FENTANYL

Sublimaze

Reviewed by Dr Carl Kuschel and Brenda Hughes
October 2004
Dose and Pharmacology Newborn Drug Protocol Index Newborn Services Home Page

 

Management of  Fentanyl Citrate Administration

Description

Prescription

Continuous infusions are charted on fluid chart giving:

Also charted on drug chart under continuous infusions giving:

Administration

Slow IV Injection

Administered by nursing staff except the first dose in the nonventilated perioperative neonate.

  1. Administer by slow IV injection over 3-5 minutes. Filter prior to administration through a Pall 0.2 micron filter.
  2. Is compatible with D5W and NS. Compatible with IVN at the Y-site.
  3. Do not mix with other drugs or blood products.
  4. Flush before and after administration of fentanyl with NS.

Slow IV Infusion

  1. Administer by slow IV infusion over 1 hour using a syringe pump. Filter prior to administration through a Pall 0.22 micron filter.
  2. Is compatible with D5W and NS. No data available on dobutamine and dopamine.
  3. Do not mix with other drugs or blood products.
  4. Flush before and after administration of fentanyl with NS.

Continuous Infusion

  1. Dilute prior to administration.
  2. Filter prior to administration through a Pall 0.22 micron filter.
  3. Is compatible with D5W and NS. No data available on dobutamine and dopamine.
  4. Do not mix with other drugs or blood products.
  5. Administer via a syringe pump.
  6. Change fluid and tubing every 24 hours.

Nursing Considerations

Warning: Rapid IV injection may result in respiratory paralysis.

  1. Baby is managed by a Nurse with neonatal IV drug certification.
  2. Evaluate baby's need for and response to medication.
  3. Assess IV site closely for signs of extravasation.
  4. Assess for signs of adverse reactions.
  5. Continuous cardiorespiratory and blood pressure monitoring.
  6. Monitor oxygen saturations.
  7. Monitor respiratory status carefully. Effect on respiration is longer acting that analgesic effect.
  8. Ensure naloxone and resuscitation equipment is readily available.
  9. Monitor urinary and bladder function.
  10. Drug documentation.

Storage

References

1 Collins C, Koren G, Crean P, Klein J, Roy WL, MacLeod SM. Fentanyl pharmacokinetics and haemodynamic effects in preterm infants during ligation of patent ductus arteriosus. Anesth Analg 1985; 64:1078-80.
2 Koehntop DE, Rodman JH, Brundage DM, Hegland MG, Buckley JJ. Pharmacokinetics of fentanyl in neonates. Anesth Analg 1986; 65:227-35.
3 Arnold JH, Truog RD, Scavone JM, Fentan T. Changes in the pharmacodynamic response to fentanyl in neonates during continuous infusion. J Pediatr 1991; 119:639-43.
4 Lane JC, Tennyson MB, Lawless ST, Greenwood RS, Zaritsky AL. Movement disorder after withdrawal of fentanyl infusion. J Pediatr 1991; 119:649-51.
5 Bergman I, Steeves M, Burckartg, Thompson A. Reversible neurologic abnormalities associated with prolonged intravenous midazolam and fentanyl administration. J Pediatr 1991; 119:644-9.
6 Nursing 97 Drug Handbook Spinghouse 1997, p357-60.
7 Barrington KJ, Byrne PJ.  Premedication for neonatal intubation.  Am J Perinatol. 1998 Apr;15(4):213-6.