Fentanyl placement?

[ohbet]

Ive always understood that Fentanyl patches can be placed anywhere,chest back etc.

But we have one nurse,who recently went to a Pain Seminar,that insists the patch must be place ot the torso,as it is absorbed best there.

She gets bent out of shpae when she finds them anywhere else.

Has anyone seen any literature in regards to fentanyl placement?

[aimeee, BSN, RN]

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.

[adrienurse, LPN]

I guess the fentanyl half-dosing thing has happened often enough for somebody to do a study on why it shouldn't be done.

[NRSKarenRN, BSN, RN]

Check out http://www.duragesic.com/ for answers

[Monica RN,BSN]

We find that duragesic patches will stick longer and better if you place a piece of tegaderm over it to help reinforce the secureness to the skin, and sometimes a swipe of skin prep along the outer edge will also help to keep it in place better, (Not under the patch though ,of course) The most recent pain management seminar I attended is exact with what jansgirl has stated, but we were told not to place them over the boney prominances as the medication needs the fatty layer to absorb.( a problem with ineffective management of pian in a very skinny boney person)

Thanks for letting me share! :)

[Dave ARNP]

Anybody ever thought of using Dermabond?

Just something that crossed my mind today, and thought I would share.

Dave

[leslie :-D]

if my pt. is bony, frail, etc., i never use the chest wall but do prefer the tricep area or upper back covered by an opsite. for the pd nurses that don't use the opsite, one of the biggest interferences is when the cnas sprinkle talcum powder on them, or lotion them up-both of which will affect the sticking power. i've had great success with duragesic in my elderly, cancer/cachetic pts., again, as long as it's covering an adequate area of sc fat.

[mittels]

I have to agree with your nurse that gets bent out of shape. One of the reasons it is best absorbed is because on the chest (best placed) is because of the type of fatty tissue their and the ability for it to be absorbed equally and timely.

[Dave ARNP]

Just a note, on women...

I don't suggest placing these patches in a place where that the drug would absorb through breast tissue.

Just a little something that I advise. No clinical data, no studies. I just don't like the idea of any drug passing through there when we don't need it to. We certainly don't place HRT/ERT patches there.

Dave

[aGrandma]

I'm not a nurse, but my husband has used Fentanyl for about 3 years now. He can only use the generic brand because the name brand falls off. He's thin but muscular. Also he changes his every 48 hours, it has never lasted 3 days on him. Anyway my question is, he has always placed it on his shoulder, alternating sides each new patch. The past few weeks he gets chills the day he is supposed to change the patch. He feels like it's withdrawals. So we tried something we've never tried before and placed the patch on his upper chest area near his arm, and we cannot believe the chills stopped. He hasn't had chills since he moved the placement of the patch about 2 weeks ago, and he was getting them consistently every 2 days. Have any of you heard of this happening with fentanyl? Can a place on your body get to where it doesn't absorb the drug any longer? I can't find that on the Internet anywhere.

Also - just f.y.i. for you nurses - my husband used to use a much stronger patch but he ended up in the emergency room about 5 times for withdrawals - it was horrible for him every time. Probably 3 of those times he had not done anything wrong - he'd changed his patch as directed. This is such a seriously strong drug. He's been on the weakest patch (12.0 mcg/hr) for probably 18 months now and has never been to the ER since he's been at this dose. He has arthritis in both shoulders and this really helps with the pain.