Parenteral Medications & Administration - Chapter 10

• Chapter 10 focuses on parenteral medications and administration, instructed by R. Schrinel, BSN, RN, during the 2023-2024 term.

Key Terms

• Ampule: A small sealed glass container that holds a single dose of medication.
• Calibrated: Marked with specific measurements.
• Emboli: Blood clot, air bubble, or fatty deposit that has been carried in the bloodstream to lodge in a vessel and cause an embolism.
• Gauge: A standard measure of the diameter of a needle.
• Infiltration: The process whereby fluids pass into a tissue.
• Intradermal (ID): Within or between the layers of the skin.
• Lumen: The space inside a tubular part or organ, such as the space within a blood vessel or intestine.
• Parenteral: Administered or occurring elsewhere in the body than the mouth and alimentary canal.
• Phlebitis: Inflammation of a vein.
• Subcutaneous (SUBQ): Beneath the skin.
• Thrombus: A blood clot formed in situ within the vascular system of the body and impeding blood flow.
• Topical: Applied to the surface of the skin.
• Vial: Glass or plastic container sealed with a rubber stopper
• Wheal: A raised, circumscribed area of edema and erythema brought on by the injection

Topical Medications

• Applied directly to the skin and can be absorbed for local or systemic effects.
• Semisolid preparations include:
  • Ointments: Petroleum-based and keep medication in contact with the skin.
  • Creams: Water-based and absorb into the skin.
  • Gels: Suspensions with drug particles in a thickened water base.
  • Plasters: Adhere to the skin.
  • Liniments (salves): Contain skin irritants to increase blood flow along with medication.
  • Lotions: Water-based and absorb into the skin.
• Solid preparations:
  • Powders: Reduce moisture.
  • Transdermal Patches: Deliver medication over time.

Transdermal Patches

• Advantages: Easy to apply, evenly distribute the drug, and are effective over time.
• Disadvantages: Risk of overdose, improper disposal, and the need to keep the patch in place.
• Always wear gloves, and include the date and your initials on the patch after application

Ophthalmic Medications

• Placed directly into the eye, drops lubricate through absorption, and ointments are thickened solutions applied to the lower eyelid.
• Ocular inserts are also available as a transparent membrane containing medicine.
• Wear gloves and instruct the patient to look upward, administering drops before ointment if both are prescribed.

Otic Medications

• Administered into the ear.
• Adults: Pull ear back and up to administer.
• Children under 3 years: Pull the ear back and down.

Vaginal Medications

• Used for local effects and may come in forms such as foams (aerosolized), gels (solid medication particles in thick suspension), or creams/lotions (for yeast and contraceptive treatment)
• Usually self-administered while laying on the left side to ease administration, and the patient should remain in position for approximately 10 minutes.

Nasal Route of Medications

• Treat seasonal allergies, asthma, congestion, and sinus conditions.
• Forms include:
  • Sprays: Fine droplets.
  • Inhalers: Changes from liquid to powder.
  • Instillation: Liquid drops.

Inhaled Medications

• Administers medication or oxygen directly to the lungs.
• Methods include:
  • Nasal cannulas.
  • Masks.
  • Continuous Positive Airway Pressure (CPAP) machines.
  • Metered-Dose Inhalers (MDIs).
  • Nebulizer machines.

Injectable Medications

• Administered via needle and syringe and include:
  • Intradermal (ID).
  • Intramuscular (IM).
  • Subcutaneous (SUBQ).
  • Intravenous (IV).

Intradermal (ID)

• Injected just below the epidermis for TB and allergy testing.
• Injected volume of 0.1ml – 0.2ml, typically in the inner forearm or upper back.
• Use a 25 to 27 gauge needle that is 5/8 inch in length.
• The insertion angle should be 10 – 15 degrees, without aspiration.
• A wheal should form if given correctly, indicating a slight elevation of skin where medication was administered.

Intramuscular (IM)

• Injected directly into the muscle, allowing quick absorption into the bloodstream.
• Used for antibiotics, pain medications, and immunizations.
• Injection sites include the deltoid, ventrogluteal, and vastus lateralis muscles with a 90-degree insertion angle.
• Needle size is typically 20 to 23 gauge, with a 1 to 2-inch needle.

Deltoid Muscle

• The smallest muscle for IM injection, limited to a 1-inch needle and 1mL of fluid.

Ventrogluteal Muscle

• Not commonly used, but safe for patients older than 2 years and can inject up to 3ml using a 2-inch needle.

