IV Fentanyl use on Med/Surg Unit

[abdnnurse]

I am wondering if anyone out there has concerns about the use of IV fentanyl on a general med/surg unit for pain. We have been debating this issue in our hospital for months. Physicians are pressuring administration to allow them to order it for any pain situations they want. Many of us Med/Surg nurses believe that the literature supports our reluctance to push IV fentanyl to patients that we may not be able to monitor closely in a 1:1 setting. The literature says IV fentanyl is used in anesthesia and sedation type settings...where patients are monitored very closely and people are trained in airway management. Our doctors are alway giving "ranges" of amount and frequency that leave a lot to nursing judgement. It is frightening to think of our junior nurses managing this medication. We are not afraid to IV push meds like MS or dilaudid as they do not "read" like fentanyl in the medication literature. Duragesic patches and Actiq are acceptable methods of delivering Fentanyl on a med/surg unit that we are happy to use.

We have been told we need to develop a "time line" to bring the IV method of delivering fentanyl to the med/surg unit. Therefore, we need to know how other institutions are handling this drug. Is it treated differently than IV morphine or dilaudid in your institution? Do nurses need ACLS or extra training? Do patients have monitors on them like oximetry?

[suzanne4, RN]

There is no way that I would feel comfortable pushing fentanyl on an med-surg unit. It is my license on the line.................If the physician wants it bad enough, tell him that he has to be the one to come in and give it.......

Very scary thought.................like giving versed IV to a patient without a pulse-ox..............

[canoehead, BSN, RN]

Seems to me that if you are comfortable with Dilaudid there is not much more risk with Fentanyl.

[mdfog10]

I work in a large teaching hospital and we do not give fentanyl IV push. The only way it is allowed on a med-surg unit is in a PCA. Bottom line is that in med-surg units your patient assignment does not allow you to be able to monitor the patient as much as they need.

[Jailhouse RN]

Fentanyl is a very dangerous drug, especially in untrained or unfamiliar hands. Its IV use demands very close watch of vital signs especially respiratory rate and B/p. It has no place on a med-surg unit where the busy nurses cannot always keep a 1:1 monitoring of a patient.

[weezieRN]

wow, i never knew of such a controversy with fentanyl, we give it iv push all the time and have never seen any ill affects. Also we many times have GI surgery pts come up with epidurals of fentanyl, which they do have to be monitored frequently as do our pca's. Our urologist frequently orders fentanyl for pain his regular orders fentanyl 50mcg q 2 severe pain, toradol 30 and demerol 25 q4 pain.

[PA-C in Texas]

I generally don't use IV fentanyl for pain management unless there is possible hemodynamic compromise. It seems to have a better hemodynamic profile than many of the other Schedule II drugs. I am sorry, but 50 mcg of fentanyl doesn't require 1:1 monitoring. If you look on an equianalgesic chart, you would see that 50 mcg is roughly equivalent to 5 mg MS or 75 mg meperidine. The induction dose for anesthesia with assisted respirations is 10-15 mcg/kg, so unless your patient weighs five kilos, I think you will be okay. Do you tell a doc no (and look like a complete fool) when they order 5 of MS for your average post-op pt?

I have had a few nurses tell me that they won't administer such and such medication, so I walk in there and do it myself, and then they have a totally defeated look on their faces. For some reason they believe that telling me "NO" is going to alter my clinical decision. One of them made a habit of it and lost her job.

[teeituptom, BSN, RN]

Use it all the time for pain control

also use it for concious sedation

what are your concerns

[suzanne4, RN]

No problem using it in a PACU, ER, or ICU. But many nurses have 6 patients and more on a med-surg floor, how closely can you observe the patient?

[kimmicoobug]

I push Fentanyl all the time on the med-surg floor. I try to use it as a last resort, but will use it for breakthrough pain when it is not yet time to administer MS or other pain meds. I always start with the lowest dose possible and work from there. I would much rather give it push, then PCA d/t one of my patients nearly coding from a Fent PCA set on the lowest settings (happened in the shift before mine). I have also seen ill effects from Dilaudid, as well. And MS...

[Jailhouse RN]

There is a flipside; the half-life is too short to be of real use if given IV on the med-surg floors. I too have used it and do not find it to be so wonderful. Great for induction and sedation because of the low incidence of N/V. A final note to PA-C in Texas, If I think something is wrong I WILL question it and give my reason why. I don't care if you are a PA or the attending. I will not do something I feel is unsafe.

[Gompers, BSN, RN]

I don't work med-surg, but if I did I don't know how safe I'd feel using it. I've had many infants completely clamp down after IV push fentanyl, including one that needed CPR and intubation. It wasn't just respiratory depression - it was nearly impossible to bag the baby, and it wasn't until we got Narcan in him that his compliance improved. I would think the same kind of affects can happen with adults? We give 1-2 mcg/kg doses.

We don't use it in bolus form often, really only for procedures such as intubation, painful dressing changes, and PICC line insertion. With the continuous IV drips I haven't seen any respiratory problems though. But for regular IV bolus analgesia, we prefer morphine.

I do have a friend who was on a regular floor who recieved fentanyl and ended up having some respiratory depression. She ended up on monitors in the ICU after almost coding.