Description

• Clear colourless solution 5 mg/ml (=5000 micrograms/1ml) in 1 ml ampoules for IM, IV or SC use.
• DBL preparation contains no preservative.

Prescription

Stat doses

• Charted on the stat page of prescription chart in micrograms/dose.
• Maintenance doses are charted on the prescription chart in micrograms/dose.
• Bolus doses of a continuous infusion should be charted on the stat page as
  Bolus of morphine infusion with the strength, volume to be administered, and dose in micrograms
  e.g.  For a 1kg baby, prescribe "Bolus morphine infusion (25 micrograms/kg in 0.5ml) - dose 2ml (100 micrograms) IV"

Continuous infusion

Charted on the fluid chart giving:

• dose in micrograms/kg/hour
• rate in ml/hour.

Also charted on drug chart under continuous infusions giving:

• amount of drug to be added
• base fluid, type and volume
• micrograms/kg/ml

Administration

Slow IV Injection

Administered by nursing staff except the first dose in the non-ventilated postoperative baby.

1. Dilution required if infant <2500g.
   • Dilute 0.1ml morphine sulphate (5mg/ml=5000microgram/ml) with 0.9ml sterile water for injection.
   • This gives a diluted solution of 500 micrograms/ml.
2. Administer by slow IV injection over 5 minutes. Filter prior to administration through a Pall 0.2 micron filter.
3. Is compatible with D5W, D10W, NS. May be co-infused with IV solution, IVN and 0.5 units/ml heparin at Y injection port near infusion site.
4. Do not mix with other drugs, blood or blood products.
5. Flush with NS before and after administration of morphine.

Continuous Infusion

1. Dilute prior to administration.
2. Filter prior to administration through a Pall 0.2 micron filter.
3. Is compatible with D5W, D10W, NS. May be coinfused with, IVN and 0.5 units/ml heparin at Y injection port near infusion site.
4. Administer via a syringe pump.
5. Solution should be changed every 48 hours.

Observation and Documentation

1. Evaluate baby's need for and response to medication, analgesic effect up to 7 hours.
2. Monitor for adverse effects.
3. The baby is attached to a continuous cardiorespiratory monitor and managed by a nurse with Neonatal IV Drug Certification.
4. Document heart and respiratory rate hourly.
5. Monitor respiratory status carefully.
6. Provide comfort measures for baby.
7. Record baby's dose out of the narcotic register.
8. Record balance discarded out in the narcotic register.
9. Two nurses must witness the discarding of the unused diluted drug, syringes, and ampoule into the sharps container.
10. Two nurses must sign when discarding any unused drug from a continuous infusion.

Storage

• Unopened ampoule - stored at room temperature in the narcotic cupboard.
• Discard as above once opened.

Selected References