Do you push Fentanyl on the floor?

[General E. Speaking, RN]

Saw a thread on this from 2004 but nothing recent.

One of our docs ordered Fentanyl push PRN for a patient on our Tele unit. We don't usually administer it push (PCA or patch usually). Anyway, we ended up transferring the patient to CCU for closer monitoring because the doc didn't want to order anything else. He was quite upset because we push other meds (Morphine and Dilaudid). According to him, Dilaudid is more dangerous than Fentanyl.

Just curious about your facility. Do you or have you pushed it in a non-critical care setting?

[RN1982]

Usually I am in an upright position...

[silentRN]

I always thought Fentanyl wasn't a vasodilator like dilaudid is...plus the half life is a lot shorter. I need to look this one up again. I know that Fentanyl is something like 100x more potent than morphine is.

[Virgo_RN, BSN, RN]

I usually push it in the vein.

[shiccy]

We used to only be able to give 25mcg, but there was no time limit in the rules. We've now had a recent change to 100mcg for those 65yo -- all IVP. I've not seen a person that is in genuine pain have an issue with fentanyl, and it's quick acting and fast to be eliminated from the body. This is why they have patches - if you have problems with the med (sedation, resp issues, etc) you can rip the darned thing off and improve more quickly than some other meds.

We use it quite a bit on our floor, but as with any other nurse, we'd rather use other things (percs, etc) that are more long lasting and have less a chance of causing extreme cases of sedation and resp depression.

I do have to say that I have heard more horror stories from other people with Dilaudid and Morphine than I have with fentanyl, personally. And have seen more myself as well.

As with any other IVP med, push it slow, use good nursing judgement r/t sedation and resp status, and if you're worried about it, ensure that Narcan is also ordered JUST in case.

[Jokerhill]

Doesn't pushing Fentanyl risk chest wall paralysis? I seem to remember this happening in the NICU. The baby was vented but had no chest rise. It was a tough couple of minutes.

It sure does, I have seen it happen.

[Tait, MSN, RN]

We give it, not often as most people are cool with dilaudid or morph, but we do.

[General E. Speaking, RN, RN]

Of course. Why wouldn't we?

Not really helpful to my question.

[babyburperrn]

Fentanyl is commonly given IV push in labor and delivery unit. Usually 50-100mcg is given to laboring patients and can be given again in 1 hour if the patient needs it. It really helps take the edge off the pain for these women and they generally tolerate it well. Of course, they should be observed closely after the dose is given.:)

[BluegrassRN]

I'm on a medical floor. Smallish hospital. We give it ALL THE TIME IV push, same with dilaudid and morphine. I don't see how it is any more dangerous than those.

[General E. Speaking, RN, RN]

Thanks for the responses. I am going to bring this up at Nurse Practice Counsel next month and the Pharmacy Committee meeting. I certainly understand the doctor's point, however, (because it is not something that we commonly push) I see nursings concern about safety issues too. It is not cost effective to have to move a patient to CCU for the sole reason of Fentanyl IV push but the patient must be able to be monitored closely. A luxury that sometimes is not possible on the floor.

[ONCRN84]

When I worked inpatient oncology, yes. All the time. We had Fentanyl CADDs in doses that would kill you and I in 5 minutes. Right now I'm in the ICU and Fentanyl is like water.

[cynicalnurse]

i pushed fentanyl all the time on multiple floors in multiple hospitals and never had any problems. however, the second someone makes a med error (it is given in mcgs) i bet that's when they pull it off the floors.