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Parenteral Administration
- 6. ∗ Assessment ∗Injection site ∗Drug allergies ∗Patient condition – be alert to changes that can affect drug therapy ∗Consent forms
- 7. Parenteral Administration ∗ Parenteral Medications are given through a route other than the alimentary canal; these routes are: ∗ ∗ ∗ ∗ Intradermal (ID) Subcutaneous (SC or SQ) Intramuscular (IM) Intravenous ( IV)
- 8. EQUIPMENT ∗ Needles ∗ Available in different gauges – the smaller the number, the larger the gauge (inside diameter) ∗ Length – long enough to penetrate the appropriate layers of tissue ∗ Syringes ∗ ∗ ∗ ∗ Barrel Plunger With or without needle Calibrated in milliliters or units
- 9. Needles A needle has three parts, the hub, the shaft, and the bevel.
- 10. The hub is at one end of the needle and is the part that attaches to the syringe. The shaft is the long slender stem of the needle that is beveled at one end to form a point. bevel- is the slanted part at the tip of the shaft The hollow bore of the needle shaft is known as the lumen.
- 11. Needle Size-is designated by LENGTH AND GAUGE The length of a needle is measured in inches from the juncture of the hub and the shaft to the tip of the point. Needle lengths range from 3/8 inch to 3 1/2 inches; some special use needles are even longer. The gauge of a needle, used to designate the size of the lumen, ranges from 27 (the finest) to 13 (the largest).
- 12. The smaller the number, the larger the gauge (inside diameter).
- 16. SYRINGES ∗ Tip-which connects the needle ∗ Barrel-outside part, which contains measurement calibrations ∗ Plunger-which fits the inside the barrel and has a rubber tip THE NURSE MUST ENSURE THAT THE SYRINGE TIP, INSIDE OF THE BARREL, SHAFT & RUBBER PLUNGER TIP & SHAFT OF THE NEEDLE ARE KEPT STERILE.
- 17. Parts of a Syringe
- 18. TYPES OF SYRINGES ∗ Standard- comes in 3ml,5 and 10ml ∗ Insulin-designed specially for use with the ordered dose of insulin ∗ Tuberculin-narrow syringe, use to administer small or precise doses such as pediatric dosages. ∗ Should be used for doses of 0.5ml or less
- 22. Parenteral Drug Packaging ∗ Ampule – glass or plastic container that is sealed and sterile (open with care) ∗ Vial – small bottle with rubber diaphragm that can be punctured by needle
- 27. Preparing to Administer a Drug (cont.) ∗ Rules for administration ∗ Give only drugs the doctor orders – use drug reference, if necessary ∗ Wash your hands ∗ Prepare in a well-lit area ∗ Focus on task; avoid distractions ∗ Calculate the dose carefully ∗ Do not leave a prepared drug unattended – never give a drug that someone else has prepared
- 28. Preparing to Administer a Drug (cont.) ∗ Rules for administration ∗ Identify patient properly ∗ Physician should be in the office ∗ Observe patient following administration ∗ Discard any ungiven medications properly ∗ Report error to physician immediately ∗ Document properly
- 29. Parenteral Dose Forms ∗ Parenteral preparations must be sterile ∗ free of microorganisms ∗ To ensure sterility, parenterals are prepared using ∗ aseptic techniques ∗ special clothing (gowns, masks, hair net, gloves) ∗ laminar flow hoods placed in special rooms
- 30. Preparing to Administer a Drug (cont.) Seven Rights of Drug Administration 1. Right patient 2. Right drug 3. Right dose 4. Right time 5. Right route 6. Right technique 7. Right documentation
- 32. Apply Your Knowledge How do you properly identify the patient before administering a drug? ANSWER: To ensure that you have the right patient, you should check the name and date of birth on the patient record and ask the patient to state his/her name and date of birth.
