fentanyl drip in an IVP or CADD pump

[Zookeeper3]

thanks all in advance. I've worked a few facilities and they vary with the policy with fentanyl/dilaudid continuous IV infusion in VENTED patients. Some require a CADD or PCA pump, others allow just an IV drip on a pump.

Our standard concentration is 1000mcg in 100 ml, so 10 ml per hour for 100 mcg. So by the time you prime the tubing, have some run off and so forth your pharmacy drip sheet does not exactly match with what you have infused. The CADD pump or PCA pump is much more accurate, but requires much more documentation every two hours (for allergic reaction pain controll, urinary retention, LOC, breathing), but does not reflect the accurate status of a vented patient, since almost none of that applies as they are sedated as well.

We are considering a new vented fentanyl/dilaudid PCA quick check form to make everyone happy as far as administration safety/ narc documentation and nurses time.

Will you please share a brief moment on how you handle fentanyl/dilaudid drip in the vented patient and what your documentation if extra includes. Thanks so much as my goal is to provide safety but yet limit our documentation. I appreciate your time with your responses!

[perkizme]

We do fentanyl drip on regular IV pumps - even if they are maxed at 200mcg/hr (same concentration bag) on our vented pts. We dont do dilaudid drips for sedation. Usu fentanyl, ativan, versed, propofol. If a pt requires high doses of ativan - then our pharms will usu ask us if we would rather have it in a higher concentrated PCA (esp if on fluid restriction). We only use the other drugs as PCA if ordered as a PCA by the MD. Once drip dc'd or if we have to change out tubing, then we 'waste' whats left in bag and estimate of what's in tubing and write on our MAR.

[dorimar, BSN, RN]

We hang our fentanyl drips on a regular pump (unlocked, uncounted!!!). This was a big change from other facilities I have worked in. We have standing order sets that state to titrate to FLACC scale of 0. It works ok, but the FLACC scale was originally intednded for neonates and infants. Have you seen the latest AJCC just This month??? There is a reaearch anaylisis on pain scales for ventilated patients in ICU.

[JeffTheRN]

Fentanyl on regular pump for us, no flowsheets or scales. As far as as Dilaudid goes, always in a PCA with a Q1H flowsheet.

[cardiacRN2006, ADN, RN]

We don't use dilauded for vented pts. We use Fentanyl 1250mcg/250mL on a regular, unlocked Alaris pumps. Same as Versed. It's 100mg/100mL.

When we withdraw care on pts we use Morphine gtts. Again, it's a 100mL bottle that we hang on a regular ol pump.

That gets me thinking, it would be difficult to bolus/titrate on a PCA if you needed the keys and all the steps. Sometimes my pts just need a little 50mcg bolus of Fentanyl when we are doing procedures or dressing changes, etc. Seems difficult and time consuming when titrating via PCA...

[Keysnurse2008]

Fentanyl drips - 1000mcg/ 100ml ...or in RF patients we do 3000mcg/ 100 ml to limit fluid intake. We just hang our on a regular IV pump, not a PCA. But...we do alot of procedures at the bedside , having a PCA would be hindersome.

[Keysnurse2008]

Sorry ...I just saw the diluadid part. Diluadid is always on a PCA at our hospital. Lg glass amps...pharmacy doesnt mix the diluadid...so it goes in the PCA every time. Our pharmacy "allows" us 12 ml to prime the tubing in PCA's....and never complains if we have to use 15ml if there is air in the line.

[PICNICRN, BSN, RN]

Our Fentanyl goes on a regular pump mixed 10:1 in a 55cc syringe(kids) each syringe has a control # tracked by pharmacy and changed/wasted every 24 hours or whenever it runs out(whatever comes first)..... if it is not wasted- the "narcotic police" pay you a visit.

[highlandlass1592, BSN, RN]

We use syringe pumps for our fentanyl gtts. Diluadid is used by PCA or IVP, depending upon situation. I like the syringe pumps, easy to give a bolus (just program in the dose) and easy to change, not as much waste in the tubing.

[IDoNotGiveOut]

We just run the fentanyl on a normal pump (Alaris - which does at least require you to scan your badge and holds a TON of information, so they could track boluses, etc. and who administered it if they wanted to). We do have a process of signing out the drip and wasting, but it is purely estimation when we waste and I don't know how they would account for priming the tubing if there was an issue.

We never use dilaudid as a continuous gtt, but we use it as a PCA for awake people. I've never even heard of using a PCA pump for anything other than PCA. Interesting.

[cardiacRN2006, ADN, RN]

Eeeks! Our Alaris pumps don't have the scan option (thank God!)...