique Identifier:
CORP/PROC/577
Version Number:
2
Scope:
Trust Wide
Status:
Ratified
Classification:
Organisational
Author/Originator and title:
Responsibility:
Blackpool Teaching Hospitals NHS Foundation Trust and Trinity Pharmacy
Hospice Task Group
Replaces:
Description of amendments:
Version 1 Use of the CME T34 Syringe
Pump for Adult Patients Corp/Proc/577
Name Of:
Divisional/Directorate/Working
Group:
Date of Meeting:
Validated by:
A Gibson, Director of Pharmacy
Validation Date:
21/06/2012
Ratified by:
Medicines Management Committee
Ratified Date:
21/06/2012
Review dates may alter if any significant changes are made
Risk
Assessment:
Not Applicable
Financial
Implications
Not Applicable
Which Principles
of
the
NHS
Constitution
Apply?
Principle 1-4
Issue Date:
21/06/2012
Review Date:
01/06/2015
Does this document meet the requirements of the Equality Act 2010 in relation
to Race, Religion and Belief, Age, Disability, Gender, Sexual Orientation, Gender
Identity, Pregnancy & Maternity, Marriage and Civil Partnership, Carers, Human
Rights and Social Economic Deprivation discrimination? Initial Assessment
Contents
1 PURPOSE..................................................................................... Error! Bookmark not defined.
2 SCOPE ........................................................................................................................................ 4
2.1
Professional Responsibilities/Training and Competency ................................................. 5
2.2
Training package ............................................................................................................ 5
2.3
Updates .......................................................................................................................... 5
3 PROCEDURE .............................................................................................................................. 5
3.1
Obtaining a CME T34 Syringe Pump .............................................................................. 5
3.1.1
Hospital ................................................................................................................. 5
3.1.2
Community ............................................................................................................ 6
3.2
Medication ...................................................................................................................... 6
3.3
Setting up the Syringe Pump .......................................................................................... 6
3.4
Equipment ...................................................................................................................... 6
3.5
Overview of CME T34 ................................................................................................ 7
3.5.1
Syringe recognition system .................................................................................... 7
3.5.2
Keypad .................................................................................................................. 8
3.6
Safety check prior to use ................................................................................................ 8
3.6.1
Battery life ............................................................................................................. 8
3.7
Preparation of medication for administration by syringe pump ........................................ 9
3.8
Infusion Site Selection .................................................................................................. 10
3.9
Attaching the Syringe to the CME T34 ........................................................................ 111
3.10 Connect the Infusion to the Patient ............................................................................. 122
3.11 Starting the Infusion ...................................................................................................... 12
3.12 The Giving Set .............................................................................................................. 13
3.12.1
Siting a new giving set during an infusion ............................................................ 13
3.12.2
Siting a new giving set at the end of an infusion .................................................. 13
3.13 Keypad Lock ................................................................................................................. 14
3.14 Lock box ....................................................................................................................... 14
3.15 Monitoring the Infusion.................................................................................................. 14
3.16 Infusion Completion ...................................................................................................... 15
3.16.1
Discontinuation .................................................................................................... 15
3.16.2
Continuation of Infusion ....................................................................................... 15
3.16.3
Temporary Discontinuation .................................................................................. 16
3.16.4
Resuming of Infusion after Temporary Discontinuation ........................................ 16
3.17 When a Patient Dies ..................................................................................................... 17
3.18 Discharge from Inpatient Unit........................................................................................ 17
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: Use of the CME T34 Syringe Pump for Adult
Patients
Do you have the up to date version? See the intranet for the latest version
Next Review Date:01/06/2015
Page 2 of 55
3.19 Maintenance ................................................................................................................. 17
3.19.1
Hospital ............................................................................................................... 17
3.19.2
Community/Trinity ................................................................................................ 18
3.20 Infection Control/ Decontamination ............................................................................... 18
3.21 Troubleshooting ............................................................................................................ 18
3.21.1
Pump will not start ............................................................................................... 18
3.21.2
Infusion Running Too Fast ................................................................................... 18
3.21.3
Infusion running too slow ..................................................................................... 19
3.21.4
The pump has stopped infusing, but contents remain in the syringe .................... 19
3.21.5
Site Irritation ........................................................................................................ 19
3.21.6
Precipitation, cloudiness or colour change in syringe contents or giving set ........ 19
3.21.7
Syringe becomes displaced ................................................................................. 20
3.21.8
Alarms and Alerts ................................................................................................ 20
3.22 Medication errors involving the CME T34 syringe pump. .............................................. 20
4 ATTACHMENTS ........................................................................................................................ 21
5 ELECTRONIC AND MANUAL RECORDING OF INFORMATION . Error! Bookmark not defined.
6 LOCATIONS THIS DOCUMENT ISSUED TO ............................... Error! Bookmark not defined.
7 OTHER RELEVANT/ASSOCIATED DOCUMENTS ...................... Error! Bookmark not defined.
8 SUPPORTING REFERENCES/EVIDENCE BASED DOCUMENTS ............. Error! Bookmark not
defined.
9 CONSULTATION WITH STAFF AND PATIENTS ......................... Error! Bookmark not defined.
10 DEFINITIONS/GLOSSARY OF TERMS ........................................ Error! Bookmark not defined.
11 AUTHOR/DIVISIONAL/DIRECTORATE MANAGER APPROVAL . Error! Bookmark not defined.
Appendix 1 Drug Information .......................................................................................................... 24
Appendix 2: Patient Information Leaflet........................................................................................... 25
Appendix 3 - Continuous Subcutaneous Infusion Monitoring Chart ................................................. 29
Appendix 4: ............ Subcutaneous ‘as required’ & Syringe Driver Prescription Administration Record
(JiC4CD MAR) .............................................................................................................. 30
Appendix 5: Equality Impact Assessment Tool ................................ Error! Bookmark not defined.4
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: Use of the CME T34 Syringe Pump for Adult
Patients
Do you have the up to date version? See the intranet for the latest version
Next Review Date:01/06/2015
Page 3 of 55
1. PURPOSE
The purpose of this policy is to inform authorised healthcare professionals how to
configure, manage and discontinue a continuous subcutaneous infusion (CSCI) via a CME
T34 syringe pump. It does not cover the use of syringe pumps for administration of drugs
by the epidural or intravenous route.
Background
The CME T34 syringe pump is a portable battery operated medical device used to
administer medication to patients via a CSCI, providing symptom management for patients
who are unable to tolerate oral medication. Other routes of administration may be
appropriate in certain cases. Nonetheless, the use of a CSCI ensures continuous delivery
of medication over 24 hours, maintaining consistent control of symptoms.
Typical indications for the use of a CSCI include:

nausea and vomiting

intestinal obstruction

suspected malabsorption

difficulty or inability to swallow (e.g. mucositis, stomatitis)

severe weakness or unconsciousness
There are advantages and disadvantages to the use of the syringe pump:
Advantages

provides a steady plasma level of drugs rather than peaks and troughs of using “as
required” (PRN) medication

a combination of different drugs (always check for compatibility) can be used in one
syringe covering a variety of symptoms e.g. pain, nausea and agitation

daily renewing of syringe pump medication means patients can forget about regular
medication times

the device is lightweight and compact which is beneficial for ambulatory patients
Disadvantages

some patients may become “dependant” on the device.