- 33. Techniques for Administering Drugs (cont.) ∗ Methods of injection ∗ Intradermal ∗ Into upper layer of skin ∗ Used for skin tests ∗ Subcutaneous ∗ Provides slow, sustained release and longer duration of action ∗ Rotate sites ∗ Intramuscular ∗ ∗ ∗ ∗ More rapid absorption Less irritation of tissue Larger amount of drug Z-track method ∗ Intravenous ∗ Not usually given by medical assistants
- 34. Intradermal or Intracutaneous ∗ -to diagnose TB, identify allergens, administer local anesthetics ∗ -drugs are absorb slowly from this site ∗ -commonly used for ID injection are the INNER ASPECT OF THE FOREARM (upper chest and upper back beneath the scapula) ∗ -drug’s dosage contained in a small quantity of solution (0.01 to 0.1 ml)
- 36. Intradermal Injections ∗ Given into capillary-rich layer just below epidermis for ∗ local anesthesia ∗ diagnostic tests ∗ immunizations
- 37. Intradermal Injections ∗ Examples of ID injections include ∗ skin test for tuberculosis (TB) or fungal infections ∗ typical site is the upper forearm, below the area where IV injections are given ∗ allergy skin testing ∗ small amounts of various allergens are administered to detect allergies ∗ usually on the back
- 40. Subcutaneous Injections ∗ Given at a 45-degree angle ∗ 25- or 26-gauge needle, 3/8 to 5/8 inch length ∗ No more then 1.5 mL should be injected into the site ∗ to avoid pressure on sensory nerves causing pain and discomfort
- 41. Subcutaneous Injections ∗ Administer medications below the skin into the subcutaneous fat ∗ outside of the upper arm ∗ top of the thigh ∗ lower portion of each side of the abdomen ∗ not into grossly adipose, hardened, inflamed, or swollen tissue ∗ Often have a longer onset of action and a longer duration of action ∗ compared with IM or IV injection
- 42. Subcutaneous Injections ∗ Insulin is given using 28- to 30-gauge short needles ∗ in special syringe that measures in units ∗ Insulin is administered following a plan for site rotation ∗ to avoid or minimize local skin reactions ∗ Absorption may vary depending on ∗ site of administration ∗ activity level of the patient
- 43. Subcutaneous Injections ∗ Keep insulin refrigerated ∗ Check expiration dates frequently ∗ opened vials should be discarded after one month ∗ A vial of insulin is agitated and warmed by rolling between the hands and should never be shaken ∗ The rubber stopper should be wiped with an alcohol wipe
- 44. Subcutaneous Injections Do not shake insulin.
- 45. Subcutaneous Injections ∗ Medications administered by this route include: ∗ epinephrine (or adrenaline) ∗ for emergency asthmatic attacks or allergic reactions ∗ heparin or low molecular–weight heparins ∗ to prevent blood clots ∗ sumatriptan or Imitrex ∗ for migraines ∗ many vaccines
- 46. Subcutaneous Injections ∗ Normally given with the syringe held at a 45-degree angle ∗ in lean older patients with less tissue and obese patients with more tissue, the syringe should be held at more of a 90-degree angle ∗ Correct length of needle is determined by a skin pinch in the injection area ∗ proper length is one half the thickness of the pinch
- 47. Subcutaneous Injections ∗ When administering insulin, air is injected into vial ∗ equal to the amount of insulin to be withdrawn ∗ Air is gently pushed from syringe with the plunger ∗ Patient should plan meals, exercise, and insulin administration ∗ to gain the best advantage of the medication ∗ avoid chances of creating hypoglycemia
- 48. Intramuscular Injections ∗ Typical needle is 22- to 25gauge ½- to 1-inch needle ∗ Intramuscular (IM) injections are administered at a 90-degree angle ∗ volume limited to less than 3 mL
- 50. Intramuscular Injections ∗ Care must be taken with deep IM injections to avoid hitting a vein, artery, or nerve ∗ In adults, IM injections are given into upper, outer portion of the gluteus maximus ∗ large muscle on either side of the buttocks ∗ For children and some adults, IM injections are given into the deltoid muscles of the shoulders
- 51. Intramuscular Injections ∗ Used to administer ∗ antibiotics ∗ vitamins ∗ iron ∗ vaccines ∗ Absorption of drug by IM route is unpredictable ∗ not recommended for patients who are unconscious or in a shocklike state
- 52. Parenteral Administration ∗ Intramuscular Injection ∗ Promote rapid drug absorption. ∗ Provide an alternate route when drug is irritating to subcutaneous tissue. ∗ Sites ∗ Gauge and needle length Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 30-52
- 55. Intravenous Injections or Infusions ∗ Intravenous (IV) injections are administered at a 15- to 20-degree angle
- 56. Parenteral Dose Forms ∗ Intramuscular (IM) injections ∗ into a muscle ∗ Subcutaneous injections ∗ under the skin ∗ Intradermal (ID) injections ∗ into the skin
- 57. Advantages and Disadvantages of the Parenteral Route ∗ The IV route is the fastest method for delivering systemic drugs ∗ preferred administration in an emergency situation ∗ It can provide fluids, electrolytes, and nutrition ∗ patients who cannot take food or have serious problems with the GI tract ∗ It provides higher concentration of drug to bloodstream or tissues ∗ advantageous in serious bacterial infection
