Unit 13 Administration of Parenteral Medications

Obtain the correct medication.

Identify the patient. Explain the procedure.

Obtain the correct medication. a

Identify the patient. Explain the procedure.

Once the needle is inserted, gently pull back on the plunger - aspirate - to ensure that the needle is not in a blood vessel.

If blood appears in the syringe upon aspiration, smoothly withdraw the needle, properly discard the used unit, and prepare another injection for administration.

Caution: Extreme caution should be used when giving intramuscular injections in the dorso-gluteal area.

Improper site selection can result in damage to the sciatic nerve or injection into the superior gluteal artery or vein.

The parenteral route of drug administration offers an effective mode of delivering medication to a patient when a rapid and direct result is desired.

Injected drugs are absorbed directly into the bloodstream; therefore, they manifest their medicinal effects within minutes.

Body size: the amount of medication given and the size of the needle used are directly related to the size of the patient.

Pediatric and geriatric patients usually have less subcutaneous and muscular tissue per body surface area than the average adult.

Patients who are small or thin usually require less medication than the average adult, and a longer needle to reach the appropriate tissue level.

Sex: (muscular build) male patients are generally more muscular than female patients.

A younger persons skin usually has more tone than that of an older person.

Slightly more force is required to penetrate skin that is tough or lacking in tone.

Cover site. do not massage. Rationale: Because of the tissue irritating properties of the medication, do not massage the area. Dispose of equipment.

Special Considerations For The Administration of Insulin

1. intravenous- produces fastest effect.

2. Intramuscular- produces next fastest effect.

Site Selection

A subcutaneous injection is given at an angle of 45 degree, just below the surface of the skin wherever there is subcutaneous tissue.

3. Subcutaneous- produces effect slower than the other two.

Advantages of the Parenteral Route

Patient Assessment

Age: During infancy, early childhood and old age, a smaller dose of medication may be required than would be appropriate for the other stages of life.

Explain the purpose of the injection and the desired effect that it should have on the patient.

An informed patient will usually be more cooperative relaxed and agreeable.

Select an appropriate injection site.

Aspirate to be certain needle is not in a blood vessel. Rarionale: When blood appears in the needle, you are most likely in a blood vessel.

When injecting insulin, the following special considerations should be observed:

Be sure that you have selected the correct insulin for administration.

Thoroughly wash the site where the stick occurred with soap and water.

Cleanse the skin with an antiseptic.

Repeat the previously described steps.

Do not massage the site when administering insulin, Imferon, or heparin.

Report the incident.

Document the incident and retain a copy for yourself.

Obtain medical attention. Be tested for hepatitus B virus and HIV.

Fill out appropriate OSHA paperwork - 200 form.

• The parenteral route provides a method of delivering a precise dose to a targeted area of the body.

For example, a physician may give an intra articular injection - within joint - or an intrathecal injection - within the spinal canal - to deliver a medication to a target area.

Because parenteral medications do not enter the digestive system, there is no possibility that the drug will be lost as a result of vomiting.

For example, insulin is made of amino acids and would be digested.

Intravenous therapy requires extensive knowledge of many factors and it is not the intent of this author to present anything other than a brief overview of the subject.

Intravenous therapy has change dramatically over the past 5 years.

Physical Condition: Female patients during pregnancy or while breast feeding should not be given certain contrindicated medications.

Males suffering from hemophilia require special considerations to counter bleeding following an injection.

Slowly and gently roll the bottle of insulin between the palms of your hands to evenly mix the components of the drug.

Never shake the bottle.

If you inject the medication, it will go directly into the bloodstream - intravenous; this is not the correct route of administration.

Note: If blood appears in the syringe-needle unit upon aspiration, smoothly withdraw the needle, properly discard the used unit, and prepare another injection for administration.

Administering an Intradermal Injection

Perform Medical asepsis hand wash. Adhere to OSHA guidelines.

Administering a Subcutaneous Injection

Perform medical asepsis hand wash. Adhere to OSHA guidelines.

Administration of Subcutaneous, Intramuscular, and/or Intradermal Injections

Perform medical asepsis hand wash. Adhere to OSHA guidelines.

Assess the patient. Put on gloves.

