pediatric drug administration
DESCRIPTION
Different medications must be absorbed to be effective. For absorption, the drug must be administered in proper manner. To choose a route of administration we need to relate the dosage form, the advantages and disadvantages etc.TRANSCRIPT
DRUG ADMINISTRATION
DRUG ADMINISTRATION
INTRODUCTION
Different medications must be absorbed to be effective. For absorption, the drug must be administered in proper manner. To choose a route of administration
we need to relate the dosage form, the advantages and disadvantages etc.
ROUTES OF ADMINISTRATION
Definition It is the way of getting a drug onto
or into the body. It is chosen based on the effect upon the speed and efficiency with the drug action.
CLASSIFICATION
1. Enteral Oral Rectal2. Topical Otic Nasal Ophthalmic3. Parenteral Intravascular Intramuscular Subcutaneous Inhalation
ENTERAL
Desired effect is nonlocal, it is systemic
Substance is given via digestive tract
It is supplied in many forms as : Liquids Powders Tablets CapsulesThe equipments used are: Medicine cup Spoon Plastic oral syringe Dropper Nipple without bottle
ORAL ADMINISTRATION
TABLETS & CAPSULES
PROCEDURE• Crush the tablet (for children under 5-6 years)• Mix with pleasant tasting liquid• Never mix tablet with food FOR AN OLDER CHILD• Place tablet at the back of tongue• Tell child if there is medicine in food
LIQUIDS It should be given with proper equipment
as mentioned in packet. Drop size may vary from one to another. Do not use syringe for parental administration.
PROCEDURE• Shake well before use• While using dropper direct liquid directly to
posterior side of mouth• Slowly in small amounts• Allow child to swallow
In case of nipple without bottle:• Fill nipple by keeping medication directly • Place infant in upright positionIn case of tube feeding:• Medicine should be in liquid form• Check tube placement before and after
administration• Flush tube before and after to maintain
patency
ADVANTAGES
• Most convenient and commonly used route• Ease and safety of administration• Active ingredient is in powder or
granule form which dissolve in GI tract• Sub linguinal administration has
rapid onset (< 5 minutes)
DISADVANTAGES
• Delayed onset• Destruction of drug by GI fluids, food
or drink in stomach • Not indicated in patients with
nausea, sedated or unable to swallow
RECTAL ADMINISTRATION
It is not a preferred route for administration in children as it may be irritating and unpredictable. Method is invasive and upsetting. It is used when child is vomiting or receiving nothing by mouth.
Suppositories and enemas are two types of rectal administration of medication
SUPPOSITORY
This drug delivery system is inserted into rectum, vagina or urethra where it dissolves or melts. Suppositories are inserted as solids it dissolves to deliver medicine which is received later by blood vessels.
Example : glycerin paracetamol diclofenac
PROCEDURESEnsure the child in side lying
positionInsert suppository into the rectum
quickly but gentlyInsert suppository above anal
sphincterUse index finger for insertion FOR AN INFANT OR CHILD UNDER
3 YEAR OF AGEUse fifth finger for insertion To prevent expulsion of suppository,
hold buttocks together for several minutes
ENEMAS Usually used for cleaning the bowel, it has laxative action. In the case of diseases, drug is administered as enema.
ADVANTAGESCould be administered in unconscious patients and children.
Useful for nauseous patient and children
Easy to terminate exposureRelieve constipation or hemorrhoids
DISADVANTAGES
Absorption is slow and unpredictable in effectiveness
Irregular drug absorptionInconvenience.
TOPICAL It is the application of the drug directly to
the surface of skin. it includes administration of drugs to any mucous membrane. In this type of administration, the desired effect is local.
EyeNoseEarLungsUrethraColon
The dosage forms include:CreamsSolutionsOintmentsLotionsGelsTran dermal patchesSprayspowders
OPHTHALMIC MEDICATIONThey are supplied in the forms of drops or
ointmentsEnsure medication is at room temperature administer when child is not crying..PROCEDUREplace child in supine positionSlightly hyperextend neck with head lower than bodyRest the heel of your hand to stabilize on child’s foreheadRetract the lower eyelid & place medication in
conjunctival sac.
For ointment, apply medication on a thin ribbon from inner canthus outward without touching eye or eyelash
For an older child, we should instruct child to gently close the eyes to allow medication to be dispersed.
OTIC MEDICATIONSTypically they are in the form of drops.This root is upsetting because child cannot see the procedure..•Ensure that medication is at room
temperature.•Cold ear drops cause pain & vertigoPROCEDURE•Place child in supine or side lying position with affected ear exposed.•Pull pinna downward & back in children under
3 years.•Pull pinna upward and back in children over 3
years.
•Instill medication using dropper•Have the child remain in the same
position for several minutes.•Massage the area anterior to promote
passage of medication
NASAL ADMINISTRATIONThese medications are typically drops &
spraysAdditional help may be needed to keep
child’s position.PROCEDURE•Position child in supine position with
hyper extended head to ensure that the drops will flow back to nares.
•A pillow or folded towel can be used to facilitate the hyper extension.
•Place thee tip of the dropper just at or inside nasal opening
•Bottle should not touch the nares•After installations, maintain child’s head in hyperextension for 1 minute.
FOR NASAL SPRAYS
•Position the child upright•Place tip of spray bottle just inside nasal opening and tilted to back.
•Squeeze the container for instillation
ADVANTAGES•Local therapeutic effects•Lower risk of side effects•It offer steady level of drug in the system
DISAVANTAGES•Messiness•Irregular drug absorption•Improper technique leads to risk of side
effects•Alter drug efficacy
PARENTERAL ROUTE
It is an infusion by means of needle or catheter inserted into the body. Any method of administration that does not involve passage through the digestive tract is called parenteral .
