Parenteral Manual

FentaNYL citrate

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
SUBLIMAZE®
Classification: 
Narcotic analgesic
Original Date: 
August 2005
Revised Date: 
December 2019
Indications: 

Pain relief

  • Adjunct to general or regional anaesthesia

*Morphine is the preferred drug of choice.  Fentanyl may be useful in patients who:

  • Are allergic to morphine
  • Cannot tolerate the histamine release of morphine
  • Cannot tolerate a decrease in peripheral vascular tone due to hemodynamic instability
Reconstitution and Stability: 
  • Store at room temperature. Protect from light.
  • Diluted solutions (5-20 mcg/mL in normal saline) stable 30 days and (5 mcg/mL in D5W) stable 48 hours at room temperature
Compatibility: 

- Solutions Compatible: D5W, 0.9% NaCl

- Additives/Above Cassette Compatible: atracurium, bupivicaine, dimenhydrinate, diphenhydramine, hydroxyzine, midazolam, morphine, ranitidine, ropivicaine

- Y-site Compatible: amiodarone, dobutamine, dopamine, epinephrine, furosemide, heparin, KCl (up to 40 mmol/L), propofol, SMOF Lipid 20%, TPN

- Incompatible: azithromycin, fluorouracil, phenytoin

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC YES
IM YES
IV Direct

YES, Max 2 mcg/kg/dose 
Usual dilution: 10 mcg/mL OR 50 mcg/mL
Infusion time: 3-5 minutes; rapid injection may cause apnea
IV Intermittent Infusion

YES
Usual dilution: 10 mcg/mL OR 50 mcg/mL
Infusion time: at least 20 minutes
IV Continuous Infusion

YES
Standard concentrations in PICU: 10 mcg/mL, 50 mcg/mL

Click here to access SDC Drug Infusion Sheet

Pharmacokinetics:

  • Onset IV:  1 minute
  • Duration IV:  30-60 minutes (prolonged with high doses due to accumulation in tissue storage sites)
  • Peak respiratory depression: 5-15 minutes (may persist longer than analgesic effects)
  • Half-life:  2-4 hours
  • Metabolized in liver, excreted in bile (enterohepatic recirculation of active metabolites)
Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Analgesia:

IV bolus:

  • Children/adults: Usual dose: 0.5-1 mcg/kg/dose  Higher doses 2-4 mcg/kg/dose
  • Give 3 minutes before procedure; may repeat in 2-5 minutes

IV infusion:

  • Children: Initial IV bolus 1-2 mcg/kg/dose then 0.5-1 mcg/kg/hour; increase by 0.5 mcg/kg/hour increments (Range:  2-10 mcg/kg/hr)

PCA:

  • Continuous rate: 0.15 - 0.5 mcg/kg/hr
  • Bolus dose: 0.25 mcg/kg/dose

DOSING ADJUSTMENT IN RENAL IMPAIRMENT:

  • CrCl 10-50 mL/minute:  Administer 75% of dose
  • CrCl < 10 mL/minute:  Administer 50% of dose
Potential hazards of parenteral administration: 
  • Respiratory depression, hypotension, bradycardia
  • CNS depression, drowsiness, sedation, dizziness
  • ADH release, hypersensitivity reactions
  • Nausea, vomiting, constipation, biliary tract spasm, urinary tract spasm

Opiod reversal:

  • Administer 02 immediately
  • Naloxone (see Naloxone monograph)
Notes: 
  • Monitor RR, BP, HR, 02 saturation, bowel sounds, and abdominal distention

NURSING MONITORING GUIDELINES:

  • Check physician's order against guidelines; question dosage if higher.
  • Safely prepare and administer medication as per Medication Administration Policy.
  • Continuous infusion must be on a pump.
  • 02 and suction must be available at bedside
  • Patient may need to be on a respiratory monitor (or Oximeter )if there are concerns
  • IV solution without the added narcotic must be available at bedside with tubing primed, ready to be hooked to patient in case of an emergency.

- MONITOR:

for first dose - Baseline vital signs including sedation score (level of consciousness), HR, RR, BP, oxygen saturation and pain score

-  10 & 20 minutes after start of IV direct - repeat sedation score, HR, RR, BP, oxygen saturation, and pain score

-  Monitor oxygen saturation continuously for 30 minutes post start of IV push

 for subsequent dose(s) - HR, RR, pain score, and oxygen saturation 15 minutes post dose x 1

  • Naloxone must be available in the patient care area as ward stock

SIGNS & SYMPTOMS OF COMPLICATIONS:

  • Respiratory depression (RR <10 breaths/minute)
  • Somnolence, difficulty in arousing
  • Orthostatic hypotension with bradycardia
  • Nausea and vomiting
  • Allergic reaction.

ACTIONS:   Notify physician if:

  • Respiratory rate below 10 breaths per minute
  • Blood pressure decreased by 25% from baseline
  • Patient difficult to rouse
  • Allergic reaction

- Stop infusion of narcotic and start plain IV solution.  Notify physician.

- Maintain patient airway and administer O2 as indicated.

- Contact Pharmacy, Anaesthesia, or Poison Information Centre if after hours, for appropriate dose of naloxone (Narcan)

EXAMPLES of RATES for INFUSIONS

Using solution of  FentaNYL 10 mcg/mL

WEIGHT (Kg) dose ordered:  1 mcg/kg/hr dose ordered: 3 mcg/kg/hr
  IV RATE:   mL/hr IV RATE:  mL/hr
10                  1                  3
20                  2                  6
30                  3                  9
50                  5                 15
70                  7                 21

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