may be problems with local skin reactions

patients may feel restricted at home if requiring daily changes of medication

risk of loss of symptom control in obese or oedematous patients
The administration of medication via a CSCI should not be viewed as a convenient
alternative to oral medication. Other routes should also be considered and may be more
appropriate in some cases e.g. rectal or sublingual. However, one advantage of using the
CME T34 syringe pump is that it delivers continuously over 24 hours and avoids “peaks
and troughs” of drug delivery which may cause difficulties in maintaining consistent control
of symptoms. This can be reassuring to patients and their carers.
2. SCOPE
The document applies to all practitioners within Blackpool Teaching Hospitals NHS
Foundation Trust (BTH NHS FT) and Trinity Hospice. This policy is in response to the
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: Use of the CME T34 Syringe Pump for Adult
Patients
Do you have the up to date version? See the intranet for the latest version
Next Review Date:01/06/2015
Page 4 of 55
National Patient Safety Agency Rapid Response Report (NPSA/2010/RRR019) alert.
Across the above organisations only the CME T34 syringe pumps will be used to deliver
CSCIs.
The policy should be read in conjunction with the relevant and up to date Infection
Prevention and Control policies, Medicines Management Policies, Medical Devices
Policies as well as Mandatory Training policies. For prescribing refer to the latest
Lancashire and South Cumbria Palliative Care Prescribing Guidelines.
2.1 Professional Responsibilities/Training and Competency
All authorised staff that use the CME T34 syringe pump must have completed approved
training in the safe use of medical devices and have been assessed as competent to use
the CME T34 specifically. Each professional is responsible for his/her own competencies
and knowledge and maintaining their competency record. The individual user is
responsible for ensuring they keep up to date with device/equipment competency and
maintaining personal records of competency and training on any equipment.
2.2 Training package
A training package and workbook is available via key trainers in all areas. Training in the
use of CME T34 syringe pumps must be provided by authorised key trainers and an
assessment of competencies undertaken. The date and outcome of assessment must be
made and recorded as per local policy and electronic learning management systems (if
appropriate).
2.3 Updates
Key trainers are required to complete updates every 2 years.
A professional accepts accountability for his/her competency and must review the need for
CME T34 updates on at least an annual basis or as required.
Each professional is responsible for their own level of knowledge and competency when
using any medical device and medicine.
3. PROCEDURE
3.1 Obtaining a CME T34 Syringe Pump
3.1.1 Hospital
A CME T34 syringe pump can be obtained by contacting the Medical Equipment Library
Service:
 Monday-Friday 08.00 – 16.00 hours call ext. 5323
 Monday-Friday 16.00 – 20.30 hours, bleep 675
 Saturday and Sunday 08.00 – 13.00 hours, bleep 675
 Outside these hours contact 002 bleep holder for all loan requirements
To request an equipment loan you will be asked to provide the following information:
a) Name of the requesting person
b) Location where equipment is to be used
c) Type of equipment required
d) Patient Name
e) Patient Hospital Number and/or NHS number
f) The time the loan is required
g) Expected loan period
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: Use of the CME T34 Syringe Pump for Adult
Patients
Do you have the up to date version? See the intranet for the latest version
Next Review Date:01/06/2015
Page 5 of 55
3.1.2 Community
CME T34 syringe pumps are obtained from District Nursing Teams during normal working
hours. Out of hours, these are available from the Urgent Care Centre (for the Blackpool,
Wyre and Fylde area) or from the District Nurse evening/night services based at QVC (for
the Lancaster area).
3.2 Medication
The CME T34 syringe pump is most commonly used to deliver compatible combinations of
up to four drugs via CSCI over a 24 hour period. Various combinations of drugs used
together in a single syringe can allow a number of different symptoms to be controlled with
minimum inconvenience for the patient.
Drug combinations should be reviewed on a regular basis to assess the continued need
for each drug and the appropriateness of the doses being used. All prescribers are
responsible for ensuring their own knowledge and skills relating to the prescribing of drugs
for use in a syringe pump. Refer to (Appendix 1) for common drugs used in syringe
pumps. The prescriber is responsible for ensuring patient consent is obtained should any
drugs be used for an unlicensed (or off-label) indication.
If there are any problems or questions relating to prescribing, contact the prescriber and /
or specialist palliative care services for advice:



within working hours please contact ext. 3670 or bleep Specialist Palliative Care CNS
via hospital switchboard
out of hours – contact Trinity Hospice (01253 359359)
In the community, contact CNS team at Trinity on 01253 359359 or St John’s Hospice
01524 382538
Healthcare professionals must be aware of the compatibility of drugs used in the syringe
pump. It is the responsibility of the healthcare professional involved to ensure that he/she
has up to date knowledge and understanding of the drugs used, including appropriateness
and safety of doses as per professional guidance.
Refer to Lancashire and South Cumbria Palliative Care Prescribing Guidelines (2012), or
contact the Palliative Care Team or Trinity Hospice and Palliative Care Services for further
information. Prescribing guidelines are available for Blackpool Teaching Hospitals NHS
Foundation Trust via the intranet homepage.
For the latest information, refer to www.cancerlancashire.org.uk (registration required).
3.3 Setting Up The Syringe Pump
Before setting up the CME T34 syringe pump, discussions should occur with the patient
and family/carer as to the reasons for its use, how it works and (if applicable) how to
respond to any incidents which may occur. Ensure the patient and/or carer receives the
patient information leaflet (see Appendix 2). In addition, refer to local policy for consent.
When a patient lacks capacity best interest decisions must be used. The setting up of the
syringe pump should only be undertaken by, or under the supervision of, appropriately
trained personnel (see section 2.1)
3.4 Equipment
 CME T34 Syringe Pump and 9 volt PP3 alkaline battery with lockbox and key
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: Use of the CME T34 Syringe Pump for Adult
Patients
Do you have the up to date version? See the intranet for the latest version
Next Review Date:01/06/2015
Page 6 of 55

A spare battery must always be available

20mL OR 30mL Luer lock syringe (20mL syringe as minimum; larger syringe may be
necessary for large volume infusion)

As per local policies, blunt end filter needles, where available, should be used when
drawing from glass ampoules (not required when drawing through a rubber bung)

1mL/ 2mL/ 10mL Luer lock syringes for reconstituting and drawing individual
medicines prior to adding to larger syringe

CME cannula and giving set. For example, the code for the giving set (with butterfly)
is FKA350 and the BD 20 ml syringe is FWD018. Where necessary, Sof- Set® may be
used.

