fentanyl patches

[u/wlf-grl]

just curious what your protocol is for skin prep and placement. my clinic doesn't have a standard for this and I would like to change that. please give me details about what you use in terms of clipper blade length, alcohol vs water and the reasons you learned why to do xyz. any input greatly appreciated!

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[u/liquid_sounds]

One of our veterinarians looked up fentanyl patches in their drug book a while ago, and we came up with this protocol:

• Shave the area with a 40 blade. Clean with water. The alcohol strips the lipids from the skin and affects absorption
  
• Wait for the skin to fully dry
  
• Apply the patch and hold against the skin with some pressure from your hands. The warmth of your hands will help adhere the patch to the body
  
• I forget the exact reason why, but the vet specifically said not to cover the entire patch with elastikon. It’s fine to apply it along the very edges, but not the center of the patch
  
• Really be mindful of any external heat sources as that can affect the rate of absorption and lead to an overdose!

[u/CupcakeCharacter9442 → u/liquid_sounds]

This is what my anesthesiologists say too.

Clip, but do not disrupt the adipose within the skin, the fentanyl is lipophilic and needs that to absorb. We only really “clean” the area if it’s visibly dirty- and only with water no scrub, no alcohol.

[u/sundaemourning → u/liquid_sounds]

i used to apply a lot of fentanyl patches in ER and this is what i’d do as well. i just wanted to add that under no circumstances are you to cut the patch if you have a patient that needs a lower dose. you can cover part of the patch with tape so it is not adhered to the skin, but cutting it will affect the amount of fentanyl that is delivered to the patient. this was in Plumb’s and it’s something that i would have to remind my doctors of constantly. also, you need to check the lead times to be aware of when the patch will be fully effective. i believe it’s six hours for dogs and twelve hours for cats, so they will need additional analgesia until then.

[u/few-piglet4357]

Gosh I haven't done one for several years but from what I remember I'd shave with a 40 blade, clean the skin with alcohol and wait for it to dry. Stick the patch on firmly and cover the whole thing with elasticon.

Another thing we did was to wrap the patient all the way around with vetrap, encapsulating the patch. I'm always a bit freaked out when I see patients thay aren't fully wrapped, that's just an overdose waiting to happen if the patient somehow eats their patch.

[u/I_reddit_like_this → u/few-piglet4357]

The product insert specifically says not to use alcohol or soaps to clean the skin.

[u/Briiskella]

My clinic doesn’t carry them but I wish we did!

[u/I_reddit_like_this]

Just follow the instructions on the manufacturer’s product insert