Parenteral Manual


Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Narcotic analgesic
Original Date: 
August 2005
Revised Date: 
December 2019
  • Management of moderate to severe pain
Reconstitution and Stability: 
  • Available as: 
    - 2 mg/mL  (2000 mcg/mL) - 1 mL vial
  • Store ampoules/vials at room temperature, protect from light
  • Diluted solutions (0.1 mg/mL - 10 mg/mL) stable 30 days at room temperature or refrigerated
  • CHEO PCA cassettes  available as 40 mcg/mL and 500 mcg/mL
  • A slight yellowish discolouration has not been associated with loss of potency

- Solutions Compatible: D5W, 0.9% NaCl, ringer's solution, ringer's lactate

- Additives/Above Cassette Compatible: bupivicaine, dimenhydrinate,, ketorolac, lorazepam, metoclopramide

- Y-site Compatible: ampicillin, ketamine, midazolam, morphine, amino acids/dextrose with up to 40 mmoL/L KCL, SMOF Lipid 20%

- Incompatible: cefazolin, diazepam, fat emulsion (Intralipid 20%), sodium bicarbonate, thiopental, phenytoin,


(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC Infusion Restricted to Palliative Care Service
IV Direct YES - no further dilution required
Infusion time: 2-3 minutes
IV Intermittent Infusion YES - usual concentration: 40 mcg/mL
IV Continuous Infusion

Standard drug concentrations: 40 mcg/mL and 500 mcg/mL

Epidural Infusion YES

Click here to access SDC Drug Infusion Sheet


(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Moderate to Severe Pain:

  • Intermittent: 15-20 microgram/kg/dose IV Q 2-4 hours PRN
  • IV continuous infusion:  4 -6 microgram/kg/hour IV
    - Dosage adjustment should be considered in patients with hepatic insufficiency.


  • Continuous rate: 1 - 4 mcg/kg/hr
  • Bolus dose: 4 - 10 mcg/kg/dose


  • Continuous rate: 2 - 4 mcg/kg/hr
  • Bolus dose: 4 mcg/kg/dose

Sickle cell PCA:

  • Continuous rate: 4 - 6 mcg/kg/hr
  • Bolus dose: 4 mcg/kg/dose




      HYDROmorphone 1000 mcg = 1 mg


     ______________mcg   ÷ 1000 = ____________mg


Potential hazards of parenteral administration: 
  • CNS depression, dizziness, sedation, confusion
  • Respiratory and circulatory depression (hypotension)
  • Orthostatic hypotension with rapid IV injection
  • Increased intracranial pressure
  • Nausea, vomiting, constipation, increased biliary pressure (common), urinary retention
  • Locallized allergic reactions, pruritus, rash
  • Antidote: Naloxone (see Naloxone monograph)
  • ApMonitor  RR, HR, BP, O2 saturation, pain relief, level of sedation


  • Check physician's order against guidelines; question dosage if higher
  • Safely prepare and administer medication as per Medication Administration Policy
  • Continuous infusion must be on a pump
  • 02 and suction must be available at bedside
  • Patient may need to be on a respiratory monitor (or Oximeter) if there are concerns
  • IV solution without the added narcotic must be available at bedside with tubing primed, ready to be hooked to patient in case of an emergency.


for first dose - Baseline vital signs including sedation score (level of consciousness), HR, RR, BP, oxygen saturation and pain score

- 10 & 20 minutes after start of IV direct - repeat sedation score, HR, RR, BP, oxygen saturation, and pain score

- Monitor oxygen saturation continuously for 30 minutes post start of IV direct

 for subsequent dose(s) - HR, RR, pain score, and oxygen saturation 15 minutes post dose x 1

  • Naloxone must be available in the patient care area as ward stock


  • Respiratory depression (RR <10 breaths/minute)
  • Somnolence, difficulty in arousing
  • Orthostatic hypotension with bradycardia
  • Nausea and vomiting
  • Allergic reaction.

ACTIONS: Notify physician if:

  1. Respiratory rate below 10 breaths per minute
  2. Blood pressure decreased by 25% from baseline
  3. Patient difficult to rouse
  4. Allergic reaction
  • Stop infusion of narcotic and start plain IV solution.  Notify physician.
  • Maintain patient airway and administer O2 as indicated.
  • Contact Pharmacy, Anesthesia, or Poison Information Centre if after hours, for appropriate dose of naloxone (Narcan).



using solution of  HYDROmorphone (Dilaudid) 0.04 mg/mL (40 mcg/mL)

WEIGHT (kg) dose ordered:  4 mcg/kg/hr dose ordered:  6 mcg/kg/hr
  IV RATE:  mL/hr IV RATE:  mL/hr
10                  1                  1.5
20                  2                  3
30                  3                  4.5
50                  5                  7.5
70                  7                 10.5


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