70% isopropyl alcohol wipe

Semi permeable dressing to secure needle

Label for syringe barrel

Valid prescription and appropriate documentation

Continuous Subcutaneous Infusion Monitoring Chart (see Appendix 3)

For community patients, the Subcutaneous ‘as required’ and Syringe Driver
Prescription and Administration Record (Appendix 4)
3.5 Overview Of CME T34
3.5.1 Syringe recognition system
1
3
2
Figure 1 - Illustration of where the syringe attaches to the pump
1. Barrel clamp arm – (detects syringe size / width of barrel, securing clamp arm)
2. Syringe ear / collar sensor (detects secure loading of syringe collar)
3. Plunger sensor (detects secure loading of syringe plunger)
4. Actuator
All these areas need to be able to register the syringe before the pump will function
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: Use of the CME T34 Syringe Pump for Adult
Patients
Do you have the up to date version? See the intranet for the latest version
Next Review Date:01/06/2015
Page 7 of 55
4
3.5.2 Keypad
8
1
1.
2.
3.
4.
5.
6.
7.
8.
2
3
4
5
6
7
Figure 2 - Control buttons
INFO Key - access event log/Set Up (code protected)/battery status
▲ + / ▼ - arrow keys – increase / decrease parameters / scroll options
YES / START key - confirms selection / starts infusion
NO / STOP- step back a screen / stops infusion
FF ◄◄ (forward) - moves actuator forward
BACK ►► - moves actuator back
ON / OFF
LED indicator
3.6 Safety Check Prior To Use
 Insert battery, check the battery level before ( see battery life below ) use.
 Ensure the barrel clamp arm is down then press and hold the “ON / OFF” key until the
“pump identification” screen appears (shows model and software version).
 The LCD display will show “PRE-LOADING” and the actuator will start to move (see
Figure 3). Wait until it stops moving and the syringe sensor detection screen (syringe
graphic) appears.
Figure 3 - Pre-loading screen
 During pre-loading the actuator always returns to the start position of the last infusion
programmed. If the actuator is not in the correct position to accommodate the syringe,
leave the barrel clamp arm down and use the “FF ◄◄” or “BACK ►►” buttons on the
keypad to move the actuator. Forward movement of the actuator is limited, for safety;
therefore repeated presses of the “FF ◄◄” key may be required when moving the
actuator forward. Backwards movement is not restricted
 Always check the battery power before commencing the infusion. Press the INFO key
until the battery level option appears on the screen (see Figure 4) and then press YES
to confirm. The average battery life, commencing at 100%, is approximately 3-4 days
depending on use.
3.6.1 Battery life
 In the inpatient setting, if the battery has less than 10% power remaining at the start of
an infusion then consideration should be made to discarding the battery and installing a
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: Use of the CME T34 Syringe Pump for Adult
Patients
Do you have the up to date version? See the intranet for the latest version
Next Review Date:01/06/2015
Page 8 of 55
new one (as recommended by CME).
 In the community, if the battery has less than 40% power remaining at the start of an
infusion then consideration should be made to discarding the battery and installing a
new one.
 Document the battery level on the Continuous Subcutaneous Infusion Monitoring Chart
(see Appendix 3).
 The battery should be removed from the syringe pump when not in use.
Figure 4 - Battery level indicator
3.7 Preparation Of Medication For Administration By Syringe Pump
As a rule, no more than three drugs should be mixed in one syringe. If four or more drugs
are thought necessary, refer to section 3.2 for further guidance. It is considered good
practice to make the solution as dilute as possible to reduce the likelihood of drug
incompatibility and minimise site irritation. The following should be followed:
 The principles of Aseptic Non Touch Technique (ANTT) must be followed in the
preparation of all injectable medicines.
 To be prepared as per local policies
 Each drug must be reconstituted as per manufacturer’s recommendation.
 Prepare a clean, clear area to work on. Wash and dry hands as per local hand hygiene
policy.
 Check compatibility and choose appropriate diluents.
 Calculate the expected volume of infusion and select appropriate size syringe. The
recommended maximum fill volume for a 20mL syringe is 17mL; for a 30mL syringe this
is 22mL. In most cases a 20mL syringe will suffice, however 30mL can be used for
larger volume infusions.
 Assemble the correct number of ampoules/vials of drugs required, including the diluents
and a medicinal waste bin.
 Ampoules/vials containing liquid preparations nearly always contain an overage, so
measure the exact volume required.
 Complete additives label for the syringe barrel, which must be signed by staff involved
in process. Details required:
o patient’s name
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: Use of the CME T34 Syringe Pump for Adult
Patients
Do you have the up to date version? See the intranet for the latest version
Next Review Date:01/06/2015
Page 9 of 55
o
o
o
o
o
ward (where appropriate)
drug(s) and dose(s)
diluent
date and time prepared
signature/initial of staff preparing
 Check the drug concentration, expiry and the volume of each drug to be used.
 In the community, the batch number of each ampoule/vial should then be recorded on
The Subcutaneous ‘as required’ and Syringe Driver Prescription and Administration
Record (Appendix 4) and the ampoules/vials should be retained for the final check.
 Once completed, draw a little air into the syringe, invert it gently several times to mix the
contents, and then expel air, taking care not to expel any of the medication.
 If using a new giving set, attach it to the syringe and prime.
 If the giving set is in situ, do not attach to the syringe (see section 3.16.2).
 Needles must never be re-sheathed.
 Observe for any signs of incompatibility, such as crystallisation or cloudiness. If this
occurs discard the medication and seek advice regarding an alternative combination of
medication.
3.8 Infusion Site Selection
 Discuss with the patient preferred sites, if possible.
 Choose a suitable site (examples of which are illustrated in Figure 5).
 The site should be in an area with a good depth of subcutaneous fat.
 Both the outer arm and upper thigh are commonly used, but avoid the upper arm in
bedbound patients who require frequent turning. In other patients, the chest or abdomen
may be more suitable. Avoid the chest wall in cachetic patients (danger of causing
pneumothorax). The scapula may be considered for confused or delirious patients who
may pull on the line.
 Areas to be avoided include:
o oedematous areas (poor absorption and leaking)
o broken skin
o areas that have recently received radiotherapy
o bony prominences
o possible sites of tumour or infection
o skin folds
o areas of inflammation
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: Use of the CME T34 Syringe Pump for Adult
Patients
Do you have the up to date version? See the intranet for the latest version
Next Review Date:01/06/2015
Page 10 of 55
Figure 5 - Site selection
3.9 Attaching The Syringe To The CME T34
Before attaching the syringe to the pump, ensure the line is not connected to the
patient.
 Check the patient’s name against the identification wrist band (if appropriate) and
verbally where possible against the prescription.
 Lift the barrel clamp arm and seat the filled syringe collar/ear and plunger so the back of
the collar/ear sits in the central slot (see Figure 1) and ensure correct placement; the
syringe collar/ear should be vertical with the scale on the syringe barrel facing forward
 Click the syringe plunger (see Figure 1) into the actuator; this may require some
pressure
