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by 206bones

I have been a hospice nurse for 7 yrs now. There has been much discussion whether the use of fentanyl patches is effective in relieving pain in cachectic patients.

As patients decline, they normally lose weight, their blood pressure lowers, and vital organs slow. It is my understanding that in order to have good absorbtion, there needs to be adequate subcutaneous tissue, and adequate perfusion. With these factors constantly changing in terminal patients, it is difficult in my opinion, to titrate fentanyl patches.

I'm interested in knowing if there are any factual articles available that could be passed along to the many physicians I work with who are "married" to the old patch!

Beaumont Hospice RN

[cynthiajn1]

Re: use of fentanyl patches on cachectic patients

I am a CHPN who has worked in hospice for over 10 years, for most of my career I have heard that you needed subcutaneous fat for absorption of fentanyl, back in 2006 I started to hear from the medical directors that there has been studies saying that you do not need subcutaneous fat for absorption. This idea was hard for me to absorb myself since for most of my years in hospice I knew this to be true. I still prefer not to use this if I am dealing with a cachexic patient, also, if we are speaking of a patient that is imminent, I prefer not to have to wait so long for the fentanyl to kick in. I prefer using immediate release meds i.e. Morphine around the clock q 4 or 6 hrs with immediate release used as the breakthrough also.

[cynthiajn1]

Re: use of fentanyl patches on cachectic patients

I am a CHPN who has worked in hospice for over 10 years, for most of my career I have heard that you needed subcutaneous fat for absorption of fentanyl, back in 2006 I started to hear from the medical directors that there has been studies saying that you do not need subcutaneous fat for absorption. This idea was hard for me to absorb myself since for most of my years in hospice I knew this to be true. I still prefer not to use this if I am dealing with a cachecic patient, also, if we are speaking of a patient that is imminent, I prefer not to have to wait so long for the fentanyl to kick in. I prefer using immediate release meds i.e. Morphine around the clock q 4 or 6 hrs with immediate release used as the breakthrough also.

[earle58]

Re: use of fentanyl patches on cachectic patients

you have a valid concern.
i do not like using patches on my cachexic, frail pts.
but if the md insists on it, i use the underside of their arm.
there's always some sub cut fat hanging underside...
but never, the chest wall, or any other bony surface.
i protect it and further occlude it with a tagaderm/opsite dsg.

due to their emaciated status, i have come to observe that even half of a 25mcg patch, is often sufficient, despite the lack of adipose.
again, as long as i apply it on the triceps aspect of their arm, or even their inner thighs.
it seems to work fine.

leslie

[Nursebarebari]

Re: use of fentanyl patches on cachectic patients

Wow, I love this forum. This info about fentanyl patch is new to me. Thanks you all for this.
BTW, earle 58 I love the way you explain all your answers. Thanks again.