Fentanyl placement?

I worked in hospice and we rotated our patch sites. According to McCaffery, sites should be rotated every two to three days. The amt. of body fat does not change the absorption rate.

According to McCaffery, patches can be places on the chest, flank, back, or upper arm. Since she is one of the major leaders in pain mgmt. nursing, I'd go with her info.

McCaffery is the Goddess of Pain Management. Ill go with her too.

LOL...I got to know her through a mutual friend, and I actually called her that once; she just laughed and said that was the first time she'd heard that one.

I am studying for my hospice certification and I remember reading that Fentanyl is better absorbed over areas of muscle or adipose tissue. I am not sure that it matters where on the body, as long as the tissue is not scarred or broken, adequate circulation/perfusion is present,and body temp is normal. I have recently had very thin/cachectic patients who do not absorb transdermal meds and experienced little or no relief as a result. Also, I have found (along with my colleges) that sometimes the effects of Fentanyl do not last the 72 hr period. We frequently have to change the patch anywhere from 48-60hrs. I presume this has much to do with poor absorption, inconsistant release from the tissue, and metabolic factors that can interfere with potency and cause ineffective results. I find that the patch is an expensive, often ineffective method of pain control and the side effects can be serious. I must tell you that in certain instances when the patient is unable to swallow, drug abuse is suspected (happened when a patient's family member was taking her oxycontin and selling it), and the convenience of not having to take frequent doses or follow time schedules, fentanyl is very helpful. Our docs generally convert to something more predictable in its absorption unless the above issues are a factor.

Feel free to correct me if I have inaccurate info-I need to know this stuff. jansgalRN

The info I posted came straight from the most recent pain mgmt manual by McCaffery.

One factor that does interfere/alter absorption is if the pt is febrile; the patch won't last 72h. Chest hair may need to be shaved/trimmed.

If a patient has alot of body hair Duragesic is simply not going to work IMHO...

The drg absorbs through the glue. This is the first thing you have to know.

Read your lit on the drg. DO NOT SHAVE THE AREA THAT YOU ARE GOING TO APPLY THE PATCH TO! :)

It just simply will not stick. Atleast, not very well. The surface of the skin gets rough from the shaving. This doesn't improve during the time the patch would be placed on the pt.

If you have a pt with a FEW and I mean FEW hairs you can trim them but do not SHAVE.

Also, I always tell pts to tape the patches on. Our hospital and NSG Home does this as well. Once a patch has come off, its essentially garbage. I just tell my pts to trash the patch at that point.

Another thing...

If a pt is extremely thin... This patch will not work. You must have some fat for this drg to absorb into. You need to make sure you know what your elderly pts look like before you order one for them. I've seen them given to little old ladies who's bones were merely covered by skin that was literally dripping off of them... and people were wondering why they were crying in pain.

Duragesic forms a packet of the drug in the fat layer and absorbs through that. No fat... no go.

Finally.... If a pt. is getting some results from the patch, but I think they could be getting more... I tell them to slap it on their abdomen. Try it. These work alot better when placed there. Granted, you have to bounce around, and be careful to avoid putting it where the pants can rub it off... but you will get better absorbing doing this!

David Adams, ARNP

-ACNP, FNP

And in case you're all wondering how to administer fentanyl in doses other than which they are supplied, putting tape on half the patch is not a reliable way to do this.

TELL ME somebody didn't do this.................

Please?

Dave

Dave, you'd be surprised.

Adrienne, who shakes her head on a daily basis.

Originally posted by MD Terminator

TELL ME somebody didn't do this.................

Please?

Dave

Every now and then I hear this from patients...they tell me their doctor or pharmacist told them it was okay to cut their 25 mcg duragesic patch in half, tape the open side shut and apply.

Originally posted by MD Terminator

I've seen them given to little old ladies who's bones were merely covered by skin that was literally dripping off of them... and people were wondering why they were crying in pain.

Duragesic forms a packet of the drug in the fat layer and absorbs through that. No fat... no go.

Wish I had a dollar for every cachexic patient in pain that I've found a duragesic patch on.