 Lower the barrel clamp arm; the syringe graphic on the screen ceases to flash when the
syringe is correctly seated at all three points
 The syringe size and brand option will then be displayed as shown in Figure 6.
 If the syringe size and brand match the screen message, press the YES key to confirm
 If the syringe size and/or brand do not match, scroll with ▲ / ▼ keys until the correct
selection appears, then press the YES key to confirm.
Figure 6 – Example of syringe identification screen
 After confirming the syringe type, an example of the next screen message that appears
is displayed below (in Figure 7):
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: Use of the CME T34 Syringe Pump for Adult
Patients
Do you have the up to date version? See the intranet for the latest version
Next Review Date:01/06/2015
Page 11 of 55
Figure 7 - Example of confirmation screen
 The pump calculates and displays the total volume, duration of infusion (24 hours) and
rate of infusion (mL per hour).
 After pressing YES, refer to Figure 8 for the display on the LCD screen.
Figure 8 - Start infusion screen
3.10 Connect The Infusion To The Patient
 Explain the procedure to the patient.
 Cleanse the skin using a 70% isopropyl alcohol wipe (where appropriate)
 Grasp the skin firmly but gently.
 Insert the winged infusion subcutaneous line needle with the bevel side down at a 45º
angle and release grasped skin.
 The winged device should be firmly secured using a sterile, semi-permeable transparent
dressing to allow easy site inspection.
 If using Sof-Set®, follow manufacturer’s advice.
 Record the location of the infusion site when the syringe pump is set up and when the
line is changed (this reduces disturbance to the patient during monitoring) within the
Continuous Subcutaneous Infusion Monitoring Chart (Appendix 3) and within the
patients record.
3.11 Starting The Infusion
 Check the line is connected to the pump and patient.
 The device display will look as shown in Figure 8. Press YES to start infusion
 When the syringe pump is running, the green LED indicator (above the ON/OFF switch
– refer to button 8 in Figure 3) flashes and an example of what the screen displays is
shown in Figure 9.
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: Use of the CME T34 Syringe Pump for Adult
Patients
Do you have the up to date version? See the intranet for the latest version
Next Review Date:01/06/2015
Page 12 of 55
Figure 9 - LCD display during operation
 If the infusion has not been started and a button has not been pressed for more than
two minutes, an alarm will sound. The message `Pump Paused Too Long Confirm,
Press YES will show on the LCD display. To stop the alarm, press YES and continue
programming the infusion.
 To reduce the risk of syphonage, ensure the syringe pump is placed at the same height,
or lower than the infusion site.
3.12 The Giving Set
It is considered good practice to change the giving set and use a fresh site when the
patient’s prescribed medication has been changed, or the site has to change to the
development of a site reaction (i.e. the site is red, painful or swollen). The giving set
should be routinely re-sited at least every 72 hours.
If alternative sites are limited, e.g. in cachectic patients, or prolonged use, it would be in
the patient’s best interests to continue to use the existing site if it is viable and any newly
prescribed medicines are compatible.
3.12.1 Siting A New Giving Set During An Infusion
 Follow the instructions in section 3.16.3 to temporarily discontinue the infusion. The
following procedure should then be used:
o wash hands as per local policy, take the medicinal sharps bin, a spare giving set,
semi-permeable dressing, gauze and tape or a plaster to the patient
o without removing the syringe from the pump, disconnect the cannula from the syringe
and dispose immediately into the sharps bin
o use gauze and tape or a plaster to cover the previous site, if appropriate
o remove syringe from the CME T34 but DO NOT turn the pump off
o connect a new giving set to the current syringe and prime
o replace the syringe back into the pump
o prepare new site as per section 3.10
 Follow section 3.16.4 to recommence the infusion, but note that the syringe pump will
not deliver medication over the full 24 hour period due to priming of the new giving set
 Document the time the cannula and giving set are changed on the Continuous
Subcutaneous Infusion Monitoring Chart (see Appendix 3)
3.12.2 Siting A New Giving Set At The End Of An Infusion
If the infusion has already completed, and a new giving set and site are required for a
subsequent infusion, refer to section 3.16.2.
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: Use of the CME T34 Syringe Pump for Adult
Patients
Do you have the up to date version? See the intranet for the latest version
Next Review Date:01/06/2015
Page 13 of 55
3.13 Keypad Lock
 The CME T34 syringe pump allows users to lock the operation of the keypad during
infusion. The function should be routinely used to prevent tampering with the device.
 To activate the keypad lock, press and hold the INFO key until a chart is displayed
showing a `progress` bar moving from left to right (see Figure 10). Hold the key until the
bar has moved completely across the screen and a beep is heard to confirm the lock
has been activated.
Figure 10 - LCD display with keypad lock
 When the keypad lock is activated the INFO, YES/START and NO/STOP buttons are
still active.
 To deactivate the keypad lock (pump must be infusing) repeat the above procedure.
The `progress` bar will now move from right (lock on) to left (lock off) and a beep will be
heard.
3.14 Lock Box
 Every CME T34 syringe pump will be supplied with a lockbox. After starting the
infusion, check the syringe pump is set correctly and place it in the lockbox and use the
key to lock it. Universal keys are available. Replacement keys, if required, are the
responsibility of individual teams.
3.15 Monitoring The Infusion
 For inpatient use, following the siting of the CME T34 syringe pump the site must be
checked for signs of leakage, inflammation, blanching or pain. This must be undertaken
after 15 minutes or as per local policy and recorded on the Continuous Subcutaneous
Infusion Monitoring Chart (see Appendix 3). Subsequent observations must be made
and recorded on the Continuous Subcutaneous Infusion Monitoring Chart (see
Appendix 3) every 4 hours.
 In the community, on initial set up the syringe pump must be checked within 12 hours
and recorded on the infusion monitoring chart. The infusion monitoring chart must be
completed at each community nursing visit.
 The following observations should also be made and entered on the Continuous
Subcutaneous Infusion Monitoring Chart (see Appendix 3):
o the time the observation is made
o check the battery light is flashing; record the battery power remaining
o ensure the giving set remains securely attached to both the syringe and the patient
and that it is not leaking, kinked or trapped
o check the solution in the syringe and the giving set for cloudiness, presence of large
air bubbles (indicates syringe may be cracked; small air bubbles are not significant),
precipitation or colour change
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: Use of the CME T34 Syringe Pump for Adult
Patients
Do you have the up to date version? See the intranet for the latest version
Next Review Date:01/06/2015
Page 14 of 55
o record the flow rate and check it is correct
o record the volume of solution to be infused, the volume infused at the time of
checking and use this information to determine whether the syringe pump is
delivering the medication at the desired rate
 Document on the Continuous Subcutaneous Infusion Monitoring Chart that checking
has occurred, along with any discrepancies (Appendix 3).
3.16 Infusion Completion
3.16.1 Discontinuation
