prepare and administer parenteral medications 2

7/31/2019 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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prepare and administer parenteral medications 2

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