Parenteral Administration and IV Medication Principles

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Questions and Answers

What is a significant advantage of parenteral administration compared to oral routes?

Higher risk of allergic reactions

Immediate physiological response (correct)

Possibility of self-administration

Greater cost-effectiveness

Which parenteral route allows for administering substances directly into joint space?

Subcutaneous (SQ)

Intravenous (IV)

Intra-articular (correct)

Intradermal (ID)

Which of the following is a key disadvantage of parenteral medication administration?

Ease of administration at home

Difficulty in reversing physiological effects (correct)

Limited volume for injection

Immediate local effect

What describes the primary purpose of intradermal injections?

Diagnostic testing purposes Signup and view all the answers

What is an important consideration when administering continuous IV infusions?

Monitoring for fluid and electrolyte imbalances is crucial Signup and view all the answers

Which parenteral route is characterized by slow absorption due to its injection into the top layer of skin?

Intradermal (ID) Signup and view all the answers

What is a common complication associated with intramuscular (IM) injections?

Injection site pain and tissue damage Signup and view all the answers

What is a major benefit of using central IV access compared to peripheral IV access?

Ability to administer larger volumes and faster rates Signup and view all the answers

Which medication should NEVER be administered as an IV push due to safety concerns?

Potassium chloride Signup and view all the answers

What type of healthcare professional primarily administers parenteral medications to ensure compliance?

Healthcare professionals Signup and view all the answers

Which situation would most likely necessitate the use of a hypotonic solution?

Hypernatremia Signup and view all the answers

Which of the following describes a key difference between central and peripheral IV access?

Peripheral access allows for higher drug concentrations at target sites Signup and view all the answers

Which of the following infusions requires close titration of the infusion rate?

Continuous sedation with dexmedetomidine Signup and view all the answers

What risk is specifically associated with administering vesicants via peripheral IV access?

Infiltration leading to tissue damage Signup and view all the answers

Which type of pharmacologic responsibility includes ensuring the proper diluent is used for a medication?

Ensuring sterile dispensing Signup and view all the answers

When should an IV catheter typically be flushed to ensure proper medication delivery?

Before, after, and routinely when not in use Signup and view all the answers

Which of these is NOT a common risk associated with peripheral IV access?

Pneumothorax Signup and view all the answers

What is a potential risk of using a hypertonic solution too rapidly?

Osmotic demyelination syndrome Signup and view all the answers

Which of the following practices should pharmacists avoid while administering intravenous medications?

Diluting medications with inappropriate solvents Signup and view all the answers

Which describes the function of a volumetric infusion pump?

Delivers fluids at specific rates in mL/h Signup and view all the answers

Study Notes

Introduction to Parenteral Administration and IV Medication Principles

Parenteral administration involves medication delivery outside the digestive tract, typically via injection.
Objectives include defining parenteral routes, recognizing advantages and disadvantages of parenteral administration, detailing administration methods (IV push, intermittent, continuous infusions), identifying central and peripheral IV access differences, understanding hypotonic, hypertonic, and isotonic fluids, and describing pharmacist considerations.

Parenteral Definition

Physiologically, parenteral means located outside the digestive tract.
Medically, it means taking into the body in a way other than through the digestive tract.
Generally, parenteral administration is by injection.

Advantages of Parenteral Administration

Timing: Immediate physiologic response, ability to provide prolonged drug action (e.g., long-acting injectable antipsychotics), used for correcting serious fluid and electrolyte imbalances.
Control: Suitable for uncooperative, nauseous, or unconscious patients, easier to monitor compliance, and usually administered by healthcare professionals.
Convenience: An option for medications poorly absorbed or destroyed in the gastrointestinal tract, provides nutrients when oral intake is not possible (total parenteral nutrition), allows for local effects (e.g., steroid joint injections).

Disadvantages of Parenteral Administration

Healthcare team considerations: Generally more expensive than oral medications, typically requires more time for administration, increased risk of accidental needle sticks, and requires strict adherence to aseptic procedures, ensuring product sterility.
Patient considerations: Difficulty reversing physiological effects once administered, increased risk of complications (infection, incompatibilities, pain/irritation at site, hypersensitivity reactions).

Parenteral Routes

General: All involve injection.
Intravenous (IV): Catheter into vein, rapid effect, high predictability, less volume limitations compared to other routes
Intramuscular (IM): Injection deep into muscle; typically quicker than oral but slower than IV; suitable for sustained-release medications; common for antibiotics, biologicals, and hormonal agents
Subcutaneous (SQ/SC): Injection beneath skin; quicker absorption/onset than IM.
Intra-arterial (IA): Injection directly into an artery; high concentration at target site, with lower dilution in circulation.
Intra-articular: Injection into joint space
Intrathecal: Injection into lumbar intraspinal sacs; bypasses blood-brain barrier; rapid onset, needs preservative-free formulations (e.g., analgesia, anesthesia)

Intradermal (ID) and Subcutaneous (SQ)

Intradermal: Injected into top layer of skin; slowest absorption/onset; used for diagnostic purposes (e.g., tuberculin test, allergy tests); volume limited to 0.1 mL
Subcutaneous: Injected beneath the skin surface; deeper than ID; quicker absorption/onset than ID but slower than IV or IM; absorption can be erratic and unpredictable; volume limited to 2 mL or less.

Intramuscular (IM)

Injected deep into large muscle mass (e.g., upper arm, thigh, buttocks); common uses include antibiotics, biologic agents, and hormonal agents.
Up to 2 mL is common in deltoid; up to 5 mL is common in gluteal medial.
Medications can be administered to achieve a sustained-release effect when necessary.
Possible complications include pain, tissue damage, muscle scarring, abscess, hematoma, gangrene, and nerve injury.

