IV Fentanyl use on Med/Surg Unit - page 2

I am wondering if anyone out there has concerns about the use of IV fentanyl on a general med/surg unit for pain. We have been debating this issue in our hospital for months. Physicians are... Read More

  1. by   Tweety
    I've given it in med-surg before. As was stated it's half-life is so short, I don't think it's an effective med for pain control. Plus as was also stated, you have to monitor the patient for a while afterwards. Most of the docs here don't use it. It's quite often used in critical care situations for sedation in the form of a drip, however.
  2. by   NursesRmofun
    It isn't done in the hospital where I have worked. It is given in PACU (Post Anesthesia.)
  3. by   athomas91
    my question is why wouldn't (on the floors) they be using PCA's - pt controlled, utilized less med in the long run, lock out limits....it is a win- win for nurse and pt...
  4. by   SmilingBluEyes
    we use fentanly PCA for our post-op's who cannot use morphine for one reason or another. generally, we don't PUSH fentanyl IVP .....it CAN be used in labor, but if so, we do attach them to SAO2 monitors and watched carefully. It's shortlived relief for labor pain, from my experience, and therefore, not very effective.
  5. by   OC_An Khe
    If Fentanyl is used in PCA or in an epidural infusion on your med surg floor what is the concern if it is ordered IVP. Whats the difference between a PCA IV bolus and an IVP?
    To me all the pump is doing is pushing the Fentanyl into a running IV instead of the RN pushing it. Same drug, same doses same potential for side effects?
    That said if your argument for not using FentanylIVP is because of its short duration and should be utilized via PCA to assure better pain control that can be a valid arguement. Or if the usual patient load would preclude close monitoring that is another arguement. However, if you are arguing that the patient load is too great to allow for adequate assessment of IVP Fentanyl then I would say it is also to0 high to care for patients with PCA or continuous epidural infusions.
    Last edit by OC_An Khe on Apr 4, '04
  6. by   mattsmom81
    I've seen Fentanyl used in small doses IV, and in larger doses IM, in all areas of the hospital. Like all narcotics, the effect is dose and patient dependent. I wouldn't refuse to give it on Medsurg unless the dose was too high, the patient too compromised, etc. I also feel giving a partial narcotic test dose is a good nursing judgment in many cases, to asess response. In my facility a nurse recently gave 50 of Fentanyl IV on the floor and caused a patient to arrest. This was a case of a nurse not familiar enough with the drug, did not seek advice, did not use good judgment and thus harmed the patient with her actions, IMO. Not because 'giving the drug on the floor is dangerous" all on its own.

    Final investigation showed she misread a '50 IM' order.
  7. by   RN-PA
    I have never seen it ordered on our med-surg unit. We only see Fentanyl in continuous epidurals (with continuous pulse ox and frequent VS) or in a patch.
  8. by   kids
    Quote from ocankhe
    If Fentanyl is used in PCA or in an epidural infusion on your med surg floor what is the concern if it is ordered IVP. Whats the difference between a PCA IV bolus and an IVP?
    To me all the pump is doing is pushing the Fentanyl into a running IV instead of the RN pushing it. Same drug, same doses same potential for side effects?
    That said if your argument for not using FentanylIVP is because of its short duration and should be utilized via PCA to assure better pain control that can be a valid arguement. Or if the usual patient load would preclude close monitoring that is another arguement. However, if you are arguing that the patient load is too great to allow for adequate assessment of IVP Fentanyl then I would say it is also to0 high to care for patients with PCA or continuous epidural infusions.
    My thoughts exactly (tho mine are not as well composed).
  9. by   Brownms46
    I totally agree!
  10. by   abdnnurse
    I have been doing some more research and ran across an article from the American Hospital Formulary Service. This information is "manufacturer's recommendations" and says that residual effects of one dose of fentanyl may potentiate the effects of subsequent doses. It talks about "redistribution" as the main cause of the brief analgesic effect of fentanyl. "Following IV administration, fentanyl distributes rapidly from blood into the lungs and skeletal muscle and more slowly into deeper fat compartments. The drug then redistributes slowly from these tissues into systemic circulation. Large single doses or repeated doses can result in substantial accumulation of the drug, potentially resulting in an extended duration of effect." This may explain why small continuous PCA fentanyl seems to be safer than giving IV bolus doses.

