Fentanyl as a MDV or SDV


Looking for practice information from PACU nurses:

We have automated dispensing machines and have EMR--

When ordered Fentanyl 25mcg q 5min, do you use the pulled amp of 100mcg/2ml to dose more than once or do you pull one amp, give one dose and then pull another to provide. Great debate at our facility! What is your practice?

azhiker96, BSN, RN

1 Article; 1,127 Posts

Specializes in PACU, ED. Has 16 years experience.

We use it as a MDV but only use it on one pt. Any Med not used for that one pt is wasted with a witness. It is important to label the syringe with Med and pt name to prevent confusion and errors. The same goes for using 100 mg vials of labetalol for an order of 5 mg q5min prn SBP > 160.

Has 3 years experience.

MDV, although pharmacy at my facility does not like that practice. But we go through fentanyl like candy that if we have to pull out one vial at a time, we would quickly run out. We have labels for fentanyl, versed, dilaudid and morphine.

HeySis, BSN, RN

435 Posts

Specializes in PACU. Has 25 years experience.

Same as the others. We pull one vial, scan it into the MAR with the first dose. Have a titration flow sheet in the charting with our vitals, Aldrete's and assessments. If we have to pull a second vial we do not have to rescan, we can continue to add to our titration. Our titration document has two rows per med per column. the column is the time and the first row is the dose given at that time and the second row is the total given in the PACU so far (think spread sheet). Then at the end of the case we go back into the MAR and update it with the final amount given (from the second row) and waste the rest.

We also have the stickers to put in the syringes to let us know what we've drawn up. And never use the same vial/syringe on another patient.


100 Posts

I have worked at two different facilities, one that used MDV and the other used SDV. The MDV still had to remain specific to that patient (a couple of other drugs, notably insulin, were MDV across the patient pool). But, at neither hospital have I seen doses like 25 mcg of fentanyl q 5 min. Our dosing is at most q 10 min.