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?

[cc_nurse]

In the NICU we never push it, it only goes in over 10-15 minutes or we risk chest wall rigidity. Maybe different risks in the adult world?

[TiffyRN, BSN, PhD]

the second someone makes a med error (it is given in mcgs) i bet that's when they pull it off the floors.

I don't agree. The most commonly prescribed meds are at very different dosages. Granted, they are generally dosed in milligrams rather than micrograms, but any nurse that draws up a dose of pain med and needs multiple vials of the med needs to be alert that something is up. I checked the baxter site on Fentanyl citrate and it appears that adult doses are mixed 50mcg/ml in 2 or 5 ml vials. If a nurse draws up 40mls to give an IV push med (that would be 2mg). . . Ok, if a nurse on your floor is asking you where to get the 60ml IV syringes so he/she can dose Ms. Smith for pain, please ask a couple of questions!

Almost every pain med is dosed vastly differently. A rough equalanalgesic dose of Morphine 5mg=Dilaudid 0.75mg= Fentanyl 50mcg =Demerol 37.5mg. And those are just rough estimates using one hospice site as a reference. But see how vastly different the dosing is?

Almost everyone uses pyxis type machines for medications & any time one takes out more than 1 or 2 units, a question mark needs to automatically go into one's mind as to why.

[inkedRN]

We don't use Fent on either of the M/S floors I work on. My guess is it has to do with the type of monitoring a patient would need. It is used in the OR, PACU, and ICU where they can monitor better.

[chelynn]

We give small doses usually 25 to 100 mcgs titrsted for pain in the ER. We don't need to do any extra monoriting on them except VS before and after push so I don't know why you would need to on the floor?

[Elvish, BSN, DNP, RN, NP]

Yep. Not all the time but on the occasion we have a PP hemorrhage requiring a manual placental extraction we'll give 50-100 mikes. Helps out a lot with the pain of the extraction and doesn't last long. Usually 50 is all we need.

[Aymese]

In cath lab we give Fentanyl in combination with Versed IVP to nearly every patient. I know I gave it in CCU but I specifically recall that at that hospital, all critical care nurses had to pass an annual competancy on conscious sedation. Maybe if your hospital was able to create a nursing inservice on IV narcotics and anxiolytics, they would feel more comfortable with the nurses administering them and monitoring the patient?

[PostOpPrincess, BSN, RN]

You have to be very, very careful with opiate naive patients.

They WILL stop breathing....

[meandragonbrett]

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.

Fentanyl can result in chest wall rigidity which causes the inability to ventilate a patient. That's the issue with Fentanyl.

[BluegrassRN]

They all have their potential side effects. Increased seizures with MS in pts with a hx of seizure activity, profound respiratory depression with hydromorphone. I recognize that fentanyl carries its own precautions, but these do not preclude its usage in a non-ICU or non-stepdown environment.

[Up2nogood RN, RN]

Yes, we push it on our floor, it's not as common as dilaudid though. I just gave it the other night as a matter of fact.