Subcutaneous Morphine Infusions

Note: It is necessary to estimate the expected 24 hour dose of Morphine at the time of prescription then commence a subcut infusion – this is easiest and safest if the patient has previously been on oral Morphine or has been titrated on subcut Morphine.

Boluses of subcut Morphine are often more effective for acute severe pain than commencing an infusion – aim to change to an infusion as soon as the appropriate Morphine dose is known.
Infusions can be delivered via a battery operated syringe driver e.g. Graseby Pump (small size, portable, fixed rate of delivery) or via an electrically driven syringe pump.
All subcut infusion scripts should be charted on the QMR0235 – See Appendix B - Sample Graseby Subcutaneous Prescription.
Subcut bolus or oral Morphine must always be available for breakthrough pain (generally the subcut dose is 1/6 of the 24 hours infusion dose).
If regular breakthrough doses are needed the infusion dose should be increased.
Morphine is often mixed with other medications e.g. antiemetics and sedatives – See Appendix A - Syringe Driver Compatibility Chart. Do not prescribe more than three medications (including morphine) in an infusion.
Graseby pumps are made up to 48 mm with water and run at 2 mm/hour over 24 hours – these can be used where there are nurses who have competency training to use these pumps and under the direction of the Palliative Care Service (except on Ward 25 or 27).
Electric syringe pumps are made up to 48 ml and are set at 2 ml per hour.
Subcutaneous infusions must not run at more than 2 ml per hour as absorption is unreliable.


Information about this Canterbury DHB document (4055):
Document Owner:	Palliative Care Service (see Who's Who)
Issue Date:	July 2009
Next Review:	July 2010
Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document.
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Topic Code: 4055