Morphine Administration of very small doses

[dance45]

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.

[Preemienurse23]

We are spoiled and have an awesome computer system that does the calculations for us. We just put in the mcg/mg, the volume, the dose, and it give us the total volume we are drawing up. We do dilute our own. As with Fentynal, If I'm giving 2mcg, I tell it I'm pulling up 50mcg and diluting it in 10cc. So I would put 1ml of my Fentynal in 9ml of NS, and then draw up my dose. It would also be nice to have pharmacy have it pre-diluted too!

[lvnurs9]

We are not allowed to push anything less then 0.1ml because the manufacturer says anything less then that is not accurate. I agree. Anything less then 0.1ml but greater then 0.01ml is diluted 10:1 and anything less then 0.01 is diluted 100:1. This way you can guarantee what your patient is getting. Trying to "eyeball" a number smaller then that is definately not going to be accurate, because 0.1ml is equal to a drop. How can you give something that is less then a drop??

[SteveNNP, MSN, NP]

We are not allowed to push anything less then 0.1ml because the manufacturer says anything less then that is not accurate. I agree. Anything less then 0.1ml but greater then 0.01ml is diluted 10:1 and anything less then 0.01 is diluted 100:1. This way you can guarantee what your patient is getting. Trying to "eyeball" a number smaller then that is definately not going to be accurate, because 0.1ml is equal to a drop. How can you give something that is less then a drop??

We mainly use fentanyl here, so the amounts are usually slightly higher, but I draw up the med to the 0.05 mark, or whatever, and then draw up enough NS to make 0.5cc TV. The amount of drug in the 28ga needle is negligible.

Now that I'm more aware of neonatal total fluid requirements, I am MUCH more careful in how much I flush, and how much extra volume I'm giving with my meds. On a 500gm baby, that baby really only needs 60cc's of fluid TOTAL per 24hr period. Figure in your arterial line, and you've just given him almost half. Figure in, say 2 doses of amp, and one of gent. That's around 3ccs (give or take) If you flush with 1.5cc's, that's another 4.5cc volume. Total for meds: 4.5ccs. Add in 4-5 PRN doses of pain/sedation meds..... It all adds up. I go crazy when someone flushes UACs on a tiny one with a full 2ccs of fluid. Anyway, that's another thread...

I used to freak when I went from NICU to the ER briefly, and saw nurses were flushing PIVs on adults with a full 10cc NS flush...

[MissKittyRN076]

Where I work we do the serial dilution 0.1 med with 0.9 NS. Some nurses feel that it dilutes the med to much but it probably isn't much different then putting in the top of the tubing and doing a 1ml flush behind it.

Liz

[lvnurs9]

We don't really have a policy on flushes, but we have a standard. Obviously we have to flush enough to cover the tubing (which sucks). 0.6ml is the least amount we can flush, so we try to stick with that for the tiny ones. It sucks to give half their volume in flushes! We run our aterial lines at 0.5ml/hr on most kids, unless they are over 35 weeks, or if they just won't work running that low. I hate UACs for the very reason of having to flush them, but you can usually clear the line enough (at least a 3.5fr) with 0.5ml.

[nicuRN2007]

Our morphine comes in the 10 mg/ml vials. I pull up 0.1 ml, then pull up 0.9 of NS to dilute it to a concentration of 1 mg/ml. I mix it in the syringe, then push it out to the dose. So if my dose is 0.1 mg, I'll push up 0.1 ml. So now I have the dose in my syringe, but I go ahead and pull up enough saline to fill up the 1cc syringe and mix it so I can push it slower, and that way I'm sure it's not all just sitting in the hub.