This technique may be considered for children in severe pain while waiting for intravenous access to be established. It should not replace IV morphine as the standard treatment for severe pain. Appropriate intravenous access should still be achieved as early as possible.

DOSE SCHEDULE

(Dose for 3 – 18 years of age, 100 micrograms/kg, max dose 10mg; BNFc)

Note:

1. Select weight of child (to nearest 5kg)
2. Add appropriate volume of Water for Injections to a 10mg ampoule of diamorphine
3. Draw up 0.2ml of solution into a 1ml syringe for intranasal administration. The dose should be administered directly from the syringe.

• Patients should be monitored and managed as for intravenous opioid administration.
• This is intended as a “single shot” analgesic technique. After administration any remaining solution must be discarded and not kept for follow-up doses.
• EMLA / Ametop should be applied to the skin while the diamorphine is working to allow comfortable intravenous access to be established. If further parenteral opioid analgesia is required it must be given intravenously.
• Refer to Paediatric PONV Guidelines for recommended antiemetic therapy.