Vastus Lateralis Muscle

• Site of choice for infants and small children, allowing injection of up to 3ml with a 2-inch needle.

Z-Track Method

• Used to administer IM injections, especially when the medication is irritating to the skin or may cause staining.

Subcutaneous (SUBQ) Injection

• Injected into the fat layer; Heparin, Lovenox and Insulin are often administered via the Subcutaneous route.
• Absorbed slower than IM or ID injections.
• Common injection areas are the upper arm, abdomen, and thigh.

Syringe Rotation

• Important to rotate injection sites for patients requiring frequent Subcutaneous injections
• Inject up to 1ml.

Syringe Types

• Standard Syringe:
  • Ranges from 3ml to 60ml, with 3ml being popular for Subcutaneous and most intramuscular injections.
• Insulin Syringe:
  • Available in U-100, U-50, and U-30, calibrated in units, holding no more than 1ml.
• Tuberculin Syringe:
  • Holds no more than 1ml and is calibrated to measure as small as 0.01ml drug doses.

Needle Gauge

• The LARGER the number, the SMALLER the needle.
  • 25, 27, and 29 gauge needles: Used for ID injections.
  • 25 gauge needles: Used for Subcutaneous injections.

Needle Length

• Intramuscular (IM):

• Deltoid: 5/8 inch needle.

• Ventrogluteal: 1 ¼ - 3 inch needle. -Vastus Lateralis (adult): 1 to 1 ½ inch needle.

• Vastus Lateralis (pediatric): 5/8 - 1 inch needle.

• Subcutaneous (SUBQ): Various sites require a 5/8 inch needle.

• Intradermal (ID): Under the epidermis, use a 5/8 inch needle.

Syringe Preparation:

• Use aseptic technique.
• Protect surfaces that must remain sterile:
  • Needle, tip, and inner part of the plunger.
• Label the syringe with the patient's name, medication name, and dose.

Ampule Administration

• Review the administration video.

Vials

• Glass or plastic container sealed with a rubber stopper
• Could either be single dose, multi dose, between 1 mL and 50 mL
• Powder medications are reconstituted with a solute

Vial Administration

• Review the administration video.

Reconstituting a Drug

• Drugs unstable as liquids are prepped in powder form.
• Solute is mixed with diluent BEFORE drawing up into the syringe.

Intravenous (IV) Needles

• Butterfly needles:
  • Are winged infusion sets with a smaller gauge (21 to 25).
• Angiocath needles:
  • Feature a straight needle with a larger gauge (14 to 22).

Intravenous (IV) Medications

• Injection of medication directly into the vein to:
  • Treat illness.
  • Prevent illness.
  • Assist with diagnostic procedures.
  • Provide nutrition and hydration.
• The quickest method of administration, guided by State Regulations.
• Advantages:
  • Rapid absorption
  • Quick relief of symptoms
  • Many options for medication and fluid delivery
  • Avoids multiple injections
  • Indwelling catheter
  • Fastest method in emergency
• Disadvantages:
  • Higher costs
  • Incompatible medications
  • Risk of complications

Types of IV Fluids

• Dextrose: Mixtures of sugar and water.
• Saline: Sodium chloride solution.
• Lactated Ringers (LR): Mix of dextrose, potassium chloride, sodium lactate, and calcium.
• Total Parenteral Nutrition (TPN): Nutritional solution.
• Lipids: Fats.
• Blood Products: Whole blood, platelets.

IV Medication Administration

• Infusion: Slow administration of a large volume of fluid.
• Piggyback: Separate IV bag and tubing connected to primary IV tubing, administered over a short period.
• IV Push: Quick delivery of a small amount of medicine in a syringe.

IV Administration Supplies

• Fluid bag or bottle.
• IV tubing: 6 to 120 inches.
• Filter.
• IV pole.
• All supplies must be sterile.

Key Reminders

• Observe the 6 rights of medication administration.
• Know expected/possible side effects of drugs.
• Date all multidose vials when opened.
• Know correct needle size and gauge.
• Know landmarks and injection techniques.
• Know compatibility of medications.
• Question any order that is not clear.

This chapter, instructed by R. Schrinel, BSN, RN, during the 2023-2024 term, focuses on parenteral medications. Key terms include ampule, calibrated, emboli, gauge, and infiltration. Intradermal, lumen, parenteral, phlebitis, subcutaneous, thrombus and topical are also covered.