morphine IV

MN BigJ · Mar 14, 2009

They are chemically different but Dilaudid is codeine based like morphine so they have some similarities. I always "pretreat" people getting higher doses of MS or anyone getting dilaudid with a one time dose of Zofran because these two can cause n/v very quickly even when pushed slow depending on the pt.

I_LOVE_TRAUMA, RN · Mar 14, 2009

It blows me away at times, the high doses that we give of morphine and dilaudid when we have a trauma, even hours after the fact. Just remember if you are giving it to a normally healthy trauma (no medical problems) you always have narcan... and dilaudid is 14 times more potent than morphine. I know it makes us nervous at times, but pain control to a tolerable level is very important. I always remember too that if you look at the amount we give of fent, dil, & morph, in the pca it is a lot, and we even bolus around those frequently!

MikeyBSN · Mar 16, 2009

Morphine is a narcotic, and with all opiod narcotics you always want to keep breathing in mind. MS can reduce respiration rates, so you want to check breathing. The second thing you want to watch is the blood pressure. Always check the BP before you give morphine IV Push. I've seen patients with pressures of 90 or 100 drop to 50 or 60 systolic and become unresponsive after only 4 mg of morphine. You should also check for allergic reaction, it's fairly common with morphine.

General side effects are flush and nausea. You should give MS with fliud, if possible. This reduces the risk of you wearing the patient's dinner after you push morphine.

allnurses Guide · Mar 18, 2009

Pushing morphine too fast is a sure way to get someone to vomit. Need to go really slow with it.

ErNrsLynzzie · Mar 21, 2009

With peds we base it on kg with a max of 15mg per dose. Generally I put it on a med pump for 10-15 minutes. I always have an SpO2 monitor on them and BVM/Sx at BS. I never run morphine without IV fluids simultaneously (like through a lock).

I have given larger doses IV push to patients like sickle-cell with severe pain. I usually push it over at least 2-5 minutes. But frankly, putting it on a pump for 10 minutes does about the same minus the instant side effects caused by pushing.

nursejean2004 · May 20, 2012

can anyone please help me with this? how do you give IV morphine in the ER if its not an infusion? at what rate? what dose is considered as an overdose? what are the things that you have to be alert for? what about pediatric patients?
thanks!

I see that someone stated that they like to dilute the morphine with saline for comfort measures stating so that it will not burn. I am completing a study and part of it relates to this. After talking to several pharmacists, they state that morphine does not burn and that no study supports this. So, what I want to ask, what makes a nurse believe it does burn? Many times patients will complain from the saline itself burning.

kids · May 20, 2012

I see that someone stated that they like to dilute the morphine with saline for comfort measures stating so that it will not burn. I am completing a study and part of it relates to this. After talking to several pharmacists, they state that morphine does not burn and that no study supports this. So, what I want to ask, what makes a nurse believe it does burn? Many times patients will complain from the saline itself burning.

More than likely it's based on experience that the pharmacists you've spoke to don't have.

A lack of studies doesn't surprise me, studies are rarely done on the sensations parents experience during administration of most drugs.

Injectable morphine often contains formalin and phenol as preservatives. From personal experience I believe it's the preservatives that cause the burning and the sensation is different from the sting of normal saline. Additionally, histamine reaction including local tissue irritation are documented side effects, it's not unreasonable to assume that could also be interpreted as "stinging".

Larry77, RN · May 21, 2012

I definitely have had more complaints of burning with Morphine than Dilaudid but not as much as other drugs that are famous for burning (ie calcium, K+). I have no studies to back this up just years of practice...

psu_213, BSN, RN · May 21, 2012

I dilute my morphine does in NS because it is easier to push 10 mL over a few minutes than to push 0.5 mL over that length of time. Never had any pt c/o burning even if is is not diluted.

As for the OD issue....I have been told by many 'pain nurses' that there is no upper limit for narcotics as long as they are still breathing. Tylenol has a recommend max of 4 grams/day. If the pt is still producing a good respiratory effort, they can get more morphine....there is no 'toxic' dose.

brainkandy87 · May 22, 2012

Like others, I dilute whatever amount in a 10 ml NS flush. I do that with pretty much every drug though. Not only is it easier to push slower than 1 ml or less, but for the opiate naive, it doesn't smack them in the face as hard.