parenteral administration

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  • PARENTERAL ADMINISTRATION ALEXA C. ABIDIN, RN,MN
  • Is injection an invasive procedure?
  • Assessment Injection site Drug allergies Patient condition be alert to changes that can affect drug therapy Consent forms
  • 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)
  • 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
  • Needles A needle has three parts, the hub, the shaft, and the bevel.
  • 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.
  • 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).
  • The smaller the number, the larger the gauge (inside diameter).
  • 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.
  • Parts of a Syringe
  • 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
  • PRE-FILLED SINGLE-DOSE SYRINGES
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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.
  • 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
  • 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) -drugs dosage contained in a small quantity of solution (0.01 to 0.1 ml)
  • Intradermal Injections Given into capillary-rich layer just below epidermis for local anesthesia diagnostic tests immunizations
  • 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
  • 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
  • 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
  • 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
  • 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
  • Subcutaneous Injections Do not shake insulin.
  • Subcutaneous Injections Medications administered by this route include: epinephrine (or adrenaline) for emergency asthmatic attacks or allergic reactions heparin or low molecularweight heparins to prevent blood clots sumatriptan or Imitrex for migraines many vaccines
  • 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
  • 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
  • Intramuscular Injections Typical needle is 22- to 25gauge - to 1-inch needle Intramuscular (IM) injections are administered at a 90-degree angle volume limited to less than 3 mL
  • 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
  • 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

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