 If the patient has died, go to section 3.17.
 When the infusion is nearing completion, the LCD will display “Syringe nearly empty” 15
minutes before the end of the infusion, together with an audible intermittent alarm.
When the infusion is complete and the syringe is empty, the pump will stop
automatically and an alarm will sound. The LCD will show “End Program. Press YES
to confirm”
 Press YES to confirm the end of the infusion, disable the keypad lock and press and
hold the ON/OFF switch to ensure the pump is switched off.
 If the infusion is to be stopped before the syringe is empty (press STOP, deactivate the
keypad lock, as described in section 3.13, then press and hold the ON/OFF button) the
giving set must be disconnected from the patient before removing the syringe from the
pump to avoid an accidental bolus dose of drug(s). Record the remaining volume on
the Continuous Subcutaneous Infusion Monitoring Chart (Appendix 3).
 Removal of the cannula and/or discontinuation of the infusion should only be carried out
by appropriately trained staff.
 Refer to the following procedure to remove the giving set:
o wash hands as per local policy, take the medicinal sharps bin, semi-permeable
dressing, gauze and tape or a plaster to the patient
o without removing the syringe from the pump, disconnect the giving set from the
syringe and dispose immediately into the medicinal sharps bin
o use gauze and tape or a plaster to cover the previous site if appropriate
 Clean the pump and lockbox as detailed in section 3.20.
3.16.2 Continuation Of Infusion
 If the syringe pump is still required, press YES to confirm the end of the infusion, disable
the keypad lock and press and hold the ON/OFF switch to ensure the pump is switched
off.
 If a new giving set and site are required:
o removal of the cannula and/or discontinuation of the infusion should only be carried
out by appropriately trained staff
o wash hands as per local policy, take the medicinal sharps bin, semi-permeable
dressing, gauze and tape or a plaster to the patient
o without removing the syringe from the pump, disconnect the giving set from the
syringe and dispose immediately into the medicinal sharps bin
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: Use of the CME T34 Syringe Pump for Adult
Patients
Do you have the up to date version? See the intranet for the latest version
Next Review Date:01/06/2015
Page 15 of 55
o use gauze and tape or a plaster to cover the previous site, if appropriate
o refer to sections 3.7 - 3.13 to set up a new infusion
 If medication is to remain the same and the line is to remain in situ:
o wash hands as per local policy
o disconnect giving set from the previous syringe before removing the syringe from the
pump (preventing inadvertent bolus)
o remove the previous syringe from the pump
o prepare the new syringe as per sections 3.7-3.9 but do not attach the giving set
o after attaching the syringe to the syringe pump, check the giving set is full of fluid; if
not, a new giving set will be required
o connect the giving set to the new syringe ensuring the Luer-lock is fully screwed on
to the thread of the syringe tip
o follow section 3.11 to commence the infusion
3.16.3 Temporary Discontinuation
 This is not normal practice and should only be used in exceptional
(this should not be used for priming a second giving set)
circumstances
 Press STOP, deactivate the keypad lock (as described in section 3.13) and press and
hold the ON/OFF button.
 Do not remove the syringe from the syringe pump.
 Note the time the syringe pump was stopped Continuous Subcutaneous Infusion
Monitoring Chart (see Appendix 3)
3.16.4 Resuming Of Infusion After Temporary Discontinuation
 To resume the infusion, check the prescription and syringe label match the patient’s
details.
 Press and hold the ON button until a beep is heard.
 The screen will request confirmation of the syringe size and syringe brand.
 Press the YES key to confirm if the syringe size and brand match the screen message
 Should the syringe size and/or brand not match, scroll down with the ▲ / ▼ keys until
the correct selection appears, then press the YES key to confirm.
 The LCD will display the following message (Figure 11):
Figure 11 - Resuming an infusion
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: Use of the CME T34 Syringe Pump for Adult
Patients
Do you have the up to date version? See the intranet for the latest version
Next Review Date:01/06/2015
Page 16 of 55
 Press the YES key to resume the previous programme. The screen will
`volume, duration and rate. `
display
 Pressing NO will instruct the CME T34 to begin a completely new 24 hour infusion. If
this is pressed in error, the pump would deliver the remaining contents of the syringe
over the next 24 hours. The current syringe would need discarding and a new one
would have to be prepared.
 Check against the Continuous Subcutaneous Infusion Monitoring Chart (Appendix 3)
that the duration, rate and remaining volume are correct.
 Press YES to confirm and the screen will display `Start Infusion?`, press the YES key to
confirm
 Note the time infusion resumed on the Continuous Subcutaneous Infusion Monitoring
Chart (Appendix 3)
3.17 When A Patient Dies
 Once verification of death has taken place, stop the syringe pump by pressing STOP.
 If in any doubt about the circumstances of the death leave the pump in place and refer
to your line manager.
 Switch off the syringe pump by disabling the keypad lock and then press and hold the
ON/OFF button.
 Record the date, time and amount of solution remaining to be infused (in mL). The
syringe pump can be disconnected from the patient and the contents managed
according to local guidelines.
3.18 Discharge From Inpatient Unit
 The doctor must complete the “Subcutaneous ‘as required’ and Syringe Driver
Prescription and Administration Record” (Appendix 4).
 If discharging a patient with a syringe pump the patient and/or carer must be given clear
guidance on what to do, and who to contact, in the event of a problem arising. This
information will be available in the patient information leaflet (Appendix 2).
3.19 Maintenance
 All medical devices must be maintained and serviced in accordance with local policy.
 Users must ensure that new device settings are added to the patient’s record.
 Ensure medical devices are cleaned in accordance with local policy on decontamination
prior to use or servicing and repair.
 Undertake day-to-day care and maintenance of medical devices.
 When not in use each syringe driver, appropriate infusion lines, syringes, spare
batteries and adhesive dressings should be stored and transported in a sealable
waterproof container. The container must be restocked each time any of the contents
have been used.
3.19.1 Hospital
 Report medical device malfunction or unsatisfactory performance to the Medical
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: Use of the CME T34 Syringe Pump for Adult
Patients
Do you have the up to date version? See the intranet for the latest version
Next Review Date:01/06/2015
Page 17 of 55
Equipment Library through the Estates Helpdesk System as per local policy, marking
the device as faulty and making it available for repair in a clean condition and labelled
with a ‘Medical Device/Equipment Repair Label’ and decontamination certificate.
 Report adverse incidents or suspected faults in line with Trust procedure and MHRA
reporting procedure.
 Make medical devices available for Planned Preventative Maintenance (PPM) on time
and in clean condition. Keep records of devices loaned between departments. Check
device functionality, including that of alarms, whenever the device is switched on.
3.19.2 Community/Trinity
 The syringe driver must have its performance checked annually by the medical
electronics department EBME at Victoria Hospital. Telephone Estates Help Desk on