Intra muscular Intra venous Intra-arterial Intra-cardiac
Intra-thecal Intraosseous- into bone marrow Intrapleural Intraperitoneal Intra-articular Intradermal (Intracutaneous) Subcutaneous route (Hypodermic)
INTRAVASCULARIt is placing the drug
directly into blood stream. It would be intravenous or intra arterial. It is used when we need a rapid response.
For administration in pediatrics an IV device should be inserted peripherally or centrally. Insertion is traumatic but it is less compared to the pain of multiple injections.
IV SITES Peripheral Sites: -vein in hand or forearm -scalp vein or foot vein in infant
(possible but central IV site preferred in neonates)
Central IV Sites: subclavian vein into superior vena cava
-central line inserted peripherally -umbilical vein in neonates
Different methods could be taken for administration including :
large volume infusion pumps
syringe pumps are accurate for small volume delivery
volumetric infusion devices (Buretrol) used for small total fluid requirements and slow rates of administration
PROCEDURE Place the child in supine position Seek the help of other nurses to hold
the child Check the patency of IV line Choose the area for IV administration(Scalp vein is best for infant & toddler.
Others sites are hand, foot antecubital fossa)
Meditation should be diluted appropriately
It should be given at the rate of over 2 – 3 minutes
Watch for irritation to small veins or any adverse reactions.
ADVANTAGES Complete and rapid drug absorption
with rapid onset of action Immediate access to cardiovascular
system Useful in neonates with little muscle
mass Less painful route for frequent
injections Administer drugs which cannot be
given by another route
DISADVANTAGES Rapid drug/fluid delivery means
immediate onset of adverse reactions inability to withdraw infused solutions Risk infusion of air, microorganisms,
pyrogens and particulate matter Risk sepsis (infection), phlebitis
(venous irritation), extravasations/infiltration (leaking outside of the vein)
INTRAMUSCULAR INJECTIONS
Here the drug is administered directly into skeletal muscle. For children it is given into deltoid muscles of shoulders.
Typical needle is 22- to 25-gauge ½- to 1-inch needle
Intramuscular (IM) injections are administered at a 90-degree angle.
volume limited to less than 3 mL
Fewer medications are given by this route due to potential for pain.
Medications typically given IM Newborn—Vitamin K Immunizations At times antibiotics Vastus Lateralis muscle for newborns, infants and
young children (Rectus femoris muscle is an alternative)
Dorso gluteal site is not used until the child has been walking ( atleast 1 year)
SITES
PROCEDURE Select the needle size and gauge based
on size of child’s muscle. Position the child with proper assistance Deltiod – 1 finger below acromion
process Vastus lateralis – lateral aspect of thigh (one handbreadth from greater
trochanter and one handbreadth above femoral condyle in the lateral aspect)
Rectus femoris – lies over the femur
(one handbreadth from greater trochanter and one handbreadth above femoral condyle in the anterior aspect)
Spread the skin apart Insert needle at a 90 degree angle. Aspirate for blood and administer. If it is an infant or a child with
small muscle mass, 45 degree angle is preferred
ADVANTAGES convenient ways to deliver medications
Compared with the IV route: onset of response of the medication is slower duration of action is much longer
Practical for use outside the hospital Used for drugs which are not active orally Absorption is rapid than subcutaneous
route. Oily preparations can be used. Irritative substances might be given
DISADVANTAGES Neurovascular damage Bleeding (eg anticoagulant therapy) Pain Infection Delayed absorption in shock
SUBCUTANEOUS
Here we administer medications below the skin into the subcutaneous fatoutside of the upper armtop of the thighlower portion of each side of the
abdomen not into grossly adipose, hardened,
inflamed, or swollen tissue
SITE
Given at a 45-degree angle
25- or 26-gauge needle, 3/8 to 5/8 inch length
SITES
Abdominal wallThighDeltoid area
PROCEDURE
Position the baby with proper assistance
Select the site and clean the areaPinch skin together and insert needle in 45 degree angle
Aspirate for blood and administer
ADVANTAGESslow and constant absorption Often have a longer onset of action and a
longer duration of action compared with IM or IV injection
DISADVANTAGESabsorption is limited by blood flow , affected if
circulatory problems exist concurrent administration of vasoconstrictor will slow
absorption
INHALATION
Inhalation may be the route of choice to avoid the systemic effects. In this way drugs can pass directly to the lungs. Drugs used involve volatile drugs and gases. Examples include aerosols like salbutamol; steam inhalations include tincture and Benzoin.
solids and liquids are excluded if larger than 20 micron. the particles impact in the mouth and throat. Smaller than 0.5 micron , they aren't
retained.
Medications can be administered directly into the respiratory tree in cases of respiratory distress resulting from reversible airway disease including asthma and certain types of chronic obstructive pulmonary disease. These medications are usually nebulized into a water vapor and breathed with normal respiration.
PROCEDURE Shake canister well “Prime” by pressing down and activating a practice dose. Insert canister into a mouthpiece or
spacer to reduce the amount of drug deposited on the back of the throat.
Breathe out and hold spacer between lips making a seal
Activate & take a deep slow inhalation. Hold breath briefly &slowly exhale
through nose
Advantages:
Rapid absorption takes place.Rapid onset of action takes place.
This route has minimum side effects.
No first pass effect takes placeThis method is easy.Fewer doses is required
Disadvantages:
Special apparatus is required.Irritation of the respiratory tract may take place.Cooperation of the patient is required.
Airway must be patent.
THANK
YOU..