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Discussion

The 12 mcg Fentanyl patch(vent)

Had my first dealings with the ridiculous 12 mcg Fentanyl patch this weekend as I had a patient on 37 mcg total. First, I had to go pick it up as it was of course not stocked in our Pyxis. I open both packages. When I open the 12 mcg one, it appears to be empty. Hmmm, strange. Maybe I got an empty package by mistake. Oh no, there it is, the size of a small clear Pez candy. I take that one and the 25 out of their packages(first mistake) and put them on top of the tegederm dressing l'll use over them. I take the old patches off and place them aside as they'll need to be wasted. Then I get the 25 and the tegederm but the 12 is nowhere to be found. Oh god. Images of my nursing career flashing before my eyes, I search frantically on the floor and surrounding area to no avail. Well, it was a good run. 7 years. Before they thought I diverted a 12 mcg patch. I turn on bright lights and finally see it, taunting, malicious, and barely visible. I hold it in my hand the entire time until I place it.

They really need to improve the packaging/coloring on that thing. Maybe a fluorescent pink stripe or something.

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    • Expert

    I agree 100% but then you run into patients being allergic to the dye and complaining it can be seen. It's a lose lose proposition.

    I never open both and keep all supplies in a new emesis basin when in the room.

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    • Author

    Or at least a larger piece of covering attached to the patch? Emesis basin is a good idea.

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    They should change fentanyl patches from clear, how many times have I had pts from a nursing home still have one on and now they are getting dilaudid or oxycodone and they are very somnolent. My first pt in nursing school had a fentanyl patch on that they did not know about with a dilaudid pca for a hip fx and they needed to use narcan on her! If I hadnt been in the room all day conscientiously checking her spot check pulse ox because that is all I knew how to do at the time as a nursing student, who knows what would've happened...

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    I agree with iluvgusgus. No reason it needs to be clear. If I need fentanyl I do not care if the patch is NEON orange

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    The fentanyl patches at my hospital are beige not clear. I never open the new patches in advance, always at the bedside after removing the old patch.

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    • Author

    Those beige ones are much easier to see!

    I was at the bedside when I opened the packages, btw. But you're right, I should have been ready to slap them right on.

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    I know you're venting and this doesn't directly help your situation but thank you for posting this. It's not something I would want to have to run into as a relatively new nursing student and I thank you for the heads up. :crossing my fingers the fentanyl patches at the new clinical site are beige still:

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    Begs the question of how much bedside nursing input is obtained when the pharm companies engineered that design?

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    I put one of the 12.5 ones on today. It is clear but the backings around it aren't.

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    "Oh god. Images of my nursing career flashing before my eyes":roflmao:

    Fentanyl patches clear or flesh colored ( whose flesh)... are dangerous.

    My last code as a floor nurse was due to the fact that the off going nurse did not remove the old patch.. lucky me ,patient went into respiratory arrest the first hour of my shift.

    Patient was obese, the patch was (well) hidden in a roll. Are we required to do a complete body scan to make sure there is only one invisible patch on the patient? Or can we safely assume the nurse applying the patch followed procedure?

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    • Expert

    When I put on a fentanyl patch, I always cover it with paper tape and label the tape. I also enter a MAR note explaining where it is. Doesn't help me find patches, but it will help the next nurse three days later.

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    • Author

    Yeah I placed a tegederm over the new patches but put a large opaque label on the side of the dressing with date, time, dosage, drug, and initials. And our med administration system requires we enter the place we put the patch(es.) The safety issue is a good point though.

    Glad my tale could serve as a warning:) oh and the covering on the one I placed was clear too. The whole minuscule unit was as good as invisible. Like I said, I thought the package was empty at first.

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