Do you push Fentanyl on the floor?

[General E. Speaking, RN, 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?

[SteffersRN87, BSN, RN]

Fentanyl has a high risk of causing sedation and respiratory depression and can drop a BP. I worked in ICU and we gave it like candy. I work in outpatient oncology and invasive/surgical procedure receovery and we are not allowed to give it nor would I feel comfortable.

[TiffyRN, BSN, PhD]

My adult floor experience is old (>7yrs ago) but the only form we gave Fentanyl was patch, PCA or rarely in Innovar IM. Innovar was a combo med with Fentanyl & Inapsine that was only allowed to be given on the floor as a pre-op IM.

In the Neonatal ICU was also hand it out like candy, but only to intubated infants.

[zacarias, ASN, RN]

Again, as licensed professionals, RNs should be allowed to push Fentanyl IV just like other narcotics. I remember a patient that had horrible wounds all over her body r/t to something strange. She screamed like bloody murder when dressing changes were done. We used fentanyl IV for the dressing change. While she still screamed occasionally, it did help. What I like is its fast half-life; After the dressing change, I don't have to worry about it staying in her system too long and risk oversedation.

[TiffyRN, BSN, PhD]

I actually agree with the MD mentioned above, that Fentanyl's as safe as Morphine or Dilaudid. There is just a lack of familiarity with it. Even in our unit, it was not used very much until some of the newer MD's coming in the last 2-3 years have started using it a lot more. I seriously doubt we will ever see it used on non-intubated patients but our Neo's rarely allow anything but tylenol once they are extubated. But that's another topic for another day. . .

[mrsshifflette09]

I work on a Neuro stepdown unit and we give it pretty often IV push. We sometimes even give it to the floor patients that we have. More often when they are on SD though for post op crani's.

[RNSC]

Doesn't pushing Fentanyl risk chest wall paralysis? I seem to remember this happening in the NICU. The baby was vented but had no chest rise. It was a tough couple of minutes.

[Virgo_RN, BSN, RN]

Of course. Why wouldn't we?

[mom4josh]

A few years ago we didn't, until the policy was changed. We give it fairly frequently now, especially to terminal patients.

[Straydandelion]

Ortho we just used the patch though at the time fentanyl was relatively new.

[BrnEyedGirl, BSN, MSN, RN, APRN]

We used to be able to push it on the floor,...they stopped that about 4yrs ago after several close calls. We just weren't able to watch our pts close enough to keep them safe. It's kinda of funny though,.I work ER now and we give it like candy,..and send them to the floor!

[medicrn13]

Given it a few times and have had no problems with it. It's understandable to be concerned about it, but I'd be more worried if the doctor was ordering an outrageous dose than just ordering the drug. As someone already pointed out, Fentanyl has a shorter half life than some other narcs. This is a plus in that it's eliminated faster, and oversedation isn't as likely.