abdnnurse

The idea about giving it as long as it is hospital policy probably wouldn't fly in a court of law. I think it goes something like this..."what would any PRUDENT nurse do in a similar situation". One thing I know for certain is that fentanyl is NOT just another narcotic. It causes problems that narcan can't fix...I'll stick to my Morphine thank you very much. This little debate has made me more certain than ever that I personally won't give it on a med/surg unit. I'd rather be fired and have my license in my pocket than lose it because I didn't use the knowledge I have. Another thing....if the patient died it won't matter if there was a hospital policy or not....I would know that I did not do everything I could to assure the patient's safety. If I get fired I can sue the hospital or just find another job...if the patient dies, that was a human being who trusted me to deliver the safest care possible! We are patient advocates, that is an important nursing responsibility. :)

Thank you for all the information you all gave. It is now in the hands of management and I can only hope they will do the right thing. Our nursing management does have major concerns so I believe we and our patients will be protected. I will keep you all posted. :)

I have been doing some more research and ran across an article from the American Hospital Formulary Service. This information is "manufacturer's recommendations" and says that residual effects of one dose of fentanyl may potentiate the effects of subsequent doses. It talks about "redistribution" as the main cause of the brief analgesic effect of fentanyl. "Following IV administration, fentanyl distributes rapidly from blood into the lungs and skeletal muscle and more slowly into deeper fat compartments. The drug then redistributes slowly from these tissues into systemic circulation. Large single doses or repeated doses can result in substantial accumulation of the drug, potentially resulting in an extended duration of effect." This may explain why small continuous PCA fentanyl seems to be safer than giving IV bolus doses. The article goes on to state,"Because of the potential respiratory depressant effects of the drug, the manufacturers recommend that fentanyl injections and buccal lozenges only be used in a monitored setting by individuals specifically trained in the use of anesthetic agents and the management of opiate-induced respiratory effects in the age group being treated, including establishment and maintenance of an adequate airway and assisted ventilation... and only used as a premedicant prior to anesthesia or for inducing conscious sedation prior to diagnostic or therapeutic procedures in a monitored anesthesia setting." "Skeletal and thoracic muscle rigidity occur frequently...Muscular rigidity may be associated with reduced pulmonary compliance and/apnea, laryngospasm, and bronchoconstiction." (Explains the baby problems!) Now, I must wonder, if the manufacturer has such strong directives and warnings for the use of this medication and it really isn't all that great a drug for short or long term pain control....why are we taking the risk to use it on a general med/surg unit that is not that controlled a setting? In fact, Massachusetts General Hospital Departments of Pharmacy and Nursing developed administration guidelines for use in Critical Care but under "special considerations" it states, "consideration of an alternative agent should be explored as other medications provide superior analgesia." I appreciate the information, stories and comments...much food for thought! We do try to provide our patients with the best and latest in treatment. The push for this drug from our physicians really puzzles me though, I don't see the advantages! We use epidurals and PCA's regularly so we are keeping up with technologies. We do have P&P's in place for these types of things, it is just that this push for IV fentanyl is new for us! Please keep sharing your information and thoughts and I will continue to monitor and let you know how this turns out!

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?