Q: Why does the sickle cell disease guideline advise against giving morphine via the IV route for pain due to sickle cell crisis?
A: In hospital, the SC route is the preferred route for administration of morphine for patients experiencing pain due to sickle cell crisis. The IM and oral route can also be considered. It takes time to establish IV access, and for some patients access to veins becomes increasingly difficult. If the patient has a sickle cell disease individualised treatment care plan then this should be followed. Individuals with sickle cell disease (SCD) have a lifelong condition that presents with unpredictable intermittent pain, but they are also immunocompromised due to hyposplenism and hence can present acutely bacteraemic or even septic, this is not uncommon in paediatrics.
Additionally individuals with SCD can develop co morbidities that require them to be placed on lifelong transfusion programs for example for stroke prevention or disease severity, 6% of adult patients will end up on dialysis. Both treatments require frequent IV access.
Parenteral opioid treatment is essential in managing sickle cell pain and for all the sickle units in the NHS the standard of care for parenteral opioids is S/C delivery, this both guarantees timely analgesia delivery and effective analgesia without adding the complication of IV cannulation.
For all the reasons noted above clinicians managing the care of individuals with SCD are keen to preserve their veins where we can. Recurrent and avoidable IV access has contributed to a significant proportion of patients who are difficult to gain IV access in and has also contributed to delays in delivery lifesaving treatments including antimicrobial treatment in patients with bacteraemia and may have played a role in some patient deaths.
Additionally individuals with SCD can develop co morbidities that require them to be placed on lifelong transfusion programs for example for stroke prevention or disease severity, 6% of adult patients will end up on dialysis. Both treatments require frequent IV access.
Parenteral opioid treatment is essential in managing sickle cell pain and for all the sickle units in the NHS the standard of care for parenteral opioids is S/C delivery, this both guarantees timely analgesia delivery and effective analgesia without adding the complication of IV cannulation.
For all the reasons noted above clinicians managing the care of individuals with SCD are keen to preserve their veins where we can. Recurrent and avoidable IV access has contributed to a significant proportion of patients who are difficult to gain IV access in and has also contributed to delays in delivery lifesaving treatments including antimicrobial treatment in patients with bacteraemia and may have played a role in some patient deaths.