MORPHINE SULPHATE

Morphine

Reviewed by Dr Carl Kuschel,  Brenda Hughes, and Robyn Wilkinson
October 2004
Amendment to dilution instructions February 2007 - Diane Hogan, CNE
Dose and Pharmacology Newborn Drug Protocol Index Newborn Services Home Page

 

Management of  Morphine Sulphate Administration

Description

Prescription

Stat doses

Continuous infusion

Charted on the fluid chart giving:

Also charted on drug chart under continuous infusions giving:

Administration

Slow IV Injection

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

  1. Dilution required if infant <2500g.
  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

Selected References

1

Bhat R, Gopal C, Gulati A, Aldana 0, Velamati R, Bhargava H. Pharmacokinetics of a single dose of morphine in preterm infants during the first week of life. J Pediatr 1990; 117:477-81.

2

Bhat R, Abu-Harb M, Gopal C, Gulati A. Morphine metabolism in acutely ill preterm infants. J Pediatr 1992; 120:795-9.

3

Lynn AM, Slattery JT. Morphine pharmacokinetics in early infancy. Anesthesiologyr 1987: 66:136-9.

4

Koren 0, Butt W, Chinyanga H, Soldin S, Tan Y, Pape K. Postoperative morphine infusion in newborn infants: Assessment of deposition characteristics and safety. J Pediatr 1985; 107:963-7.

5

Hartley R, Levene MI. Opioid pharmacology in the Newborn In: Baillieres Clinical Paediatrics Vol 3, No 3, p 467-493, August 1995.