How do you give morphine sulfate IV?

[Chris27229, LPN]

Many nurses where I work have been giving morphine sulfate IV undiluted using the rule of pushing 1mg/minute, so 2 mg would be given over 2 mins. If giving above 2mg always dilute in 5ml of NS so that it isn't inadvertly given it too fast. I was orienting a new grad the other day and we looked this up in a drug book which recommended always diluting in 5ml of ns and giving it over 4-5mins, for dose ranges of 15mg or less. How are you giving morphine IV for pain control?

[psalm, RN]

I always give over 4-5 minutes so my pts don't get a quick high, some ask for it faster! If a hep lock, I dilute, if in a running IV, I don't dilute. If incompatible with running IV, obviously, dilute, stop IV, saline flush, med, saline flush, and then continue IV. I don't think I have ever given more than 10mg.

[Chaoticdreams33, MSN, RN]

The policy for IV morphine where I have clinical is to give 5mg or less undiluted over 1-2 minutes. Over 5mg dilute in at least 5ml of NS and give at 2-3mg per minute. It doesn't hurt to dilute any amount though (as long at the pt can tolerate an extra 5mls) and it doesn't hurt to give it over a longer period of time if you have 5 minutes to push it. I like to give it slowly the first time I give it to a pt to see how they react, then later on I will give it faster.

[KodieRN]

We have vials 10mg/ml. For IVP I waste 1 ML of NS out of a 10ML syringe and draw back the 1ML of morphine giving me 1mg/ml mix. That way it can be pushed slowly 2-5 min and easy to give the right dose

[Altra, BSN, RN]

Typically not diluted where I work, usual dosing of 2-5mg per dose.

Check your facility's policy.

[mamalle]

For my postop patients- normally 2mg at a time from the farthest port undiluted. ER, may be different depending on the situation- then I dilute 10mg with 9 cc NS.

[GrnHonu99, RN]

We don't have any hard fast rules, we give per recommended dose. I usually give morphine via MIVF so I wont dilute it. If I give it through a periph IV then I usually just mix it with some ns so I don't give it so fast. I have had many pts ask me to push it faster.

[AnnieOaklyRN, BSN, RN, EMT-P]

I have alway given MS undiluted no matter what the dose, the key is to just push it slowly.

Sweetooth

[Roy Fokker, BSN, RN]

Most of our post-ops come up with pca pumps - so I just "bolus" a dose from that.

If I'm giving someone ivp, it's usually a "breakthrough pain" scenario (or they have no pcs) and I give it undiluted.

We have different strength pre-filled stocks :: 2 mg/ml, 5 mg/ml and 10 mg/ml (all of these strengths come in 1 ml doses - so I have 2 mg, 5 mg or 10 does per vial/syrette depending on the vial/syrette I choose).

We have similar system for fentanyl and dilaudid (different strengths of course!)

now I have a follow up question:

If you had a choice: do you prefer to give them im or iv?

Cheers

[canoehead, BSN, RN]

Dilute it, then push it in the highest port available, and it will drip in slowly over 5 min even if you need to move on to something else.

[RNsRWe, ASN, RN]

We don't have a policy on it, and some of our nurses do it undiluted, some dilute.

Me, personally, I ALWAYS dilute the IV pain meds: they are a bit harsh on the veins undiluted, and many of our patients have problem veins anyway. I figure I preserve that IV cath as long as I can!

[RNsRWe, ASN, RN]

roy fokker said:

now i have a follow up quesiton:

if you had a choice: do you prefer to give them im or iv?

Absolutely, no question for me: iv. Although I just said that giving them can be hard on the veins, diluting them mitigates that but puncturing someone repeatedly in a major muscle (who's already in pain!), sometimes as often as every one or two hours? Nope.