prepare and administer parenteral medications 2
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Prepare and Administer
Parenteral MedicationsAssist. Prof. Dr.zlem Tanrver
Yeditepe University
Medical FacultyDepartment of Family Medicine
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Route of administration
It is the path by which a drug, fluid, poisonor other substance is brought into contactwith the body.
A substance must be transported from thesite of entry to the part of the body whereits action is desired to take place.
http://en.wikipedia.org/wiki/Medicationhttp://en.wikipedia.org/wiki/Medication -
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Routes of administration can bedivided into:
topical: local effect, substance is applieddirectly where its action is desired
enteral: desired effect is systemic (non-local), substance is given via the digestivetract
parenteral: desired effect is systemic,substance is given by other routes thanthe digestive tract
http://en.wikipedia.org/wiki/Digestive_tracthttp://en.wikipedia.org/wiki/Digestive_tracthttp://en.wikipedia.org/wiki/Digestive_tracthttp://en.wikipedia.org/wiki/Digestive_tract -
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Topical
epicutaneous (application onto the skin), e.g.allergy testing, typical local anesthesiainhalational, e.g. asthma medicationsenema, e.g. contrast media for imaging of theboweleye drops (onto the conjunctiva), e.g. antibioticsfor conjunctivitisear drops - such as antibiotics or corticosteroids
intranasal route (into the nose), e.g.decongestant nasal spraysvaginal, e.g. topical estrogens, antibacterials
http://en.wikipedia.org/wiki/Local_anesthesiahttp://en.wikipedia.org/wiki/Asthmahttp://en.wikipedia.org/wiki/Enemahttp://en.wikipedia.org/wiki/Conjunctivahttp://en.wikipedia.org/wiki/Antibiotichttp://en.wikipedia.org/wiki/Corticosteroidshttp://en.wikipedia.org/wiki/Intranasal_routehttp://en.wikipedia.org/wiki/Nosehttp://en.wikipedia.org/wiki/Decongestanthttp://en.wikipedia.org/wiki/Decongestanthttp://en.wikipedia.org/wiki/Nosehttp://en.wikipedia.org/wiki/Intranasal_routehttp://en.wikipedia.org/wiki/Corticosteroidshttp://en.wikipedia.org/wiki/Antibiotichttp://en.wikipedia.org/wiki/Conjunctivahttp://en.wikipedia.org/wiki/Enemahttp://en.wikipedia.org/wiki/Asthmahttp://en.wikipedia.org/wiki/Local_anesthesia -
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Enteral
by mouth (orally), many drugs as tablets,capsules, or drops
by gastric feeding tube, duodenal feedingtube, or gastrostomy, many drugs andenteral nutrition
rectally, various drugs in suppository orenema form
http://en.wikipedia.org/wiki/Mouthhttp://en.wikipedia.org/wiki/Tablethttp://en.wikipedia.org/wiki/Gastric_feeding_tubehttp://en.wikipedia.org/wiki/Duodenalhttp://en.wikipedia.org/wiki/Gastrostomyhttp://en.wikipedia.org/wiki/Enteral_nutritionhttp://en.wikipedia.org/wiki/Rectumhttp://en.wikipedia.org/wiki/Suppositoryhttp://en.wikipedia.org/wiki/Enemahttp://en.wikipedia.org/wiki/Enemahttp://en.wikipedia.org/wiki/Suppositoryhttp://en.wikipedia.org/wiki/Rectumhttp://en.wikipedia.org/wiki/Enteral_nutritionhttp://en.wikipedia.org/wiki/Gastrostomyhttp://en.wikipedia.org/wiki/Duodenalhttp://en.wikipedia.org/wiki/Gastric_feeding_tubehttp://en.wikipedia.org/wiki/Tablethttp://en.wikipedia.org/wiki/Mouth -
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Parenteral by injection orinfusion
intravenous (into a vein), e.g. many drugs, total parenteral nutritionintraarterial (into an artery), e.g. vasodilator drugs in the treatment of vasospasm andthrombolytic drugs for treatment of embolismintramuscular (into a muscle), e.g. many vaccines, antibiotics, and long-termpsychoactive agentssubcutaneous (under the skin), e.g. insulinintraosseous infusion (into the bone marrow) is, in effect, an indirect intravenousaccess because the bone marrow drains directly into the venous system. This routeis occasionally used for drugs and fluids in emergency medicine and paediatricswhen intravenous access is difficult.intradermal, (into the skin itself) is used for skin testing some allergens, and also fortattoosintrathecal (into the spinal canal) is most commonly used for spinal anesthesia and
chemotherapyintraperitoneal, (infusion or injection into the peritoneum) e.g. peritoneal dialysis ispredominantly used in veterinary medicine and animal testing for the administration ofsystemic drugs and fluids due to the ease of administration compared with otherparenteral methods
http://en.wikipedia.org/wiki/Injection_%28medicine%29http://en.wikipedia.org/wiki/Infusion_pumphttp://en.wikipedia.org/wiki/Intravenous_therapyhttp://en.wikipedia.org/wiki/Veinhttp://en.wikipedia.org/wiki/Total_parenteral_nutritionhttp://en.wikipedia.org/wiki/Arteryhttp://en.wikipedia.org/wiki/Vasodilatorhttp://en.wikipedia.org/wiki/Vasospasmhttp://en.wikipedia.org/wiki/Thrombolytic_drughttp://en.wikipedia.org/wiki/Embolismhttp://en.wikipedia.org/wiki/Intramuscular_injectionhttp://en.wikipedia.org/wiki/Musclehttp://en.wikipedia.org/wiki/Vaccinehttp://en.wikipedia.org/wiki/Subcutaneoushttp://en.wikipedia.org/wiki/Insulinhttp://en.wikipedia.org/wiki/Intraosseous_infusionhttp://en.wikipedia.org/wiki/Bonehttp://en.wikipedia.org/wiki/Intradermalhttp://en.wikipedia.org/w/index.php?title=Skin_testing&action=edithttp://en.wikipedia.org/wiki/Allergenshttp://en.wikipedia.org/wiki/Tattoohttp://en.wikipedia.org/wiki/Intrathecalhttp://en.wikipedia.org/wiki/Anesthesiahttp://en.wikipedia.org/wiki/Chemotherapyhttp://en.wikipedia.org/wiki/Peritoneumhttp://en.wikipedia.org/wiki/Dialysishttp://en.wikipedia.org/wiki/Dialysishttp://en.wikipedia.org/wiki/Peritoneumhttp://en.wikipedia.org/wiki/Chemotherapyhttp://en.wikipedia.org/wiki/Anesthesiahttp://en.wikipedia.org/wiki/Intrathecalhttp://en.wikipedia.org/wiki/Tattoohttp://en.wikipedia.org/wiki/Allergenshttp://en.wikipedia.org/w/index.php?title=Skin_testing&action=edithttp://en.wikipedia.org/wiki/Intradermalhttp://en.wikipedia.org/wiki/Bonehttp://en.wikipedia.org/wiki/Intraosseous_infusionhttp://en.wikipedia.org/wiki/Insulinhttp://en.wikipedia.org/wiki/Subcutaneoushttp://en.wikipedia.org/wiki/Vaccinehttp://en.wikipedia.org/wiki/Musclehttp://en.wikipedia.org/wiki/Intramuscular_injectionhttp://en.wikipedia.org/wiki/Embolismhttp://en.wikipedia.org/wiki/Thrombolytic_drughttp://en.wikipedia.org/wiki/Vasospasmhttp://en.wikipedia.org/wiki/Vasodilatorhttp://en.wikipedia.org/wiki/Arteryhttp://en.wikipedia.org/wiki/Total_parenteral_nutritionhttp://en.wikipedia.org/wiki/Veinhttp://en.wikipedia.org/wiki/Intravenous_therapyhttp://en.wikipedia.org/wiki/Infusion_pumphttp://en.wikipedia.org/wiki/Injection_%28medicine%29 -
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Enteral
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Syringe from plastic or disposable glass
Needle+protective cover
or sheetBarrel
Plunger
Calibrated inccs(=mls)
http://img.alibaba.com/photo/50064808/10ml_Disposable_Sterilized_Syringe.jpg -
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Needles are sized according to their lengthand gauge (diameter of the lumen).
22-23 gauge for watery medications
20-21 gauge for thicker, oily viskosemedications.
The higher the gauge the thinner theneedle !
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Initial procedures Common to all injections
Injection Tray:
Syringe and needle with medication
Sterile alcohol wipesDisposable gloves
Patients chart
Medication Card
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Intramuscular Injection
Needle size 20-23 gauge
Depth 1 -3 inch
Angle of injection 90
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Advantages of IM Route
2 mls of medications
Absorbtion rapid
Oily injections feasible
Avoids interaction with digestive juices
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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-acromionreferance point)
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Intramuscular Sites for Injection
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Intramuscular injection
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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
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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.
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Vastus Lateralis
Landmarks: Place one hand below the greater trocanter and one hand above the lateralfemoral condyle; mid-lateral thigh.
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Deltoid
Landmarks: 2 finger widths down from the acromion process; the bottom edge is at animaginary line drawn from the axilla
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Deltoid site
Maximum injection 1 ml
Maximum needle 1 inchNo oily medications
Never for infants and children
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Infants
Deltoid and gluteal not used for infants
Vastus lateralis for infants, angle of
injection 45
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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
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SUBCUTANEOUSINJECTIONS
A subcutaneous injection is administeredbeneath the epidermis into the fat and
connective tissue underlying the dermis.For subcutaneous injections the skin should begently pinched in to a fold to elevatesubcutaneous tissue which lifts the adipose
tissue away from the underlying muscle.Subcutaneous injections can be given at 45 or90 degrees (for insulin injections).
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This space tends to hold medication for a longertime than muscle, slowly releasing themedication 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 needlesmoothly and rapidly to minimize patientdiscomfort.
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Aspirate to make sure you haven't entereda 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 themedication.
Remove the needle and massage the siteof injection.
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INTRADERMAL INJECTIONS
Medication administration
Skin testingPPD
Allergy Testing
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Steps
1.Explain procedure to patient2.Select injection site ( The inner ventral surface of the forearm isthe most common site. It should be free of hair, lesions, scars orveins).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 thethumb and forefinger6. Insert the needle at a 5- 15 degrees angle with the bevel up .7. Do not aspirate8.Slowly inject medication, making a 6-10 mm wheal under the skin
9. Pat dry. Do not apply pressure to site.
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Cleanse area, hold skin taut, inject fluid(bevel side up). A small bleb, just beneaththe skin will be evident.
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