What are important nursing considerations you have to observe when putting a transdermal patch?

Read the patient information for use before using your patch. Each product will have specific instructions for use.

Read the patient information for use before using your patch. Each product will have specific instructions for use.

Select an area of skin to apply the patch. Be sure to follow any specific instructions provided by your doctor or the product instructions as to site selection or rotation. Prepare the skin area and make sure the skin is clean and free of any powders, oils, and lotions.

Carefully open the packaging.  If using scissors, be careful not to cut the patch. Never use a patch that has been cut or damaged in any way.

Remove the protective liner according the product directions. Be sure not to touch the sticky side of the patch. Some protective liners are removed in two parts. If so, place the sticky half of the patch on the area of skin and gently peel off remaining liner.

Press down on the patch firmly with the palm of your hand.

Go around the edges with your fingers to press them onto the skin. Make sure that the patch is flat against the skin (there should be no bumps or folds in the patch).

Throw away the empty pouch and the protective liner in a closed trash can.

Wash your hands.

When it is time to remove the previous patch, use your fingers to peel it off slowly. Fold the patch in half with and press firmly to seal it shut.

Throw the used patch away in a closed trash. Used patches may still contain some medication and may be dangerous to children, pets, or adults.

Wash your hands.

Ask your doctor what to do if the patch loosens or falls off before it is time to replace it. Generally, you should try to press it back in place with your fingers. If the patch cannot be pressed back on, throw it away and apply a fresh patch to a different area. Replace the fresh patch at your regularly scheduled patch change time.

Transdermal nitroglycerin comes as a patch to apply to the skin. It is usually applied once a day, worn for 12 to 14 hours, and then removed. Apply nitroglycerin patches at around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use nitroglycerin patches exactly as directed. Do not apply more or fewer patches or apply the patches more often than prescribed by your doctor.

Choose a spot on your upper body or upper arms to apply your patch. Do not apply the patch to your arms below the elbows, to your legs below the knees, or to skin folds. Apply the patch to clean, dry, hairless skin that is not irritated, scarred, burned, broken, or calloused. Choose a different area each day.

You may shower while you are wearing a nitroglycerin skin patch.

If a patch loosens or falls off, replace it with a fresh one.

To use nitroglycerin patches, follow the steps below. Different brands of nitroglycerin patches may be applied in slightly different ways, so be sure to follow the directions included with your patches:

1. Wash your hands.
2. Hold the patch so that the plastic backing is facing you.
3. Bend the sides of the patch away from you and then toward you until you hear a snap.
4. Peel off one side of the plastic backing.
5. Use the other side of the patch as a handle, and apply the stick half to your skin in the spot you have chosen.
6. Press the sticky side of the patch against the skin and smooth it down.
7. Fold back the other side of the patch. Hold onto the remaining piece of plastic backing and use it to pull the patch across the skin.
8. Wash your hands again.
9. When you are ready to remove the patch, press down on its center to lift the edges away from the skin.
10. Hold the edge gently and slowly peel the patch away from the skin.
11. Fold the patch in half with the sticky side pressed together and dispose of it safely, out of the reach of children and pets. The used patch may still contain active medication that can harm others.
12. Wash the skin that was covered with the patch with soap and water. The skin may be red and may feel warm for a short time. You may apply lotion if the skin is dry, and you should call your doctor if the redness does not go away after a short time.

Nitroglycerin patches may no longer work as well after you have used them for some time. To prevent this, your doctor will probably tell you to wear each patch for only 12 to 14 hours each day so that there is a period of time when you are not exposed to nitroglycerin every day. If your angina attacks happen more often, last longer, or become more severe at any time during your treatment, call your doctor.

Nitroglycerin patches help prevent attacks of angina but do not cure coronary artery disease. Continue to use nitroglycerin patches even if you feel well. Do not stop using nitroglycerin patches without talking to your doctor.

Learn how to apply and remove a transdermal patch. Transdermal patch application is easy, but as the nurse you must know how to properly remove and apply a patch. This tutorial will cover the application of a Fentanyl transdermal patch.

What are transdermal patches? They are medicated sticky, adhesive patches wore on the skin. The adhesive backing on the patch that sticks to the skin contains medication that is continuously delivered via the skin to the bloodstream.  Many different types of medications can be ordered via the transdermal route. One of these medications are Fentanyl.

What is Fentanyl? It is an opioid pain medication used to treat severe pain. Patients who use transdermal Fentanyl patches are opioid tolerant, meaning they experience chronic, severe pain that cannot be controlled with oral opioid medications. Therefore, the transdermal patch can deliver continuous amounts of Fentanyl to help manage the patient’s pain. These patches are not for patients who have never taken oral opioid medications (these patches usually contain high doses of Fentanyl and can be too strong for patients who have never taken Fentanyl, which can lead to severe side effects), acute pain such as post-op or surgical related etc.

Nurse’s Role with a Transdermal Patch of Fentanyl:

When administering a new patch, ALWAYS remove the previous patch before applying the new one.

ALWAYS wear gloves when removing and applying a Fentanyl patch! Why? To prevent becoming contaminated with the drug.

ALWAYS have another nurse witness you disposing of the old Fentanyl patch and dispose according to your hospital’s protocol. Every employer has specific guidelines for how this is done.

Never apply a new transdermal patch on the same site (always rotate sites), broken or irritated skin, or on hair (it will not stick).

Sites to place a transdermal patch include: upper arm, chest, or back. If the patient is confused, place the patch on a site where the patient cannot easily pull it off.

Always time, date, and initial the patch.

When applying a new patch, assess the patient for adverse side effects:

• Respiratory depression
• Hypotension
• Decreased mental status (lethargic, confused etc.)
• Pain rating and it’s location

You may have to reinforce the patch with a tegaderm or tape to keep it from falling off, especially if the patient is sweaty, has oily skin, or it is located on an area that experiences a lot of friction.

Always chart where you place the patch so when the next dose is due the next nurse knows where to find the patch.

Video Demonstration on Transdermal Patch Application

Steps on How to Remove a Transdermal Patch

1. Note in the chart where the last nurse charted the location of the previous patch
2. Wash hands and don gloves
3. Remove patch from skin and fold it sticky side to sticky side

1. Dispose per hospital protocol with another nurse as a witness
2. Clean site with warm water to remove any residue or dead skin cells from the site
3. Doff gloves and wash hands

Steps on How to Apply a Transdermal Patch

1. Perform the patient’s 5 Rights:

• Right patient
• Right drug
• Right dose
• Right route
• Right time

2. Check the packaging (make sure it is not torn or expired)

3. Open new patch: don’t use scissors because you can mistakenly cut the patch

4. Date, time, and initial the patch (the patch still has the protective backing so do this on the opposite side)

5. Wash hands and don gloves

6. Pick a new site to place the patch and make sure skin is clean, intact, and free from hair. If hair is present, trim it (don’t shave it), and if the skin is dirty cleanse it with warm water only (not soap or lotions…this can prevent it from sticking).

7. Carefully take off one side of the back and stick it to the skin and then take off the other side of the backing.

8. Firm press down the patch for at least 15 to 20 seconds (make sure it has no bumps, folds, or bubbles). You may have to reinforce it with extra tape.

9. Chart location of the patch so the next nurse who removes it knows where it is.

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