Parenteral Medication Administration

• Parenteral medications are administered via needle injection using aseptic technique.
• Parenteral medications absorb more quickly compared to oral medications.
• Use parenteral medications when patients are vomiting, cannot swallow, are restricted from oral fluids, or require IV medications.
• Parenteral medication routes include subcutaneous, intradermal, intramuscular, and IV injection.
• Larger needles correlate to smaller gauge numbers.
• Obese patients may require longer needles for medication administration.
• For thick or painful medications, the ventrogluteal site is preferred over the deltoid.
• The vastus lateralis is preferred for infants.
• 1-3 mL syringes are adequate for Sub-Q injections.
• A bevel creates a narrow slit that quickly closes when the needle is removed to prevent leakage of medication, blood, or serum
• 1-1.4 inch needles are suited for IM injections.
• 3/8th to 5/8th inch needles are used for Sub-Q injections.
• Filter needles are used for medications from glass ampules but not for administering the medication.
• Needlestick injuries are the most frequent route of exposure to bloodborne diseases for healthcare workers.
• Use safe needle devices with automatic safety locks.
• Dispose of sharps in red biohazard containers, without overfilling.

Safety Needle System

• A bevel is a slanted tip at the end of the needle that should face up during administration.
• A protective cap covers the needle after administration.
• The needle shaft is the body of the needle.
• An activator-assist lever covers the needle post-administration.

Preparing Injections - Ampules and Vials

• Ampules are glass containers requiring the top to be snapped off.
• Use a filtered needle to draw medication from ampules, but replace it for administration.
• Avoid needle contact with the ampule's edges after opening.
• Vials have a rubber seal and can be single-dose or multi-dose.
• Clean vial tops with alcohol before drawing medication.

Mixing Parenteral Medications in One Syringe

• Mixing compatible medications reduces the number of injections.
• Consult a compatibility chart or pharmacist for compatible medications.

Onset of Action for Injections

• Intradermal injections have the slowest onset.
• Subcutaneous injections have a slightly faster onset than intradermal.
• Intramuscular injections have a faster onset than subcutaneous.
• Intravenous injections have the fastest onset.

Administering Injections (Injection Angles)

• Intramuscular injections are administered at a 90-degree angle into muscle.
• Subcutaneous injections are administered at a 45-degree angle into the dermis/subcutaneous tissue.
• Subcutaneous injections for obese patients are administered at a 90-degree angle.
• Intradermal injections are administered at a 10-15 degree angle just under the epidermis.

Injections Cheat Sheet

Subcutaneous

• Length: ¼” - ⅝”
• Gauge: 25-27
• Angle: 40-90 degrees
• Inject into abdomen, back of arms, or thighs.

Intramuscular

• Length: 1” - 3”
• Gauge: 21-25
• Angle: 90 degrees
• Inject into deltoid, ventral gluteal, or vastus lateralis.

Intradermal

• Length: ¼” - ⅝”
• Gauge: 25-28
• Angle: 5-15 degrees
• Inject into lesion-free, lightly pigmented, hairless areas, commonly the ventral forearm.

Administering Intradermal Injections

• Typically given for skin testing.
• Use a TB or small syringe with a short, fine-gauge needle.
• Insertion angle is 5 to 15 degrees.
• Inject only a small amount of medication (0.01 - 0.1 mL) intradermally.
• Create bleb with injected liquid.

Administering Subcutaneous Injections

• Inject in small doses.
• Base needle length and angle on patient weight and estimate of subcutaneous tissue.
• Abdomen, back of arms, and thighs for administration.

Special Considerations for Administration of Heparin and Lovenox

• Patients are at risk for bleeding.
• Assess for contraindications and medication interactions.
• Low-molecular-weight heparins should be injected into the right or left side of the abdomen, at least 5 cm (2 inches) from the umbilicus (the patient’s “love handles”).
• Pinch the injection site upon insertion
• Administer LMWH in its prefilled syringe with the attached needle, and do not expel the air bubble.

Special Considerations for Administration of Insulin

• Absorption rates of insulin vary on the basis of the injection site.
• Timing of injections is critical for correct insulin administration.
• Jet injection device for insulin is held at a 90-degree angle.

Insulin Timing

• Short-acting insulin should be injected 30-45 minutes before a meal.
• Rapid-acting insulin should be injected not more than 15 minutes before a meal.
• Intermediate-acting insulin needs to be taken in advance of when it is needed to act
• Long-acting insulin can be taken at any time.

Insulin Sliding Scale

• An insulin sliding scale tells you what amount of insulin to administer depending on the patient’s blood glucose.

Mixing Insulins

• DO NOT mix long-acting insulin.
• DO NOT mix rapid-acting (Humalog) with long-acting insulin.
• NPH insulin can be mixed with regular insulin or rapid-acting insulin.

Blood Glucose Monitoring

• Blood glucose monitoring is an essential component of any diabetes self-management program.
• Use the lancet to poke the padded side of the finger during a glucose check.
• Rotate fingers during glucose checks.
• Don’t apply a great amount of pressure to the poked finger.

Administering Intramuscular Injections

• Requires a longer and larger-gauge needle.
• Injection sites include ventrogluteal, vastus lateralis, and deltoid.
• The Z-track method prevents meds from leaking.
• Push skin to the side and administer the Z-track injection.
• Wait a couple of seconds and release the skin in the Z-track method.
• DON’T ASPIRATE.
• Make the ventrogluteal site the first choice whenever possible for deep intramuscular injections to avoid nerve or muscle injury.
• Inject at 1 mL per second during intramuscular injections.
• Wait at least 10 seconds before withdrawing the needle during intramuscular injections.

Injection Sites - Ventrogluteal

• The ventrogluteal site id safe for adults and children.
• Use landmarks to identify the ventrogluteal injection site.
• The ventrogluteal site is used for larger doses of meds, thicker medications, and medications that hurt when injected.
• Inject into a triangle below the anterior iliac spine at the ventrogluteal site.

Injection Sites - Deltoid

• The deltoid site is easily accessible.
• Use the deltoid site for small doses (2 mL or less).
• The deltoid site is used for immunizations and smaller volumes of medications.

Learn about parenteral medication administration via injections using aseptic techniques. This lesson covers absorption rates, appropriate usage scenarios (e.g., vomiting patients), and various routes like subcutaneous, intradermal, intramuscular, and IV. Also learn about needle sizes, site selection, and syringe types.