- Symptomatic relief of moderate to severe acute and chronic pain
- Sedation
- Clear, colourless solution. Stable at room temperature, protect from light
- Diluted solutions of 0.04-0.4 mg/mL in D5W, NS stable 7 days at room temp or in fridge
- Diluted solutions of 5 mg/mL in NS or D5W stable for 30 days at room temperature
- Solutions Compatible: dextrose up to D20W, 0.9% NaCl, dextrose-saline combinations, RS, RL
- Additives/Above Cassette Compatible: atropine, bupivicaine, chlorpromazine, dimenhydrinate, diphenhydramine, fentanyl, glycopyrrolate, hydroxyzine, ketamine, ranitidine, milrinone, midazolam, metoclopramide
- Y-site Compatible: amiodarone, clindamycin, cloxacillin (up to morphine 10mg/mL), digoxin, dobutamine, dopamine, epinephrine, esmolol, erythromycin, fat emulsion (intralipid), fluconazole, granisetron, heparin, ketorolac, labetalol, KCl (up to 40 mmol/L), magnesium sulfate, metronidazole, metoclopramide, meropenem, midazolam, nitroglycerin, norepinephrine, propanolol, nitroprusside sodium, ticarcillin, TPN (amino acids/dextrose), vancomycin, zidovudine
Incompatible: acyclovir, azithromycin, phenytoin, meperidine
(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)
| SC | YES |
| SC Infusion | YES |
| IM | YES Usual dilution: 0.5-5 mg/mL |
| IV Direct |
YES |
| IV Intermittent Infusion |
YES |
| IV Continuous Infusion |
YES |
| Continuous Epidural Infusion | YES, use epidural morphine only, (preservative free) |
Click here to access SDC Drug Infusion Sheet
(For neonatal dosages, refer to Neonatal IV Drug Manual.)
NOTE: 1000 mcg = 1 mg
Pediatric:
- IV/IM/SC:
- 0.1-0.2 mg/kg/dose Q 2-4 hours PRN. May initiate at 0.05 mg/kg/dose
- Maximum: 5 mg/dose
- IV/SC Continuous Infusion:
- Sickle cell/Cancer pain: Initial dose- 0.03 mg/kg/hour
- Postoperative pain: 0.01-0.04 mg/kg/hour
- Sedation/Analgesia for Procedures:
- 0.05-0.1 mg/kg IV 5 minutes before procedure, may repeat x 1 in 15 minutes PRN
- Adolescents (>12 years): 3-4 mg IV, may repeat in 5 minutes if necessary
- 0.05-0.2 mg/kg/dose IM 30-60 minutes pre-op
- Epidural (preservative free morphine):
- 0.03-0.05 mg/kg
- Maximum: 0.1 mg/kg/dose or 5 mg/24 hours
- NCA
- Continuous rate: 0.01 - 0.03 mg/kg/hr
- Bolus dose: 0.02 - 0.05 mg/kg/dose
- PCA
- Continuous rate: 0.004 - 0.15 mg/kg/hr
- Bolus dose: 0.02 mg/kg/dose
- Sickle cell PCA
- Continuous rate: 0.02 - 0.04 mg/kg/hr
- Bolus dose: 0.02 - 0.04 mg/kg/dose
Adults:
IM/SC:
- 2.5 - 20 mg/dose Q 2-6 hours PRN Usual: 10 mg/dose Q4H PRN
IV:
- 2.5 - 15 mg/dose Q 2 - 6 hours PRN Usual: 10 mg/dose Q4H PRN
IV/SC Continuous Infusion:
- 0.8-10 mg/hour, may increase depending on pain relief/adverse effects
- Usual range: up to 80 mg/hour, although higher doses (e.g. 150 mg/hr) have occasionally been required
Epidural (preservative free morphine):
- Initial: 5 mg in lumbar region
- If inadequate pain relief within 1 hour, give 1-2 mg
- Maximum: 10 mg/24 hours
MORPHINE CALCULATION
Morphine 1000 mcg = 1 mg
______________mcg ÷ 1000 = ____________mg
- CNS depression
- Respiratory and circulatory depression (hypotension). Antidote: Naloxone (see naloxone monograph)
- Orthostatic hypotension with rapid IV injection
- Bradycardia (Antidote: atropine)
- Increased intracranial pressure
- Nausea, vomiting, dizziness, constipation, increased biliary pressure (common), urinary retention
- Pruritus, rash
- Caution in patients with convulsive disorders, cranial injuries, respiratory insufficiency, cardiac arrhythmias and reduced blood volume
- Only use preservative free injections for epidural administration
NURSING MONITORING GUIDELINES:
- 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.
MONITOR:
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
-Morphine monitoring for first time dose and subsequent doses is not required in the critical care areas (PICU/NICU) as all patients are continuously monitored and the contextual differences allow for greater patient surveillance.
SIGNS & SYMPTOMS OF COMPLICATIONS:
- Respiratory depression (RR <10 breaths/minute)
- Somnolence, difficulty in arousing
- Orthostatic hypotension with bradycardia
- Nausea and vomiting
- Allergic reaction.
ACTIONS: Notify physician if:
- Respiratory rate below 10 breaths per minute
- Blood pressure decreased by 25% from baseline
- Patient difficult to rouse
- 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).
EXAMPLES of RATES for INFUSIONS
Using solution of Morphine 0.2 mg/mL (200 mcg/mL)
| WEIGHT (kg) |
Dose ordered: 10 mcg/kg/hr IV Rate: mL/hr |
Dose ordered: 20 mcg/kg/hr IV Rate: mL/hr |
| 5 | 0.25 | 0.5 |
| 10 | 0.5 | 1 |
Using solution of Morphine 1 mg/mL (1000 mcg/mL)
| WEIGHT (kg) |
Dose ordered: 10 mcg/kg/hr IV Rate: mL/hr |
Dose ordered: 20 mcg/kg/hr IV Rate: mL/hr |
| 15 | 0.15 | 0.3 |
| 20 | 0.2 | 0.4 |
| 25 | 0.25 | 0.5 |
| 30 | 0.3 | 0.6 |
| 50 | 0.5 | 1 |
| 70 | 0.7 | 1.4 |