Fentanyl transdermal patch is reserved for opioid-tolerant patients with chronic stable severe pain. The matrix or reservoir delivers fentanyl continuously over 72 hours. Steady state is reached after 24 hours of the first patch and after dose changes; analgesia is gradual at start and a residual depot persists 12 to 24 hours after removal. Critical teaching: (1) clean, dry, intact, hairless skin on chest, back, flank, or upper arm — clip hair, do not shave; rotate sites every 72 hours and document; press firmly for 30 seconds; (2) heat increases release and can cause overdose — avoid heating pads, electric blankets, hot tubs, saunas, intense exercise, and high fever; report fever; (3) never cut a transdermal patch unless explicitly designed to be cut (the original duragesic patch is matrix and could be sectioned in some products, but practice is to use the lowest available strength rather than cut); (4) used patches contain enough drug to kill a child or pet — fold sticky-to-sticky and dispose by flushing down the toilet (FDA flush list for high-risk opioid patches), never throw whole into trash; (5) breakthrough pain is managed with a short-acting opioid, not by adding patches; (6) confirmed allergy or skin reaction at the site requires removal and report; (7) report increased sedation, confusion, slow breathing, or fall. Heating, cutting, or doubling are unsafe.
For study reference only. Always follow current clinical guidelines and your institution’s protocols.