How is a fentanyl (transdermal opioid analgesic) patch applied?

How to Apply a Fentanyl Patch

Apply the fentanyl patch to intact, non-irritated skin on a flat surface such as the chest, back, flank, or upper arm (for adults), or the upper back (for children and cognitively impaired patients to prevent removal), changing the site with each application every 72 hours. 1

Site Selection and Skin Preparation

• Choose a flat, hairless area on the chest, back, flank, or upper arm for adults 1
• For children and cognitively impaired adults, apply only to the upper back to minimize risk of patch removal and oral ingestion 1
• Avoid areas that are oily, burned, broken out, cut, irritated, damaged, or very sensitive 1
• Avoid areas that move around excessively during normal activity 1
• If hair is present, clip it close to the skin—never shave, as this causes skin irritation 1
• Clean the site with clear water only and pat completely dry; do not use soaps, oils, lotions, or alcohol 1

Application Technique

• Remove the patch from its sealed pouch only when ready to apply; do not use if the pouch seal is broken or the patch is cut or damaged 1
• Peel off both parts of the clear protective liner from the patch 1
• Touch the sticky side as little as possible to maintain adhesion 1
• Press the patch firmly onto the chosen site with the palm of your hand for at least 30 seconds, ensuring complete contact especially around the edges 1
• Wash hands immediately with soap and water after application 1

Adhesion Management

• If the patch begins to lift at the edges, apply first aid tape only to the edges 1
• If adhesion problems persist, cover the entire patch with a transparent adhesive film dressing (such as Bioclusive™ or Tegaderm™)—never use any other type of bandage or tape 1
• If the patch falls off before 72 hours, fold it in half (sticky sides together), flush it down the toilet immediately, and apply a new patch to a different site 1

Patch Replacement Schedule

• Replace the patch every 72 hours (3 days) at approximately the same time of day 1
• A small proportion of adult patients may require 48-hour dosing intervals if adequate pain control cannot be achieved with 72-hour intervals, but attempt dose escalation first 1
• Remove the old patch before applying the new one 1
• Always rotate to a different skin site with each application—do not reuse the same location consecutively 1

Critical Safety Warnings

• Absolutely avoid exposing the patch site to any external heat sources (heating pads, electric blankets, heat lamps, hot tubs, saunas, heated waterbeds, prolonged direct sunlight) as this accelerates absorption and can cause fatal overdose 2, 3, 1
• Patients can bathe, swim, or shower while wearing the patch 1
• Keep all patches (used and unused) away from children and pets—accidental exposure can be fatal 1
• Instruct caregivers to avoid contact with unwashed application sites, as secondary exposure can occur through skin contact, hugging, or sharing a bed 1

Disposal

• Fold the used patch in half so the sticky sides adhere to each other, then flush it down the toilet immediately 1
• For unused patches, remove from pouch, remove protective liner, fold sticky sides together, and flush down the toilet 1
• Never dispose of patches in household trash where children or pets could access them 1

Common Pitfalls to Avoid

• Do not apply patches to opioid-naïve patients—fentanyl patches are only for opioid-tolerant individuals 2, 3, 1
• Do not use patches for acute or unstable pain requiring frequent dose adjustments 2
• Do not cut or alter patches in any way before application 1
• Remember that fentanyl levels continue to rise for 12-24 hours after initial application, so breakthrough medication must be available during this period 2, 3