    The article goes on to state,"Because of the potential respiratory depressant effects of the drug, the manufacturers recommend that fentanyl injections and buccal lozenges only be used in a monitored setting by individuals specifically trained in the use of anesthetic agents and the management of opiate-induced respiratory effects in the age group being treated, including establishment and maintenance of an adequate airway and assisted ventilation... and only used as a premedicant prior to anesthesia or for inducing conscious sedation prior to diagnostic or therapeutic procedures in a monitored anesthesia setting." "Skeletal and thoracic muscle rigidity occur frequently...Muscular rigidity may be associated with reduced pulmonary compliance and/apnea, laryngospasm, and bronchoconstiction." (Explains the baby problems!)

    Now, I must wonder, if the manufacturer has such strong directives and warnings for the use of this medication and it really isn't all that great a drug for short or long term pain control....why are we taking the risk to use it on a general med/surg unit that is not that controlled a setting? In fact, Massachusetts General Hospital Departments of Pharmacy and Nursing developed administration guidelines for use in Critical Care but under "special considerations" it states, "consideration of an alternative agent should be explored as other medications provide superior analgesia."

    I appreciate the information, stories and comments...much food for thought!
    We do try to provide our patients with the best and latest in treatment. The push for this drug from our physicians really puzzles me though, I don't see the advantages! We use epidurals and PCA's regularly so we are keeping up with technologies. We do have P&P's in place for these types of things, it is just that this push for IV fentanyl is new for us!

    Please keep sharing your information and thoughts and I will continue to monitor and let you know how this turns out!
  11. by   canoehead
    If you push it too fast it can cause respiratory paralysis, and of course large amounts are dangerous. But, if you have a patient in so much pain that you are pushing Fentanyl I assume you are not going to be leaving them alone anyway, until the med has taken effect and the pain is under control. Plus all nurses need to be aware of precautions before giving any med. I think that metoproplol IVP can be just as dangerous if you just push it and walk away, but that is a common med on our MS unit.

    We rarely use Fentanyl IVP, usually it is in a PCA in small frequent doses, or a continuous drip. Works very well for us that way.
  12. by   PA-C in Texas
    Quote from canoehead
    If you push it too fast it can cause respiratory paralysis, and of course large amounts are dangerous. But, if you have a patient in so much pain that you are pushing Fentanyl I assume you are not going to be leaving them alone anyway, until the med has taken effect and the pain is under control. Plus all nurses need to be aware of precautions before giving any med. I think that metoproplol IVP can be just as dangerous if you just push it and walk away, but that is a common med on our MS unit.

    We rarely use Fentanyl IVP, usually it is in a PCA in small frequent doses, or a continuous drip. Works very well for us that way.
    I think it is about being conscientious about your medication. You certainly wouldn't want to throw this stuff in like its some adenosine. I spoke with a floor nurse friend of mine who stated that she will either push it in increments over 2-5 minutes, or set it in a 100 cc bag and run it in at 20 cc/min.

    I have seen MS and a variety of other things cause almost instantaneous respiratory collapse too, but that doesn't mean we refuse to use it now. You simply have to take precautions. That is a risk of the medication that the prescribing clinician has decided is outweighed by the potential benefits. I administer all of my schedule II narcotics personally and always keep a dose of naloxone in my shirt pocket when doing so. I mean, the stuff is cheap, it doesn't have to be refrigerated, and when those unexpected things do occur, they can easily be reversed.
  13. by   PA-C in Texas
    PS I exclusively use fentanyl in intravenous form for major trauma patients who may have some undetected hemodynamic compromise. Much better hemodynamic profile than MS or hydromorphone in my experience. If they have significant respiratory compromise, I'll just throw in a little more and some lidocaine and succinylcholine, then drop a tube. I have only had to do that three or so times, and they would have all ended up with a tube anyway because they were getting shipped out on the bird, and those folks snow and tube everybody!

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