I would put this on the student section but experience nurses may have an answer for me.
So, we were asked to create a med sheet for the drugs we might encounter for our Med/Surg rotation. I was assigned "fentanyl."
While researching this, I found that it was given through many and multiple routes, but I was just wondering what is the most common route used on the Med/Surg floor?
I was leaning towards transdermal but I'm not really sure.
Mostly patches on the floor though we do have a couple ER docs who will order ivp occasionally. We use ivp fentanyl a lot in pre-op & OR, a bit less in pacu.
I didn't give it very often in med-surg, but that could be because of provider preference. Sometimes we had pts with chronic pain have it as a transdermal patch, but most post-op pts in my experience got morphine or dilaudid.
In SNF I only gave it as a patch.
Now in the ICU I almost always give it IV--usually drip, but sometimes push. Sometimes it's given in an epidural post thoracic surgery.
Transdermal is the most common route used for long-term relief of chronic pain, but, I believe for hospital use, especially post-op pain or acute pain, IV would probably be the most common route. Patches don't generally start working immediately but do last longer once they start working. IV starts working faster but doesn't last as long.
In Med surg- it was never given IV, just transdermal. Sometimes the PACU orders (IV) were still there and we knew not to give it. In the ED I give it IV 99% of the time.
I give it via the IV route more often. Usually on patients with PICC lines since it is a vesicant. I have seen it in patch form (mostly in the nursing homes) and once in a rectal suppository form too.
I was given Fentanyl IV-Push post-op open heart in both the ICU and Med-Surg Floor. Totally awesome drug.
For you nurses out there, a couple of things. First, mix the dose with normal saline (as it burns and can cause veins to blow-out real easy (in my case)). Push very slowly. If you push too fast, you will cause the patient to black out. Had a new nurse do that and she hadn't mixed the Fentanyl with Normal Saline.
As a patient, you can actually feel the drug moving throughout your body. You get a warm sensation starting at your heart and then moving outward. And yes, you are in la-la land for about an hour. But man does it ever take away the pain (back pain from being on the surgical table for 6 hours). Had it for two days, until it started making me too nauseous, then weaned off to oxycodone. Actual chest incision didn't really hurt too bad ... just my back.
Couldn't believe I went home in 4 days post surgery and had no problem going up and down stairs (I was 47 at the time).
I work L&D/ER, I have only ever given it IVP/or as a drip for sedation. I have had many pts come in with the transdermal patches on their med list, mostly cancer pts/hospice.
RainMom
1,117 Posts
Mostly patches on the floor though we do have a couple ER docs who will order ivp occasionally. We use ivp fentanyl a lot in pre-op & OR, a bit less in pacu.