PCA Question

[regerterb]

Hi Guys,

I am in my 9th week new grad- I had to check a PCA Syringe Fentanyl today with another RN and noticed that the doses may be wrong at the hospital I am at…or maybe not I couldn't figure it out- the nurse treating gave it and checked it with someone else as I was not satisfied… so the dose was 600mcg Fentanyl in 30ml Normal Saline…… the thing is. they are drawing it up in 30ml syringe…but by the time the Fentanyl is drawn up (100mcg/2ml) there was already 12ml of Fentanyl in the Syringe so only 18ml of Normal saline goes into it….to make up 600mc/18ml n/saline. Is this wrong? it seems like they need bigger syringes, maybe a 50ml to draw up the 30ml saline..then the 12ml worth of fentanyl to make a solution of 42ml? Am I just confusing myself? Or is the fentanyl already dissolved in a solution..or is it base form...

Thanks!

[dudette10, MSN, RN]

Think final concentration. All the individual numbers are messing you up.

The order 600 mcg/30 mls of fluid.

If you draw up 12 mls of Fentanyl (600 mcg) and 18 mls of NS, the total is.....600 mcg/30 mls. Six hundred mcgs is 600 mcgs, regardless of how much fluid needs to be drawn out of the Fentanyl vial.

If it was done your way, it would be 600 mcg/42 mls, which is the wrong dose.

[regerterb]

Thanks! I must have had a brain fart or been extremely tired over thinking this haha

[KelRN215, BSN, RN]

I have never heard of such a thing as drawing up/mixing PCA cartridges oneself. Our cartridges were pre-loaded with, I believe, 30 mg of morphine. I forget how much the dilaudid ones had. There was a barcode and the PCA recognized what medication it was when it was loaded.

But, OP, you are way overthinking this. The order is 600 mcg/30 mL. The fentanyl makes up 12 mL so you need 18 mL of Normal Saline to make 30 mL.