Prepare and Administer Parenteral Medications

Assist. Prof. Dr.zlem Tanrver Yeditepe University Medical Faculty Department of Family Medicine

Route of administration
It is the path by which a drug, fluid, poison or other substance is brought into contact with the body. A substance must be transported from the site of entry to the part of the body where its action is desired to take place.

Routes of administration can be divided into:

topical: local effect, substance is applied directly where its action is desired enteral: desired effect is systemic (nonlocal), substance is given via the digestive tract parenteral: desired effect is systemic, substance is given by other routes than the digestive tract

Topical
epicutaneous (application onto the skin), e.g. allergy testing, typical local anesthesia inhalational, e.g. asthma medications enema, e.g. contrast media for imaging of the bowel eye drops (onto the conjunctiva), e.g. antibiotics for conjunctivitis ear drops - such as antibiotics or corticosteroids intranasal route (into the nose), e.g. decongestant nasal sprays vaginal, e.g. topical estrogens, antibacterials

Enteral
by mouth (orally), many drugs as tablets, capsules, or drops by gastric feeding tube, duodenal feeding tube, or gastrostomy, many drugs and enteral nutrition rectally, various drugs in suppository or enema form

Parenteral by injection or infusion

intravenous (into a vein), e.g. many drugs, total parenteral nutrition intraarterial (into an artery), e.g. vasodilator drugs in the treatment of vasospasm and thrombolytic drugs for treatment of embolism intramuscular (into a muscle), e.g. many vaccines, antibiotics, and long-term psychoactive agents subcutaneous (under the skin), e.g. insulin intraosseous infusion (into the bone marrow) is, in effect, an indirect intravenous access because the bone marrow drains directly into the venous system. This route is occasionally used for drugs and fluids in emergency medicine and paediatrics when intravenous access is difficult. intradermal, (into the skin itself) is used for skin testing some allergens, and also for tattoos intrathecal (into the spinal canal) is most commonly used for spinal anesthesia and chemotherapy intraperitoneal, (infusion or injection into the peritoneum) e.g. peritoneal dialysis is predominantly used in veterinary medicine and animal testing for the administration of systemic drugs and fluids due to the ease of administration compared with other parenteral methods

Enteral

Syringe from plastic or disposable glass

Needle+ protective cover or sheet Barrel Plunger Calibrated in ccs(=mls)

Needles are sized according to their length and gauge (diameter of the lumen). 22-23 gauge for watery medications 20-21 gauge for thicker, oily viskose medications. The higher the gauge the thinner the needle !

Initial procedures Common to all injections Injection Tray: Syringe and needle with medication Sterile alcohol wipes Disposable gloves Patients chart Medication Card

Intramuscular Injection
Needle size 20-23 gauge

Depth 1 -3 inch
Angle of injection 90

Advantages of IM Route
2 mls of medications Absorbtion rapid Oily injections feasible Avoids interaction with digestive juices

Injection sites
1. Dorsogluteal site ( prone position) 2. Ventrogluteal site ( patient-to the side) 3. Vastus lateralis (patient-sitting) 4. Deltoid site ( outer upper arm-acromion

referance point)

Intramuscular Sites for Injection

Intramuscular injection

Dorsal Gluteal (greatest risk of injury)

Landmarks: Draw an imaginary line between the greater trochanter and the posterior superior iliac spine; at the middle of the imaginary line, go up about one inch

Ventrogluteal
Landmarks: With thumb toward the umbilicus, place palm of hand on the greater trocanter, index finger on the anterior superior iliac spine, and the middle finger on the iliac crest.

Vastus Lateralis
Landmarks: Place one hand below the greater trocanter and one hand above the lateral femoral condyle; mid-lateral thigh.

Deltoid

Landmarks: 2 finger widths down from the acromion process; the bottom edge is at an imaginary line drawn from the axilla

Deltoid site
Maximum injection 1 ml Maximum needle 1 inch No oily medications Never for infants and children

Infants

Deltoid and gluteal not used for infants Vastus lateralis for infants, angle of injection 45

Demonstration for vastus lateralis

Patient is seated 70% Alcohol ( circular motion) Bevel up 90 Release the skin With non-dominant hand support Aspiration Proceed injection Quickly pull the needle out (prevents tissue damage and reduces pain) Massage for easy absorbtion Throw disposable gloves Washing hands

SUBCUTANEOUS INJECTIONS
A subcutaneous injection is administered beneath the epidermis into the fat and connective tissue underlying the dermis. For subcutaneous injections the skin should be gently pinched in to a fold to elevate subcutaneous tissue which lifts the adipose tissue away from the underlying muscle. Subcutaneous injections can be given at 45 or 90 degrees (for insulin injections).

This space tends to hold medication for a longer time than muscle, slowly releasing the medication into the circulation. Wipe the injection site clean with an antiseptic solution, such as alcohol. Pinch the area with your thumb and forefinger, creating a bulge. Direct the needle at a 45 degree angle, through the skin and into the SQ space. Insert the needle smoothly and rapidly to minimize patient discomfort.

Aspirate to make sure you haven't entered a blood vessel. If you get a blood return, remove the needle, get a fresh needle, and try again. If the aspiration is negative, then inject the medication. Remove the needle and massage the site of injection.

INTRADERMAL INJECTIONS
Medication administration Skin testing PPD Allergy Testing

Steps
1.Explain procedure to patient 2.Select injection site ( The inner ventral surface of the forearm is the most common site. It should be free of hair, lesions, scars or veins). 3. Perform hand hygiene and put on gloves. 4. Clean each site with a seperate alcohol swab and allow to dry. 5. Support patients forearm. Strecth the skin taut between the thumb and forefinger 6. Insert the needle at a 5- 15 degrees angle with the bevel up . 7. Do not aspirate 8.Slowly inject medication, making a 6-10 mm wheal under the skin 9. Pat dry. Do not apply pressure to site.

Cleanse area, hold skin taut, inject fluid (bevel side up). A small bleb, just beneath the skin will be evident.