Morphine Administration of very small doses

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    Back to nursing after several (and I do mean several) years off. Hence I haven't given morphine in quite some time. Just wondering about IV morphine preparation for extremely small doses in the NICU.

    Ordered 0.05 mg morphine slow IV push q 4-8. On hand morphine 2 mg/ml. How far do you dilute the concentration? If you make it 1:1, you can't possibly draw up 0.05 cc in a 1 ml syringe. And how do you make it 1:1? Just add 1 cc NS to vial?

    I don't want to appear to be a complete idiot, but the practical aspects (i.e. the actual physical prep and admin of certain things) have left me over the years.
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  3. 17 Comments so far...

  4. 0
    We do a serial dilution. 0.1 ml of the med, 0.9 ml of NS (or whatever diluent is compatible). If your dose is 0.05, you would give 0.5 ml of your dilution.

    We have 2 mg/ml morphine as well, so in this case the you would be giving 0.025 ml. After the serial dilution you would be giving 0.25 ml, not 0.5 like I originally said.
    Last edit by preemieRNkate on May 25, '08 : Reason: clarification
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    We used tuberculin syringes and "eyeballed" it. 2mg/ml Mso4 is what we stock.
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    To Preemie RN Kate and Steve. Thanks for the input. I came up with 0.25 cc for the dose if diluted out to 0.2 mg morphine/ml. Because if you draw up 0.1 ml of the 2 mg/ml concentration and add 0.9 ml NS, you still have 0.2 mg/ml. It's not a 1:1 mix. Does that make sense?? I tend to be a bit anal and check and recheck my calculations.

    I've only ever done NICU during my nursing career. I wouldn't even consider any other area. And I know the margin for error is non-existent with the little micros. I want to make sure I'm doing everything correctly, and do what's best for the babies.
    Last edit by dance45 on May 25, '08 : Reason: spelling
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    I don't know if I'm really explaining myself clearly, but doing a serial dilution the way we do it where I work is making a tenfold dilution. Anytime we have to give a med where it works out to be less than 0.1 ml, we serial dilute. If your order says to give 0.05 mg of morphine, and you have 2 mg/ml on hand, you are going to be giving 0.025 ml. We don't eyeball it. So by drawing up 0.1 ml of the med and mixing with 0.9 ml NS, you're making a tenfold dilution and you will then give 0.25 ml. Does anyone else do this? I hope I am making sense, but maybe someone else can explain it better than me.
  8. 0
    Quote from preemieRNkate
    I don't know if I'm really explaining myself clearly, but doing a serial dilution the way we do it where I work is making a tenfold dilution. Anytime we have to give a med where it works out to be less than 0.1 ml, we serial dilute. If your order says to give 0.05 mg of morphine, and you have 2 mg/ml on hand, you are going to be giving 0.025 ml. We don't eyeball it. So by drawing up 0.1 ml of the med and mixing with 0.9 ml NS, you're making a tenfold dilution and you will then give 0.25 ml. Does anyone else do this? I hope I am making sense, but maybe someone else can explain it better than me.
    So you guys are OK with witnessing a waste done this way? It makes sense. To be honest I'd never thought about doing it that way.
  9. 0
    We don't do the serial dilution, but I will often draw up whatever my teensy amount is in the tuberculin syringe and then draw up some NS behind it to make a bigger volume going into the kiddo. In my head it makes it more likely the baby will get the med and it won't just get stuck in the hub. It's probably no more effective than a really good flush, but it makes me feel better.
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    Our pharmacy dilutes our narcotics for us. Our morphine is diluted 9ml to 1ml morphine for a final concentration of 1mg/ml. We draw up what we need, for instance the 0.05ml in a TB syringe. We use a closed med/flush system in which we have an extension tubing always hooked up with a flush on the end. We would push the 0.05ml into this tubing then hook up the flush to infuse over 1 minute, usually about 0.5ml since our med tubing is 0.2ml and the connector is 0.2 ml and 0.1 to clear the end of the cath. This way we can control how much fluid each kid gets.
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    Quote from SteveRN21
    So you guys are OK with witnessing a waste done this way? It makes sense. To be honest I'd never thought about doing it that way.
    Yeah, we draw up what we need (the 0.1 ml) and then do the dilution and then waste the rest of the med and the extra of the dilution in front of each other.
  12. 0
    Hmm...we don't dilute at my hospital. Usually the amount is so little, we push it into the med line tubing which is usually long enough so that it doesn't reach the patient, and then put a flush on. But I guess if you're busy you push in the flush as well. Hmm....:stone


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