Prepare the patient for the injection - drape, position, allay apprehension

Prepare the patient for the injection - drape, position, allay apprehension

Procedure to follow should the medical assistant sustain an accidental needlestick after the injection:

Remove needle and syringe at same angle of insertion.

Release traction of the Z position to seal off the needle track. This prevents medication from reaching the subcutaneous tissues and the surface of the skin.

Always follow the physician's order and your institution's policy when mixing insulins.

The abdomen, lower back and upper arm are all appropriate sited for giving insulin injections.

Then locate the greater trochanter of the femur and mark this spot. Draw - or imagine - a diagonal line between the two locations.

The area above and outside this line, but several inches below the iliac crest, is the correct location of the dorsogluteal site.

Intradermal injections are given at an angle between 10 degree and 15 degree within the epidermal layer of the skin.

The body areas used for intradermal injections are the inner forearm and the middle of the back.

The reasons for the use of these two sited are that the skin is thin and there is very little hair.

The dorsogluteal site may be used for giving - adult - deep intramuscular injections.

Absorption also depends upon the patient's physical state, especially his or her circulatory status, and the parenteral route of administration.

The following are the three most commonly used parenteral routes of drug administration:

There are certain situations in which the use of the parenteral route for the administration of medications is indicated because it offers definite advantages over other possible routes.

The following are three major advantages offered by the parenteral route:

This site is contraindicated for infants, and is used only as a site of last resort in children.

The muscle mass may be degenerated in the elderly, the nonwalking, or the emaciated patient.

The correct injection site is 1 to 2 inches - about the width of three fingers - below the acromion.

The vastus lateralis is the preferred site for intramuscular injections in most infants and children.

The deltoid muscle is a small but an adequate site for certain intramuscular injections.

These IM preparations include vaccines, narcotics, sedatives, and vitamin preparations.

It is also used for IM injections in adults.

This site generally accommodates the majority of IM injections ordered, and is a relatively safe because the nerves and vessels supplying the area are not generally endangered.

Commonly referred to as the "upper outer quadrant of the buttocks," this description can be easily misinterpreted and result in an injection into an inappropriate area.

To locate the correct site for a dorsogluteal injection, located the posterior iliac spine and place a small X on this spot.

The site should not be used for an infant.

To locate the deltoid injection site, place your fingers on the shoulder and find the acromion - lateral triangular projection of the spine of the scapula forming the pint of the shoulder - and the deltoid tuberosity that lies lateral to the side of the arm, opposite the axilla.

For subcutaneous and intramuscular injections, use a smooth, quick, dartlike motion to insert the needle into the patient;s skin.

Use the correct angle of insertion - 45 degree to 90 degree - for the injection.

Draw up the ordered dosage of insulin using the U-100 syringe unit.

Using a site-rotation system, select an appropriate site. Insulin injection sited must be rotated to prevent tissue damage and the accumulation of unabsorbed medication.

Insert needle quickly, using a dartlike motion at a 90 degree angle. Maintain Z position.

Wait 10 seconds before removing needle to allow medication to begin to be absorbed.

Preparing the Patient for an Injection

When explaining the injection procedure, you must take into account the patients age, physical and mental condition, level of understanding, any hearing or visual impairments, and differences in language spoken or understood.

Do not massage the injection site.

When mixing two insulins in one syringe, always make sure that they are compatible. An example of two compatible insulins that may be mixed are NPH and Regular.

Prepare the patient for the injection - drape, position, allay apprehension. a

Z-Track Intramuscular Injection Technique

Disadvantages of Parenteral route

if you fail to aspirate during the injection process, a subcutaneous or an intramuscular medication could be given intravenously.

Always inspect and palate muscle tissue with this in mind when determining the appropriate needle length to reach the appropriate tissue level. skin texture

male patinets usually have tougher skin than females.

• it provides an effective route for the delivery of a drug when the patients physical or mental state would make other routes difficult or impossible. EX pt is unconscious.

• Drugs that are administered y injection are not altered by gastric acids, nor do they cause irritation to the patients digestive system.

• any traumatized areas • scar tissue • moles, warts, birhtmarks, tumors, lumps, hard nodules

• Nerves, large blood vessels, bones • cyanotic areas • edematous areas • paralyzed areas

Injection site. You should always inspect the area of administration. Avoid the following areas:

• any type of skin lesion • burned areas • inflamed areas • previous injection sites