Palliative Care Guidelines - NHS Lanarkshire

Palliative Care Guidelines: Fentanyl patchesFentanyl patch care• Apply to intact, non-hairy skin on the upper trunk or upper arm; avoid areas treated withradiotherapy, scar tissue or oedematous areas.• Apply each new patch to a different skin site; clean the skin with water only as soap productscan alter absorption. Make sure skin is dry.• Fentanyl patches should not be cut.• Record the date, time and site if the patch is changed by different people.• Change the patch every 72 hours at about the same time of day.• Check the patch daily to ensure it is still in place.• If patch adherence is poor, use an adhesive dressing or tape; fentanyl is unsuitable for patientswith marked sweating.• Used patches still contain active drug. Fold the patch over so it sticks together. Dispose ofit safely (sharps bin for inpatients, domestic waste in the community). Wash your hands afterpatch changes.Heat / pyrexia increases the absorption of fentanyl and can cause toxicity.• Avoid direct contact with heat (eg. hot water bottle, heat pad).• Showering is possible as the patches are waterproof, but avoid soaking in a hot bath,saunas or sunbathing.• If the patient has a persistent temperature of 39°, the patch dose may need reviewed.Practice points• Fentanyl patches are used for moderate to severe, stable pain.• Do not change formulation/ brand.• Do not change fentanyl patches to another opioid in a dying patient, continue the fentanylpatch and use an additional opioid as required.ResourcesProfessionalPalliative Care Drug Information online: http://www.palliativedrugs.com/PatientPatient leaflet on website: Fentanyl patchesDischarge planning/ community use• The same patch formulation should be prescribed and dispensed consistently for each patient.• Ensure patients understand the safe use, storage and disposal of the patch, and theimportance of not heating the skin under the patch.Key references1. Donner B. Long term treatment of cancer pain with transdermal fentanyl. J Pain Symptom Management 1998;15:168-175.2. Ahmedzai S. Transdermal fentanyl versus sustained release oral morphine in cancer pain: preference, efficacyand quality of life. J Pain Symptom Management 1997; 13:254-261.3. Fine PG. Fentanyl in the treatment of cancer pain. Seminars in Oncology 1997; 24(5): 20-27.4. Dean M. Opioids in renal failure and dialysis patients. J Pain Symptom Management 2004:25(5): 497-504.5. Twycross R, Wilcock A. Eds. Palliative Care Formulary (3 rd Edition) 2007, Palliativedrugs.com Ltd., Nottingham.4 Issue date: January 2009 Review date: March 2012 © NHS Lothian