Download IV PCA (Adults)

IV PCA (Adults)
Age 15 and Older
General Guidelines
Agent
Fentanyl (10 mcg/mL)
Hydromorphone (0.2 mg/ mL)
Methadone (1 mg/mL)
Morphine sulfate (1mg/mL)
Bolus
15-50 mcg
0.1-0.5 mg
0.5-3.0 mg
1-5 mg
Lockout
3-10 min
5-15 min
10-20 min
5-20 min
Infusion Rate
20-100 mcg/hr
0.2-0.5 mg/hr
Not typically used
1-10 mg/hr
*Meperidine limit in healthy patients should be 800 mg in first 24 hours, then 600 mg q 24
hours thereafter.
Opioid IV/PO Intermittent Bolus Dosing
Drug
Morphine
Hydromorphone
Oxycodone
Fentanyl
Usual IV
starting dose
(<50 Kg)
0.1 mg/ Kg q 3-4 hr
0.015 mg/ Kg q 3-4 hr
N/A
0.5-1.5 mcg/ Kg q 1-2 hr
Usual IV
starting dose
(>50Kg)
4-10mg q 3-4 hr
1-1.5 mg q 3-4 hr
N/A
25-75 mcg q 1-2 hr
Usual PO
starting dose
(<50 KG)
0.3 mg/Kg q 3-4 hr
0.06 mg/Kg q 3-4 hr
0.05-0.15 mg/Kg q 3-4 hr
N/A
Usual PO
starting dose
(>50 Kg)
30 mg q 3-4 hr
2-4 mg q 3-4 hr
5-10 mg q 3-4 hr
N/A
Subcutaneous Infusions
• If IV access is difficult: consider subcutaneous PCA.
• Use a standard small bore angiocath with sterile technique.
• May have continuous infusion plus PCA
Medication choices would include:
Concentration
Demand Dose
Lockout
Morphine sulfate (5 mg/mL)
0.2 mL
10 min
Hydromorphone (1 mg/mL)
0.2 mL
15 min
Oxymorphone (1.5 mg/mL)
0.2 mL
10 min
(Fentanyl less useful because of depot effect secondary to lipid solubility, hydromorphone is drug of choice)