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Urgent CSCI Dose Increase Protocol — SCE Palliative Medicine MCQ

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ModerateSyringe Driver & Drug CompatibilityUrgent CSCI Dose Increase ProtocolSCE Palliative Medicine

A hospice patient is receiving a continuous subcutaneous infusion (CSCI) with diamorphine 80 mg and midazolam 20 mg per 24 hours. The patient requires an urgent increase in analgesia due to escalating pain, and the current syringe has 8 hours remaining. What is the most appropriate action?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Give an immediate single SC bolus of diamorphine (approximately 13 mg), then set up a new syringe at the increased dose without waiting for the current syringe to finish

Explanation lettering: D = shown as A · E = shown as B · A = shown as C · B = shown as D · C = shown as E

In UK palliative care practice, when urgent pain escalation occurs mid‑cycle in a CSCI, the correct action is to give an immediate breakthrough SC bolus—calculated as 1/6 to 1/10 of the 24‑hour dose (here ≈ 13 mg)—and set up a new syringe at the increased dose. Continuing the current syringe delays relief (E), adding to a running syringe is unsafe and not standard (B), stopping without bolus causes a care gap (C), and increasing the infusion rate risks unsafe delivery and offers minimal immediate benefit (D). Only option A provides prompt, safe analgesia and aligns with UK guideline practice.

Reference: Scottish Palliative Care Guidelines (Morphine—breakthrough dosing 1/6–1/10 of 24‑hour CSCI) and Sendolor (Morphine) SmPC (monograph) support