01253 306002 to book syringe driver for maintenance and to obtain a job number. Staff
must ensure the syringe driver has been decontaminated, and the decontamination
certificate must be sent with the syringe driver.
 Community staff must ensure that faulty or problematic medical devices are reported
the NHSB Risk Management Department via an untoward incident report as per local
policy.
3.20 Infection Control/ Decontamination
 Never dip or submerge the syringe pump in water.
 Staff handling used medical equipment should assume that it is contaminated and take
precautions to reduce the risk to themselves and others.
 DO NOT USE ALCOHOL-BASED PRODUCTS TO CLEAN THE SYRINGE PUMP. This
will damage the LED screen.
 Reusable medical devices will be properly decontaminated prior to use or repair.
 Medical devices should be decontaminated and stored in accordance with legislative
and best practice requirements, taking into account any guidance supplied by the
manufacturer of the device regarding decontamination and cleaning.
 Each syringe driver must be cleaned between patients .The outer surface of the driver
should be kept clean by wiping with a soft damp cloth using a mild detergent. The driver
should then be dried.
3.21 Troubleshooting
3.21.1 Pump Will Not Start
 No battery present. Fit a battery.
 Battery inserted incorrectly. Re-align battery terminals.
 Battery is depleted/very low. Fit a new battery.
 Pump is faulty. Service required (see 3.19).
3.21.2 Infusion Running Too Fast
 Complete untoward incident report and follow procedure as in 3.22
 If over-infusion occurs, stop infusion, check condition of patient and seek medical
advice.
 Check rate setting for accuracy.
 Check the correct brand or size of syringe has been programmed.
 Check for disconnection of giving set or cannula.
 Check syringe securely attached to pump.
 Check box is locked and no tampering has occurred.
 Check no air present in syringe (solution will syphon in if barrel cracked).
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: Use of the CME T34 Syringe Pump for Adult
Patients
Do you have the up to date version? See the intranet for the latest version
Next Review Date:01/06/2015
Page 18 of 55
 If syringe pump could be faulty return to the Medical Equipment Library, or EBME, as
appropriate.
3.21.3 Infusion Running Too Slow
 Complete untoward incident report and follow procedure as in 3.22
 Check patient, seek medical advice if required.
 Check the correct brand or size of syringe has been programmed.
 Has symptom control been lost, does patient require PRN medication?
 Check the syringe pump light is GREEN and flashing.
 Check the battery level.
 Check the rate setting is correct.
 Check that syringe is inserted correctly into syringe pump.
 Check if syringe pump has been stopped and restarted for any reason.
 Check contents of syringe/ giving set for any evidence of crystallisation/kinking of
tubing?
 Check site for signs of inflammation/irritation
 Change site if necessary.
 Consider further dilution of drugs to minimise irritation by setting up a fresh syringe.
 Consider metal allergy from needle or other consumable – contact Palliative Care
Team/Trinity for advice.
 If syringe pump continues to run through too slowly, change entire pump and return to
the Medical Equipment Library, or EBME, as appropriate
3.21.4 The Pump Has Stopped Infusing, But Contents Remain In The Syringe
 Check battery has not exhausted. Fit a new battery, turn pump on and confirm syringe
size and brand, then select “Resume‟ to continue infusion.
 WARNING – If you press NO, the pump interprets this as a completely new 24
hour period and the remaining contents of the syringe would be delivered over
the next 24 hours from confirming “Start Infusion‟. The patient would not
therefore receive the prescribed dose. If NO has been pressed in error, discard
the remainder of the syringe contents, and prepare and set up a new syringe.
 Trapped/kinked giving set. Free line or kink and resume infusion if appropriate.
 If still not working, return to the Medical Equipment Library, or EBME, as appropriate.
3.21.5 Site Irritation
 Refer to Lancashire and South Cumbria Palliative Care Prescribing Guidelines (see 3.2)
 Change site (use a new giving set when changing site) leave at least 3cm away from
original site.
 Consider a change of cannula if metal (nickel) allergy is suspected.
 For severe site reactions which persist despite usual measures such as increased
dilution of drugs(s), consult Palliative Care Team for advice or Trinity Hospice and
Palliative Care Services (see section 3.2).
 Document incident in patient record.
3.21.6 Precipitation, Cloudiness Or Colour Change In Syringe Contents Or Giving
Set
 Stop infusion and inform prescriber. Seek advice from pharmacist/Palliative Care Team/
Trinity Hospice and Palliative Care Services.
 Discard the contents of the syringe as per local policy.
 Ensure syringe pump is not in direct sunlight, or close to a heat source (e.g. hot
pack/heat pad or hot water bottle)
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: Use of the CME T34 Syringe Pump for Adult
Patients
Do you have the up to date version? See the intranet for the latest version
Next Review Date:01/06/2015
Page 19 of 55
 Commence new infusion at a different site (at least 3cm away) with new giving set.
 Document incident in patient record.
3.21.7 Syringe Becomes Displaced
 The alarm will sound and the infusion light will turn red. “Check Syringe Loaded
Correctly” will be displayed in the LCD.
 Check that the prescription, syringe label and patient details match, to ensure that this is
correct syringe for this patient.
 Ensure the syringe is fitted correctly.
 Refer to 3.16.4
 Complete untoward incident report and follow procedure as in 3.22.
3.21.8 Alarms And Alerts
ALARM
 The pump will activate an alert (Continuous alarm) for the following:
 End of infusion
 Pump paused too long
 End of battery
 Syringe displaced
 Occlusion/empty syringe
 Occlusion check line
 System error
When the alarm activates the infusion will stop. The LED light will turn from green to red,
and the alarm will sound continuously until the fault is rectified. An error message will be
displayed indicating the alarm cause. (See Operation manual for troubleshooting)
ALERT
 The pump will activate an alert (three beeps, approximately every 3-4 minutes) for the
following:
 Program nearly complete
 Low battery
Please note: warn and reassure patients and carers of the alarms and the actions to take
where necessary.
3.22 Medication Errors Involving The CME T34 Syringe Pump.
 In the event of a medication error/incident where a CME T34 syringe pump is part of
the medicines administration process investigation must be made into both the process,
human error and the equipment used. This includes administration errors e.g. too
fast/slow, dislodgment, failure of alarms and display errors. In the event of an incident:o Stop the infusion
o Ensure the patient is safe, reassure and provide emergency care where appropriate
o Inform the Doctor in charge and / or the Prescriber
o Complete an untoward incident form immediately
o Follow local policy regarding medication errors and medical devices
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: Use of the CME T34 Syringe Pump for Adult
Patients
Do you have the up to date version? See the intranet for the latest version
Next Review Date:01/06/2015
Page 20 of 55
4. ATTACHMENTS
Appendix Number
1
2
3
4
5
Title
Commonly used Drug List
The Syringe Pump prescribing and administration record
Continuous Subcutaneous Infusion Monitoring Chart
Patient Information Leaflet
Equality Impact Assessment Tool
5. ELECTRONIC AND MANUAL RECORDING OF INFORMATION
Electronic Database for Procedural Documents
Held by Policy Co-ordinators/Archive Office
6. LOCATIONS THIS DOCUMENT ISSUED TO
Copy No
Location
1
Intranet
2
Wards and Departments
Date Issued
