Rotation for transdermal medication patches

[2425baldy]

What is the best practice for rotation of transdermal patches? (eg..nitro, fentanyl); Specifically how many days between application to the same site?

[Lexxie, LPN]

For Fentanyl patches which are changed every 3 days, we generally rotate from right chest to right upper back to left upper back to left chest. If a resident is prone to picking at things, we'll stick to the back sites or sometimes put them on the thighs where the patch is covered by clothing or can't be reached. Oftentimes, our nitro patches are just rotated between right & left chest, since they are only on for approximately 12 hrs. Of course if either of those sites gets irritated, we'll change the site.

[juleschild]

Mother (92 yo) treated successfully with the Rivastigmine Transdermal patch. She has fewer episodes of yelling. When awake is generally happier. Even using more complicated phrases and intuitive statements. But the patch is leaving circular welts across her chest. Why does nursing continue to use the chest? And why is rotating seen as from left side of chest to right side of chest; even w. reaction to adhesive? (PA said this is the most common side effect/reaction.) To me rotating is like arm, back, leg, thigh etc. Then avoid most sensitive location. They did it for a few days...now a different nurse is on and the chest welts have begun again. I painted on her chest, with lip stain, "No patch here". Next time it'll be a permanent marker!

[PsychNurseWannaBe, BSN, RN]

Its common with exelon patches to cause irritation from the adhesive. I normally would go along the upper shoulder blades and then to the front. It doesn't stop the redness from happening, but will give it time to fade. If it is a problem, the MD might want to switch the medication. I have never seen a patient complain that it was irritated or anything.

[turnforthenurse, MSN, NP]

At my facility, we rotate nitro patches Q6H...typically I rotate between the left and right upper chest, but have used the back shoulder area, arms and legs before, too. Never had a patient complain of skin irritation...only headaches that come from the nitro lol

[runnergirl86, BSN, MSN]

Another spot to think of is the abdomen, esp for fentanyl patches. We have a resident who picks at them if they're on her chest, but doesn't notice them on her ABD.

[LaneRN]

Our pharmacy sent us a sheet for sites for the Exelon patch there are 17 sites whirch are on the back. It specifically states on back on our orders from pharmacy we do not use the chest for these or our fentanly patches.

[DixieRedHead, ASN, RN]

From the Exelon website.

[carolmaccas66, BSN, RN]

Usually 8 on and then 8 off, or just change the patch and rotate it over to the other side (depends on medication & doctor's orders).

You can rotate around in a circle, ie: left arm, left upper scapula or b/ween shoulder blades (so pt's don't pick @ them and can't reach them), then right arm, then round the upper front, just below the collar bone right, then to the left side and start all over again.

But ALWAYS document WHERE you have put the new patch in case the OLD patch doesn't get removed and then there is no confusion. Also always write the date the new patch goes on B4 you apply it, & you'll be right mate.