Parenteral Medications

Description:

Parenteral medications are drugs given through routes other than the alimentary or respiratory tract.

Indications:

• If patient needs fast and immediate drug therapeutic effect
• If oral or respiratory route is contraindicated
• If drug effects are optimal and effective in a parenteral route

Routes:

• Intradermal – into the dermis
• Subcutaneous – into a subcutaneous tissue
• Intramuscular – into a muscle
• Intravenous – into a vein

Less frequently used sites:

• Intra-atrial
• Intracardiac
• Intraosseous
• Intrathecal/intraspinal
• Epidural
• Intra-articular

Administration:

1. Perform hand washing before anything else
2. Observe the Rights in Administering Medications
3. Check doctor’s orders

• Prepare the medications (check expiration date and physical condition) and equipments
• Syringe (depends on the injection site and volume of medication to be administered)
• Needles (appropriate size depending on site/route; withdraw medication from a vial or ampule into a sterile syringe (have separate needles for withdrawal, aspiration and injection)
• Antiseptic/alcohol swab
• File
• Sterile gauze
• Vials
  • Vials have powdered medication which needs to be reconstituted, read the intended preparation in the medicine package
  • There are single dose and multi dose vials, for multi-dose vials, inspect for integrity
  • Mix the solution (as the package suggests) by rotating the vial between the palms
  • Remove protective cap or clean the rubber cap and disinfect
  • Withdraw the medication by initially injecting air equivalent to the volume of medication to be withdrawn, then invert the vial, ensure that the needle tip is below the fluid level and gradually withdraw the medication
  • Ampules (consists of premixed medications)
    • Flick upper stem of the ampule several times
    • File the neck of the ampule to start a clean break
    • Disinfect and place a sterile gauze around the ampule neck and break off the top bending it towards you
    • Withdraw the medication without touching the rim of the ampule
• Identify the patient properly and explain the medication to administer (client’s knowledge of drug action and response)
• Locate site of injection (appearance and status), disinfect thereafter
• Administer medication
  • Intradermal Injection
    • Explain that a small wheal (bleb) will be produced
    • Prepare the syringe (hold between thumb and forefinger, hold the needle almost parallel to the skin surface, bevel up)
    • Pull the skin at the site (Common sites: inner lower arm, the upper chest, and the back beneath the scapulae)
    • Insert the tip of the needle until the bevel is in place through the dermis
    • Stabilize the syringe and inject the fluid until it creates a bleb
    • Withdraw the needle, encircle the injection site with ink for observation
  • Subcutaneous Injection
    • Assess site (Common sites: outer aspect of the upper arm, and anterior aspects of the thighs)
    • Prepare the syringe for administration (hold between thumb and finger, with palm facing to the side or upward for a 45 degree angle insertion or with the palm downward for a 90 degree angle insertion)
    • Pinch the skin at site and insert the needle
    • May or may not aspirate before injection, if blood appears, withdraw the needle, continue if otherwise)
    • Inject with a firm steady push, withdraw needle afterwards, wipe the site with gauze
  • Intramuscular Injection
    • Select a site away from large blood vessels, nerves, and bone
    • Pull the skin approximately 2.5 cm to the side
    • Hold the syringe between thumb and forefinger, pierce the skin smoothly and quickly at a 90-degree angle and insert the needle into the muscle
    • Hold the barrel of the syringe steady with non-dominant hand and aspirate (if blood appears, withdraw the needle, continue if otherwise)
    • Withdraw the needle smoothly at the angle of the insertion
    • Apply gentle pressure with gauze
  • Intravenous injection
    • IV Container
      • Locate injection port, remove cover and disinfect
      • Inject the medication in the port
      • Withdraw needle
      • Mix the medication and the solution in rotating motion
      • Label (medication name, solution, date and nurse’s initial)
      • Spike the bag with the tubing, hang and regulate
    • Existing IV Infusion
      • Determine if the remaining IV solution is sufficient for adding the medication
      • Confirm the desired dilution of the medication
      • Close the infusion clamp
      • Disinfect the medication port, insert the syringe needle and inject the medication
      • Gently rotate the bag or bottle and rehang.
      • Open clamp and regulate
      • Label thereafter
    • IV Push
      • Check the IV site
      • Locate the medicine port, disinfect with alcohol swab
      • Stop the IV flow by closing the clamp or by simply pinching the tube above the port
      • Connect the syringe to the IV system
      • Aspirate a small amount of blood (checks for patent flow)
      • Inject the medication (comply to the prescribed time of medication administration)
      • After which, remove the syringe needle
• Discard the uncapped needle, dispose all equipments according to institution practice
• Wash hands
• Observe and assess for reactions/response to medication
• Document all relevant information  (time of administration, name of drug, route, client’s reaction)
• Assess effectiveness of the drug at the time it is expected to act

Part 1

Part 2

Part 3