- 58. Advantages and Disadvantages of the Parenteral Route ∗ Traumatic injury from the insertion of needle ∗ Potential for introducing: ∗ toxic agents ∗ microbes ∗ pyrogens ∗ Impossible to retrieve if adverse reaction occurs ∗ injected directly into the body
- 59. Advantages and Disadvantages of the Parenteral Route ∗ Intramuscular (IM) and subcutaneous routes of administration are 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
- 60. Advantages and Disadvantages of the Parenteral Route ∗ For intramuscular (IM) and subcutaneous routes of administration, the injection site needs to be “prepped” ∗ using alcohol wipe ∗ Correct syringe, needle, and technique must be used ∗ Rotation of injection sites with long-term use ∗ prevents scarring and other skin changes ∗ can influence drug absorption
- 61. Advantages and Disadvantages of the Parenteral Route ∗ The intradermal (ID) route of administration is used for diagnostic and allergy skin testing ∗ patient may experience a severe local reaction if allergic or has prior exposure to a testing antigen
- 62. Dispensing and Administering Parenteral Medications ∗ Most parenteral preparations are made up of ingredients in a sterile-water medium ∗ the body is primarily an aqueous (water-containing) vehicle ∗ Parenteral preparations are usually: ∗ solutions ∗ suspensions
- 63. Dispensing and Administering Parenteral Medications ∗ IV injections and infusions are introduced directly into the bloodstream ∗ must be free of air bubbles and particulate matter ∗ introduction of air or particles might cause embolism, blockage in a vessel, or severe painful reaction at the injection site
- 64. Intravenous Injections or Infusions ∗ Fast-acting route because the drug goes directly into the bloodstream ∗ often used in the emergency department and in critical care areas ∗ Commonly used ∗ for fluid and electrolyte replacement ∗ to provide necessary nutrition to the patient who is critically ill
- 65. ANY QUESTIONS SO FAR?
Notas do Editor
- Many clients have broadly classified the parenteral route into one category : “INJECTIONS” OR “SHOTS”
- An injection is an invasive procedure because it breaks the skin barrier. As such it must be performed using proper aseptic technique to prevent infection.
- alimentary canal, also called digestive tract, pathway by which food enters the body and solid wastes are expelled. The alimentary canal includes the mouth, pharynx,esophagus, stomach, small intestine, large intestine, and anus. See digestion. Other routes such as intra-arterial or spinal are only accessed by specially trained professionals. The nurse should provide the client an explanation of the various routes used when administering parenteral drugs.
- Nurses use special equipment such as:
- Most needles are disposable, made of stainless steel and individually packed for sterility. Disposable needles should always be used when preparing admixtures as they are presterilized and individually wrapped to maintain sterility. Reusable needles are seldom used, except in certain areas such as surgery and special procedure rooms.
- Bevel may have short or long Length of bevel is based on type of injection Long bevels-sharp and produce less pain when injected into the subcutaneous or muscle tissues Short bevel-must be used for intradermal and intravenous injections to prevent occlusion of the bevel either by the tissue or by a blood vessel.
- There are two considerations when choosing a needle size; the viscosity of the solution, and the nature of the rubber closure on the parenteral container. Needles with larger lumens should be used for viscous solutions. Smaller gauge needles are preferred if the rubber closure can be cored easily. Coring is when a needle punctures or tears a piece of the rubber closure and the piece then falls into the container and creates particulate material contamination. Gauge of the needle refers to the diameter of the shaft THE LARGER THE GAUGE NUMBER, THE SMALLER THE DIAMETER OF THE SHAFT Large gauge Needles-produce less trauma to the body’s tissue; however the nurse should consider the varicosity of a solution when selecting the gauge. Shaft of the needle-determines its length. The nurse selects the length of the needle on the basis of the clients muscle development and weight and type of injection, such as ID VS IM
- A needle syringe is a device used for injecting, removing or infusing fluids. They are most commonly known in health care settings for injecting medications and for use in removing blood from the body. Syringes can differ in size and type, and they can be made of glass or plastic. The syringe chosen usually depends on its intended purpose. The syringe consists of a plunger, barrel, hub, needle and the needle's protective cover. It is important that all parts of a syringe coming into contact with the body be kept free of contamination. Syringes come is different sizes ranging from 1 to 60 ml. As a rule, select a syringe whose capacity is the next size larger than the volume to be measured. For example, a 3 ml syringe should be selected to measure 2.3 ml, or a 5 ml syringe to measure 3.8 ml. In this way, the graduation marks on the syringe will be in thesmallest possible increments for the volume measured. Syringes should not be filled to capacity because the plunger can be easily dislodged.