21/06/2012
21/06/2012
7. OTHER RELEVANT/ASSOCIATED DOCUMENTS
Unique Identifier
Title and web links from the document library
Corp/proc/133
Staff Training And Competency Assessment In
The Use Of Medical Devices
http://bfwnet/departments/policies_procedures/documents/Proced
ure/Corp_Proc_133.pdf
Corp/proc/473
Performing an Aseptic Technique
http://bfwnet/departments/policies_procedures/documents/Proced
ure/Corp_Proc_473.pdf
Corp/proc/418
Hand Hygiene Procedure
http://bfwnet/departments/policies_procedures/documents/Proced
ure/Corp_Proc_418.pdf
Corp/pol/056
HandHygiene Policy
http://bfwnet/departments/policies_procedures/documents/Policy/
documents/Policy/Corp_Pol_056.pdf
Corp/proc/101
Untoward Incident And Serious Incident Reporting
http://bfwnet/departments/policies_procedures/documents/Proced
ure/Corp_Proc_101.pdf
Corp/Proc/310
Management of Procedure medication errors
http://bfwnet/departments/policies_procedures/documents/Proced
ure/Corp_Proc_310.pdf
Corp/Proc/430
Patients Discharged from Hospital with a Loaned Medical Device
http://bfwnet/departments/policies_procedures/documents/Proced
ure/Corp_Proc_430.pdf
Corp/Pol/036
Management of Medical Devices
http://bfwnet/departments/policies_procedures/documents/Policy/
Corp_Pol_036.pdf
Corp/Proc/307
Administration of Medicines
http://bfwnet/departments/policies_procedures/documents/Proced
ure/Corp_Proc_307.pdf
Corp/Proc/107
Repair and Maintenance of Medical Devices and Equipment
http://bfwnet/departments/policies_procedures/documents/Proced
ure/Corp_Proc_107.pdf
Health and Safety No Health and Safety Policy and Procedures No 7 Untoward Incident
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: Use of the CME T34 Syringe Pump for Adult
Patients
Do you have the up to date version? See the intranet for the latest version
Next Review Date:01/06/2015
Page 21 of 55
7
NHSB/Clin054
NHSB/Clin061
NHS-BNL/Clin006
NHSB/Clin110
NHSB/Clin130
NHSB/Clin133
NHSB/Clin146
NLTPCT/Clin49
Reporting and Investigation
Infection Prevention and Control Manual
Procedure for verification of expected deaths
Aseptic technique policy and procedure for community setting
Administration of medicines
Procedure for hand hygiene and hand care
Policy and Guidance for obtaining consent to examination and
treatment for Adults and Children
Safe handling of controlled drugs
Decontamination of Medical Devices Prior to Inspection, Service
or Report
8. SUPPORTING REFERENCES/EVIDENCE BASED DOCUMENTS
References In Full
Dickman A, Schneider J. The Syringe Driver. 3rd Edition OUP. 2011
Lancashire and South Cumbria Palliative Care Prescribing Guidelines 2012 (available
from homepage on the Intranet)
Nursing & Midwifery Council (2008) Standards for Medicines Management NMC
Oxford Handbook of Palliative Care 2nd Edition 2009
Palliative Care Formulary 4th edition 2011
British National Formulary – current edition
www.palliativedrugs.com
www.pallcare.info (drug compatibility table)
9. CONSULTATION WITH STAFF AND PATIENTS
Name
Designation
Andrew Dickman
Consultant Pharmacist - Palliative Care, Blackpool Teaching
Hospitals NHS Foundation Trust
Kathryn Smith
Clinical Lead, End of Life Care Providers, Community Health
Services, Blackpool Locality
Cherith
Medicines Management Specialist Nurse, Blackpool Teaching
Haythornthwaite
Hospitals NHS Foundation Trust
Janet Purdie
End of Life Care Development, NHS Blackpool
Lynn Atcheson
Practice Development Practitioner, Community Health Services,
Lancaster, Morecambe, Fylde and Wyre Locality
Julie Huttley
Matron, Trinity Hospice and Palliative Care Services
Colin Norris
Health and Safety Officer, Community Health Services, Blackpool
Gary Jackson
Patient Safety Advisor, GS&P Division, NLTPCT
Dr Sarah Wenham
Community Consultant in Palliative Medicine, Trinity Hospice and
Palliative Care Services
Dr Andrea Whitfield
Hospital Consultant in Palliative Medicine, Blackpool Teaching
Hospitals NHS Foundation Trust
Helen Hindle
Locality Manager – South, Community Nursing, Blackpool
Locality
Wendy Johnson
Head of Care, St John’s Hospice Lancaster
Lisa Drinkwater
Medicines Management Advisor, NHS Blackpool
10. DEFINITIONS/GLOSSARY OF TERMS
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: Use of the CME T34 Syringe Pump for Adult
Patients
Do you have the up to date version? See the intranet for the latest version
Next Review Date:01/06/2015
Page 22 of 55
11. AUTHOR/DIVISIONAL/DIRECTORATE MANAGER APPROVAL
Issued By
Andrew Dickman
Checked By
Alastair Gibson
Job Title
Consultant
Job Title
Director of
Pharmacist –
Pharmacy
Pallative Care
Date
June 2012
Date
June 2012
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: Use of the CME T34 Syringe Pump for Adult
Patients
Do you have the up to date version? See the intranet for the latest version
Next Review Date:01/06/2015
Page 23 of 55
Appendix 1: Drug Information
Taken from Palliative Care Prescribing, Lancashire and South Cumbria Specialist Palliative
Care Services. Refer to www.cancerlancashire.org.uk for latest information.
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: Use of the CME T34 Syringe Pump for Adult
Patients
Do you have the up to date version? See the intranet for the latest version
Next Review Date:01/06/2015
Page 24 of 55
Appendix 2: Patient Information Leaflet
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: Use of the CME T34 Syringe Pump for Adult
Patients
Do you have the up to date version? See the intranet for the latest version
Next Review Date:01/06/2015
Page 25 of 55
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: Use of the CME T34 Syringe Pump for Adult
Patients
Do you have the up to date version? See the intranet for the latest version
Next Review Date:01/06/2015
Page 26 of 55
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: Use of the CME T34 Syringe Pump for Adult
Patients
Do you have the up to date version? See the intranet for the latest version
Next Review Date:01/06/2015
Page 27 of 55
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: Use of the CME T34 Syringe Pump for Adult
Patients
Do you have the up to date version? See the intranet for the latest version
Next Review Date:01/06/2015
Page 28 of 55
Appendix 3 - Continuous Subcutaneous Infusion Monitoring Chart
Assess patient and complete this form:
Each time the syringe pump is loaded
When the giving set is re-sited
In community setting – at each visit whilst the infusion is
in progress
In the inpatient setting – every 4 hours
CME T34
Syringe Pump
Patient Name:
NHS NO:
Date Of Birth:
GP/Consultant
Date &
Time
Lock box
used
Yes/No
Volume left
(in mL)
Duration left
(in hours)
Rate set in
mL/hours
Battery
power
remaining
as a % *
Check infusion site**
Location
Condition
Ward
Check pump
&line e.g. for
leakage, not
kinked**
precipitation***
Action Taken
Discontinued
Date/Time
*In community setting – at start of infusion the battery must have at least 40% battery power remaining to ensure there is enough power to last for 24 hours.
In inpatient setting – change battery when less than 10% power left
** Site & Pump check: Location: Document insertion site of winged infusion devices e.g. Scapula region
Condition: NP = No (no problem) P = pain I = inflammation SW = swelling
B = Bleeding
H = Hardening L=Leakage from site /pump/equipment (Please state)
***If contents of syringe look cloudy, precipitation has occurred. STOP infusion and refer to guidelines in the CME T34 Syringe Pump Policy
Signature &
Designation
Appendix 4: Subcutaneous ‘as required’
Administration Record (JiC4CD MAR)
&
Syringe
Driver
Prescription
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: The Use of the CME T34 Syringe Pump
Next Review Date: 01/06/2015
Do you have the up to date version? See the intranet for the latest version
Page 31 of 55
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: The Use of the CME T34 Syringe Pump
Next Review Date: 01/06/2015
