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Kyobanim
09-26-2009, 10:00
My wife uses a 72 hour transdermal patch for pain control. Here's the problem.

The patch doesn't stay stuck to her for the full 72 hours. This is a new problem and started back in june. It's causing a lot of problems. By the second day the patch is coming off. We have tried cleaning the patch area with alcohol prior to applying, using skin clensers, and now we are using those bandages that they put over IVs to try to hold it in place. Nothing is working. In fact, you can see a good portion of the medication still in the patch when it's time to change it.

We have tried changing the location of the patch and that isn't working either.

I could use some ideas if anyone has any.

MVS2
09-26-2009, 12:18
I've worn Salonpas pain patches for 24 hours without problems with adhesion. Other than those an ace bandage would help keep a patch in place.

The Reaper
09-26-2009, 12:46
If it can be worn on an extremity, maybe a compression bandage or support hose, something like that?

TR

mugwump
09-26-2009, 13:18
This is a common problem w/ fentanyl patches, especially with the higher dose/larger ones. The upper, inner thigh is sometimes the best site depending upon body type.

When we ran clinical trials of patches we used Johnson and Johnson Bioclusive Transparent Dressing, 4" x 5" to cover the patches. 3M Biopore tape is also an option if it's tolerated.

Another thing, all fentanyl patches are not equal. Try the original Johnson and Johnson ones, they have the best adhesive, better than the Howard, etc. ones. I belive J&J fentanyl patches include the dressing I referenced or will mail them to you free upon request.

shr7
10-16-2009, 01:03
Kyo-

Sorry for the belated response.

The patient instructions for use of brand name Duragesic (fentanyl) are linked below, with directions for securing the patch if it does not stick:

http://www.duragesic.com/duragesic/shared/pi/duragesic_patient_instructions.pdf#zoom=100

I wish I had an easy answer on this one, I've heard of Tegaderm being used successfully, the patient information recommends it as well.

IF, you are using brand name Duragesic from Janssen and not a generic fentanyl patch, they will send you free Bioclusive (from J&J) dressings for the patch as mugwump mentioned. The number is 1 (800) 817-1916. They require proof of purchase of the brand name Duragesic. Just follow the instructions given in the recording.

Hope this can be of some help.

SR

P.S.
I saw you mentioned you had tried cleaning the site with alcohol. The manufacturer recommends against this. I can think of two reasons why this might be. First, if there is residual alcohol on the skin, it can change the availability of drug through the patch. Second, repeatedly using alcohol on the same area of skin can lead to irritation and damaging of the skin, which can again change the availability of drug from the patch. If it helps, just make sure the area you apply the patch to is dry and not irritated and there should not be a problem. I've just seen too many cases in the hospital due to fentanyl patches.

LongWire
10-16-2009, 01:46
Moleskin??

ES 96
10-16-2009, 03:15
Could this issue happen if one goes to a different type of soap that may change the surface of the skin eg leaving more of a film on the skin, thus making it less adhesive friendly? Moisturizing, and soaps with certain oils, etc come to mind.

bost1751
10-16-2009, 08:58
My wife has been on the patches for a couple of years now. Tagaderm patches over the pain patch works great. Hers remain stuck very well the entire time. She swims with them on also and they stay on the entire 72 hours. Tagaderms in come in a variety sizes too. They cost a bit though, but have proven to be well worth the cost.

Red Flag 1
10-16-2009, 17:26
My wife uses a 72 hour transdermal patch for pain control. Here's the problem.

The patch doesn't stay stuck to her for the full 72 hours. This is a new problem and started back in june. It's causing a lot of problems. By the second day the patch is coming off. We have tried cleaning the patch area with alcohol prior to applying, using skin clensers, and now we are using those bandages that they put over IVs to try to hold it in place. Nothing is working. In fact, you can see a good portion of the medication still in the patch when it's time to change it.

We have tried changing the location of the patch and that isn't working either.

I could use some ideas if anyone has any.
pm inbound.

RF 1

wet dog
10-16-2009, 17:44
My wife uses a 72 hour transdermal patch for pain control. Here's the problem.

The patch doesn't stay stuck to her for the full 72 hours. This is a new problem and started back in june. It's causing a lot of problems. By the second day the patch is coming off. We have tried cleaning the patch area with alcohol prior to applying, using skin clensers, and now we are using those bandages that they put over IVs to try to hold it in place. Nothing is working. In fact, you can see a good portion of the medication still in the patch when it's time to change it.

We have tried changing the location of the patch and that isn't working either.

I could use some ideas if anyone has any.

Your wife's skin is too smooth, you need to roughen it up with a wire wheel or grinder. Ok, forget that, bad idea.

Use an Ace bandage to keep it in place.

armymom1228
10-16-2009, 20:12
I think you said you wiped the area to be used with alcohol right? Try using skin prep on the edges of the area to be applied to. I have successfully used that with a number of patients whose skin is oily and the patches don't like to stick.
"skin Prep" comes in several other names.
Might try bordered gauze, again using skin prep to make the skin sticky.

NoRoadtrippin
10-16-2009, 20:44
Skin prep of some sort was my first thought. My medical expertise doesn't extend past being a Wilderness First Responder, but I have seen things like Benzoin Tincture keep patches like Tegaderm on for weeks even on wilderness kayaking trips and such where people are wet every day. I can't speak as to how this would effect the drug transfer, but it would certainly keep it sticky.

Kyobanim
10-16-2009, 21:42
I tried roughing the skin with my dremmel but that just made her jump around and hard to get the patch on. (side note: don't apply alcohol after using the dremmel)

ace bandage didn't work. She took to cutting the tops of socks off and using those but the patch still came off.

Currently using those bandages they use on you when you get an IV. I think that's what some of you suggested. This is working. Also moved patch location to mid-back to either side of the spine. Just have to wait a couple weeks to see if this is a good location.

armymom1228
10-17-2009, 08:08
Skin prep of some sort was my first thought. My medical expertise doesn't extend past being a Wilderness First Responder, but I have seen things like Benzoin Tincture keep patches like Tegaderm on for weeks even on wilderness kayaking trips and such where people are wet every day. I can't speak as to how this would effect the drug transfer, but it would certainly keep it sticky.

yes, tincture of benzion works great IF you can find it. If not, under that particular name, ask the pharmacist, try mmm, cannoat remember the name but it is in the tooth pain section and it is benzion and a low dose of benzocaine. Enough benzoin to make the skin sticky. Surfers use Tincture of Benzion to make themselves stickey when doing stunts on surfboards with another person. <---trivia.

Do NOT use the benzion on the area that the the drugs are to be delivered to,it does create a film on the skin, just the edges. If you want to try it, might try using that plastic tape that is clear with tinyholes in it. Offhand cannot remember the name, it works pretty good to and most people that have an allergy to tape seem to do okay with it, some not so good. Final alternative, that is not so hot, is papertape. In a pinch 100mph tape. Dont laugh, have a pt that swears by it, and won't use anything else. Personaly I Have told him for yrs he is a few fries short a happy meal, but he is a marine what can I say.:D

AM

armymom1228
10-17-2009, 08:16
. Also moved patch location to mid-back to either side of the spine. Just have to wait a couple weeks to see if this is a good location.

You should always rotate patch sites each time you change it out. Have a sort of schedule. Patch can go pretty much anywhere but I use both upper top thighs, deltiods both sides, upper chest, both sides, upper back both sides, then start over.. sounds like her problem is oily skin. I just thought aboutit and remembered a lady who used to wash her skin with dish soap, rinse then used skin prep to keep the patch on. It is not the patch itself but the oil on the skin that is the problem.