Question: If an opioid transdermal patch (Norspan or Durogesic) does not adhere can I secure it with a secondary dressing?
For some patients who live in warmer climates especially over summer months, the patch does not adhere to the skin due to sweating. The patch begins to peel off before it is ready to be changed.
The main problem when applying patches is the temperature of the skin. Heat increases absorption of the drug which can lead to increased release of the drug from the patch. In some instances that has been fatal, or resulted in drug overdose. The product information advises against wearing the patch in saunas or near a heat source, eg. near a heater. The patch should be monitored closely if the patient is suffering from a fever. In contrast, in cold temperatures, the release rate can be slower, resulting in less analgesia.
The application instructions from the product information advises the following: The patch should be pressed firmly in place with the palm of the hand for approximately 30 seconds, making sure the contact is complete, especially around the edges.
Thus, in order to achieve firm application and complete contact, a patch that is not adhering will need assistance. A thin, breathable dressing, such as Tegaderm, Opsite, Hyperfix or similar can be used. As the external and third lining of the transdermal patch is made of an inert material, with the medicine in a matrix in the middle layer of the patch system, there is no reason why an external secondary dressing cannot be used. The breathable secondary dressing can be applied over the whole opioid patch. Some nurses have been securing just the edges of the patch, however this is not necessary. Whilst there are no clinical trials specific to the use of secondary dressings over opioid transdermal patches, the makers of Durogesic, Jansen Cilag, supports this in those patients who require it.
If a patient requires a secondary dressing over their opioid patch, documentation is vital so that there is consistency of practice. Variation in practice - where on one patch change a secondary dressing is used and at the next patch change it is not used - is not optimum clinical practice.
A similar question was asked on Medscape:
Question: If a fentanyl patch comes off or becomes loosened before a scheduled patch change, can it be replaced with a new one?
Answer: In my experience, it is important to apply a new patch to the same location on the skin as the prior patch. This is because the skin depot of fentanyl accumulates during patch adherence is already available and it will be less likely to result in a decrease in serum concentration from a break in therapy. The newly applied patch should remain on for the full 72 hours or as otherwise directed by the prescription.
The two opioid transdermal patches currently on the market are Norspan and Durogesic patch. Are you up to date with how Norspan and Durogesic work and the difference between the two? MedRN’s Chronic Pain DVD Series, discusses these medicines in detail and in an easy to understand way so that you can administer these medicines with confidence.
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