Intravenous Administration

Catheter inserted into a vein.
Provides rapid effect, high predictability of response.
Fewer volume limitations compared to other routes.
Central venous catheter (placed into large vein near the heart) vs Peripheral venous catheter (placed into a vein closer to the surface)
Benefits are important for patients with severe conditions (ex dehydration)

IV Push

Medications delivered over a short period via syringe (seconds to minutes).
Commonly used for urgent medications (antiemetics, analgesics, cardiac medications).
Often undiluted for rapid administration.
Suitable for use when drugs are incompatible in larger volumes (ex: Phenytoin, diazepam)
Not suitable for all drugs; never administer potassium chloride using IV push.

Infusions

Can be intermittent (start/stop) or continuous.
Delivered via IV pump.
Types: Syringe infusions, Gravity infusions, and Volumetric infusion.
Other methods like elastomeric pumps and patient controlled analgesic (PCA).

Infusion Pumps

Standard, gravity, and volumetric types.
Used to deliver consistent fluids, useful in patients homes.

Intermittent Infusions

Prepared in syringe or bag.
Administered slowly over a set time (15 minutes - 3 hours)
Many example drugs are listed in IV infusion form
Includes using "piggybacks," administered via Y-site.

Continuous Infusions

Delivered continuously via infusion pump
May require close titration of infusion rates
Examples include Dexmedetomidine, diltiazem and other common drugs
Can be used for correction of dehydration
Risk of fluid overload especially in cases with comorbidities.

Flushing an IV Catheter

Ensures all medication reaches the patient; prevents blockage.
Typically flushed before and after medication administration (daily or weekly if in use).
Prefilled syringes with heparin or saline are used for this, and are not meant for other uses ( reconstitution\dilution\etc)

Central vs Peripheral IV Access

Peripheral: Placed into veins of forearm, hand, or antecubital fossa; easier and less expensive; lower osmolarity limits, and less concentration limitations
Central: Large veins [subclavian, internal jugular, femoral]; good for higher infusion rates, larger volumes of medication; longer term administration; more risk of complications.

Peripheral IV Access

Easily placed at bedside, simpler & less expensive than central access.
Limitations include Osmolarity ≤900 mOsm/L, rate of administration, and drug concentration constraints.

Risks of Peripheral IV Access

Phlebitis - vein irritation
Extravasation/infiltration - medication leakage into surrounding tissue
Vesicant medications cause severe tissue damage.
Other risks include thrombosis (blood clot), bleeding, and bruising.

Central IV Access

Placed by physician using radiology guidance.
Benefits include emptying into large veins, faster rates, good for larger volumes of medications, long-term access (such as chemo or antibiotics for infection)
Suitable for poor peripheral access patients (ex: IV drug users).

Risks of Central IV Access

Placement-related issues: Pneumothorax, venous air embolism, arterial injury, arrhythmia
Infection - local or systemic
Obstruction - central venous obstruction
Thrombosis - catheter-related venous thrombosis.

Tonicity Review

Hypotonic: Lower solute concentration than blood; causes fluid shift into cells.
Isotonic: Same solute concentration as blood; used for expanding both intracellular and extracellular fluid spaces.
Hypertonic: Higher solute concentration than blood; causes fluid shift out of cells.

Hypotonic Solutions

Used to shift water into cells to treat intracellular dehydration.
Risks include hemolysis, hyponatremia, and hypotension due to rapid infusing.

Isotonic Solutions

Used for rehydration, and as vehicles for drug delivery
Less risk than hyper- or hypotonic solutions.
Common examples include 0.9% NaCl (NS), dextrose 5% in water (D5W), and Ringer's solution.

Hypertonic Solutions

Used to correct severe sodium depletion and water overload/cerebral edema.
Risks include circulatory overload, osmotic demyelination syndrome, and venous irritation (when administered peripherally).
Restricted use in most hospitals.

Pharmacist Responsibilities

Ensure correct concentration, pH, and tonicity for the chosen route.
Recall limitations of peripheral administration (concentration/osmolarity limits).
Ensure appropriate volume for route (e.g., multiple injections of Evusheld); this can include using correct solutions, amounts, and areas.
Verify that drug selection is appropriate for the intended route (IM vs IV, etc.); this is important because of potential tissue damage in many medications especially.
Be mindful of maximum concentrations and infusion rates, such as for vancomycin, especially for patients with fluid restrictions.
Provide route and formulation recommendations tailored to individuals, particularly pediatric patients. Consider patient allergies, body composition, comorbidities, and tolerability.
Recommend appropriate care setting considerations and monitoring needs (e.g., ECG monitoring for potassium infusions).
Ensure proper equipment is in place (sterile products, filters, syringes, and appropriate needle sizes).

Practical Example

Phenergan 25mg/mL, 0.5 mL (12.5mg) IM every 6 hours PRN for nausea/vomiting, needs evaluated via pharmacist
The practitioner should consider different routes suitable for the patient.

Potential Recommendations

Consider alternative medications to avoid potential damage
Consider rectal suppositories as alternative if there are no allergies or contraindications.
Zofran can be given IV or IM and is not cause severe tissue damage as this case study has shown.

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Description

This quiz covers the essential principles of parenteral administration and IV medication methods. Explore different routes, advantages, disadvantages, and fluid types associated with parenteral therapies. Understand critical concepts like central vs. peripheral IV access and the roles of pharmacists in medication management.