Do you have the up to date version? See the intranet for the latest version
Page 32 of 55
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: The Use of the CME T34 Syringe Pump
Next Review Date: 01/06/2015
Do you have the up to date version? See the intranet for the latest version
Page 33 of 55
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: The Use of the CME T34 Syringe Pump
Next Review Date: 01/06/2015
Do you have the up to date version? See the intranet for the latest version
Page 34 of 55
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: The Use of the CME T34 Syringe Pump
Next Review Date: 01/06/2015
Do you have the up to date version? See the intranet for the latest version
Page 35 of 55
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: The Use of the CME T34 Syringe Pump
Next Review Date: 01/06/2015
Do you have the up to date version? See the intranet for the latest version
Page 36 of 55
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: The Use of the CME T34 Syringe Pump
Next Review Date: 01/06/2015
Do you have the up to date version? See the intranet for the latest version
Page 37 of 55
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: The Use of the CME T34 Syringe Pump
Next Review Date: 01/06/2015
Do you have the up to date version? See the intranet for the latest version
Page 38 of 55
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: The Use of the CME T34 Syringe Pump
Next Review Date: 01/06/2015
Do you have the up to date version? See the intranet for the latest version
Page 39 of 55
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: The Use of the CME T34 Syringe Pump
Next Review Date: 01/06/2015
Do you have the up to date version? See the intranet for the latest version
Page 40 of 55
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: The Use of the CME T34 Syringe Pump
Next Review Date: 01/06/2015
Do you have the up to date version? See the intranet for the latest version
Page 41 of 55
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: The Use of the CME T34 Syringe Pump
Next Review Date: 01/06/2015
Do you have the up to date version? See the intranet for the latest version
Page 42 of 55
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: The Use of the CME T34 Syringe Pump
Next Review Date: 01/06/2015
Do you have the up to date version? See the intranet for the latest version
Page 43 of 55
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: The Use of the CME T34 Syringe Pump
Next Review Date: 01/06/2015
Do you have the up to date version? See the intranet for the latest version
Page 44 of 55
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: The Use of the CME T34 Syringe Pump
Next Review Date: 01/06/2015
Do you have the up to date version? See the intranet for the latest version
Page 45 of 55
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: The Use of the CME T34 Syringe Pump
Next Review Date: 01/06/2015
Do you have the up to date version? See the intranet for the latest version
Page 46 of 55
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: The Use of the CME T34 Syringe Pump
Next Review Date: 01/06/2015
Do you have the up to date version? See the intranet for the latest version
Page 47 of 55
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: The Use of the CME T34 Syringe Pump
Next Review Date: 01/06/2015
Do you have the up to date version? See the intranet for the latest version
Page 48 of 55
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: The Use of the CME T34 Syringe Pump
Next Review Date: 01/06/2015
Do you have the up to date version? See the intranet for the latest version
Page 49 of 55
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: The Use of the CME T34 Syringe Pump
Next Review Date: 01/06/2015
Do you have the up to date version? See the intranet for the latest version
Page 50 of 55
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: The Use of the CME T34 Syringe Pump
Next Review Date: 01/06/2015
Do you have the up to date version? See the intranet for the latest version
Page 51 of 55
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: The Use of the CME T34 Syringe Pump
Next Review Date: 01/06/2015
Do you have the up to date version? See the intranet for the latest version
Page 52 of 55
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: The Use of the CME T34 Syringe Pump
Next Review Date: 01/06/2015
Do you have the up to date version? See the intranet for the latest version
Page 53 of 55
Appendix 5: Equality Impact Assessment Tool
To be completed and attached to any procedural document when submitted to the appropriate
committee for consideration and approval.
Would the relevant Equality groups be affected by the document? (If Yes please explain why you
believe this to be discriminatory in Comment box)
Title & Identification Number of the Document: The Use of the CME T34 Syringe Pump
Corp/Proc/577
Questionnaire
1
Yes/No
Double click
and select
answer
Grounds of race, ethnicity, colour,
nationality or national origins e.g.
people of different ethnic
backgrounds including minorities:
gypsy travellers and refugees /
asylum seekers.
No
2
Grounds of Gender including
Transsexual, Transgender people
No
3
Grounds of Religion or belief e.g.
religious /faith or other groups with
recognised belief systems
No
4
Grounds of Sexual orientation
including lesbian, gay and bisexual
people
Grounds of Age older people,
children and young people
No
6
Grounds of Disability: Disabled
people, groups of physical or
sensory impairment or mental
disability
No
7
Is there any evidence that some
groups are affected differently?
No
8
If you have identified potential
discrimination, are any exceptions
valid, legal and/or justifiable?
No
9
Is the impact of the
document/guidance likely to be
having an adverse/negative affect on
the person (s)?
If so can the negative impact be
No
5
10
No
N/A
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
Comments
ID No. Corp/Proc/577
Title: The Use of the CME T34 Syringe Pump
Next Review Date: 01/06/2015
Do you have the up to date version? See the intranet for the latest version
Page 54 of 55
avoided?
11
Please Comment
What alternatives are there to avoid
the adverse/negative impact?
12
Please Identify How
Can we reduce the adverse/negative N/A
impact by taking different action?
13 Q1 (a) Is the document Q2 (b) (i) Is the document Q3 (c) Is the document
directly discriminatory?
indirectly discriminatory?
intended to increase equality of
No
opportunity by positive action
No
b (ii) If you said yes , is this
or action to redress
(under any discrimination
justifiable in meeting a
disadvantage
legislation)
legitimate aim
N/A
 Racial Discrimination
N/A
Please give details
 Age Discrimination
To safeguard vulnerable adults
 Disability Discrimination
 Gender Equality
 Sexual Discrimination
14 If you have answered no to all the above questions 1-13 and the document does not
discriminate any Equality Groups please go to section 15
If you answered yes to Q1 (a) and no to Q3 (b) this is unlawful discrimination.
If you answered yes to Q2 (b) (i) no to Q2 (b) (ii) and no to Q3 (c), this is unlawful discrimination
If the content of the document is not directly or indirectly discriminatory, does it still have
an adverse impact?
No
Please give details
If the content document is unlawfully discriminatory, you must decide how to ensure the
organisation acts lawfully and amend the document accordingly to avoid or reduce this
impact
15 Name of the Author completing the Equality Impact Assessment Tool.
Name Cherith Haythornthwaite
Signature
Designation Medicines Management Specialist Nurse
Date June 2012
Blackpool Teaching Hospitals NHS Foundation Trust
Revision No: 2
ID No. Corp/Proc/577
Title: The Use of the CME T34 Syringe Pump
Next Review Date: 01/06/2015
Do you have the up to date version? See the intranet for the latest version
Page 55 of 55