Module 05 Different Route for Medication Administration PDF

PHARMACOLOGY SEM 01 | CYC 01 LECTURE AUF-CON NCM 0106 MODULE 05 – DIFFERENT ROUTE FOR MEDICATION ADMINISTRATION It is natural for us to take in food and OUTLINE...

PHARMACOLOGY SEM 01 | CYC 01 LECTURE AUF-CON NCM 0106 MODULE 05 – DIFFERENT ROUTE FOR MEDICATION ADMINISTRATION It is natural for us to take in food and OUTLINE drugs using our mouth I Oral/Enteral Administration ○ Compared to parenteral routes A Advantages, Disadvantages, Contraindications (causing breakage in the skin) which B Special Considerations is not naturally-occurring C Procedure II Parenteral Route ECONOMICAL/COST-EFFECTIVE A Advantages, Disadvantages, Contraindications ○ Less costly than injectable forms B Types ○ This must be considered since we are treating i Intradermal, Subcutaneous, Intramuscular, Intravascular the patient holistically · IV Push or Bolus RELATIVELY SAFE · Piggyback or Side-Drip ○ Does not involve breaking through the body’s · Special Chamber defenses Break in the skin [parenteral medications] DIFFERENT ROUTES FOR DRUG ADMINISTRATION can lead to infection ○ If a medication was administered to a wrong I. ORAL/ENTERAL ADMINISTRATION patient or vice versa, it is much easier to counteract ahead of time as it takes a longer The most desirable way to give drugs is by mouth time to take effect compared to parenteral The most practical, economical, convenient and medication safe way to administer a drug MORE READILY CONTROLLED ○ Reason why it is most commonly used ○ Drugs given by mouth produce an effect that Oral medications may be absorbed in the mouth is more readily controlled than when it is and the stomach, but they are generally absorbed administered by injection in the small intestines Chewing or swallowing such preparations is the DISADVANTAGES simplest way to get the drug into the body and on its way to the bloodstream and other tissues POSSIBLE VOMITING/GASTRIC IRRITATION Forms of Oral Medications ○ Caused by taste of drugs and/or irritation of ○ Tablets, capsules, pills, syrups, elixirs, and the gastric mucosa other forms of oral liquid drugs E.g.: Prolonged intake of aspirin (a gastric irritant) ADVANTAGES ○ May cause gastric ulcers if irritation persists EASY AND CONVENIENT UNTIMELY DESTRUCTION OF THE DRUG ○ Primarily because all of us have an oral ○ Due to the presence of digestive enzymes opening ○ Before a medication is absorbed, it first undergoes pharmaceutic phase. At times, it NCM 0106| Banaag, Diala, Mallari, Malonzo, Navarro, Paras|1  MODULE 05 — DIFFERENT ROUTE FOR MEDICATION ADMINISTRATION might suffer untimely destruction due to absent gag reflex → high risk for aspiration presence of digestive enzymes from mouth (nasasanipan) up until the gut Patients on NPO Nawawala na ‘yung active ingredient ○ Nothing per orem INACCURATE MEASUREMENT OF ABSORPTION They cannot take in food, drink, ○ Bioavailability medications, etc. through their mouth You cannot quantify the amount of ○ If patient is in NPO and the doctor also medication that will be absorbed as ordered a medication per orem, you will not some will be destroyed during immediately dismiss the order but clarify it pharmaceutic phase instead ○ A percentage of the medication was Sometimes, NPO status is due to fasting destroyed during the pharmaceutical for certain tests phase (disintegration and ○ Pwede naman ang water kasi this will dissolution) not affect the laboratory results ○ Hindi natin alam gaano karami ‘yung If the NPO status is for surgery or in strict umaabot sa circulation aspiration precaution, hindi talaga DEMANDS PATIENT COOPERATION pwede kahit water. ○ Some are uncooperative (they may spit it Patients who will receive Anesthesia out) while some are unconscious (risk for ○ Usually subjected to NPO status because aspiration) when a patient is anesthetized, their gag reflex will be temporarily absent CONTRAINDICATIONS Subjects the patient to high risk for aspiration Kung kanino hindi pwedeng ibigay Artificially putting them in a state of coma Patients with Dysphagia ○ Reinforce knowledge on these patients ○ Difficulty of swallowing regarding what can be drank and not ○ Due to lack of control on swallowing reflex, it Patients with Diarrhea, Nausea, and Vomiting may lead to aspiration ○ If patient vomited within 30 mins after taking Pediatric Clients a medication, regive the medication ○ Infants and small children cannot swallow ○ If it has been taken 30 mins or more, it is good pills, tablets, or capsules as given/absorbed They have underdeveloped reflexes which Patients with Diseases of the Oral Cavity may lead to aspiration ○ Also includes those who have undergone oral ○ Drug of choice is usually in syrup or liquid surgery form ○ Ex. Patients who have undergone cleft lip and Uncooperative Patients palate repair because nasal cavity and oral ○ Irrational, unconscious, combative, cavity have connections and there is a uncooperative, and/or restless patients blockage → high risk for aspiration It is our responsibility to protect ourselves as well SPECIAL CONSIDERATIONS DURING ORAL ○ Those who are sedated, in comatose, in ADMINISTRATION OF DRUGS vegetative state, or has GCS of less than 8 → NCM 0106 | Banaag, Diala, Mallari, Malonzo, Navarro, Paras|2  MODULE 05 — DIFFERENT ROUTE FOR MEDICATION ADMINISTRATION Avoid mixing drugs with food when the patient is Do not tilt the head backward when the patient has an infant or child difficulty swallowing in giving liquid medication ○ In the future, the child is apt to refuse a food ○ Tilting the head can cause aspiration that they associate with drug administration Explain to the child when the medication has an PROCEDURE objectionable (unpleasant) taste if the child is 1. Check the written medication order for likely to decrease their trust completeness ○ “Mapait ‘to pero bibigyan kita kaagad ng a. Should include the drug name, dosage, route tubig.” of administration, frequency, and duration of Enables you to establish trust with the the therapy child b. Check if you are giving the medication to the ○ To disguise the objectionable taste of the right patient (10 Rs of Medication medicine, the following techniques are Administration) suggested: c. Check if the patient consented to the Give the medication with generous medication administration amounts of water or other liquids such 2. Check to see if there are any special as juice and milk if permitted circumstances surrounding administration of the Allow the patient to suck on a small piece dose to the patient of ice for a few minutes before giving the a. For example, a nasogastric tube may be medication → provides numbing attached to suction or the patient may be sensation and dilutes the concentrated instructed nothing by mouth (NPO) taste b. Check with the prescriber to determine if the Pour a liquid medication over crushed medication should be administered by ice and offer it to the patient with drinking another route (if PO is not prescribed) straw 3. Be certain that you know the expected action, safe Place the medication in a dropper or dosage range, special instructions for syringe and place the syringe well back administration and adverse effects associated on the tongue while being careful not to with drug orders touch the posterior portion of the tongue a. This is simply being prepared prior to and cause the patient to gag medication administration Offer oral hygiene immediately after 4. Prepare the necessary equipment giving the medication with objectionable a. Includes medication tray, cart, medication taste or offer the patient sugarless gum if card, water, mortar, and pestle permitted 5. Wash your hands Use a dropper to give infants or very small children 6. Prepare the dosage as ordered liquid medications while holding them in a sitting or a. Remember not to crush or tamper with semi-sitting position sustained-action dosage forms (enteric ○ Place the medication between the gums and coated medications) cheeks, to prevent uncontrolled gag reflex b. Scored tablets may be broken along score leading to aspiration marks if necessary ○ Do not let it have contact with the posterior c. If dosage forms other than those available on portion of the tongue as this may elicit the the nursing unit are required for the patient, gag reflex NCM 0106 | Banaag, Diala, Mallari, Malonzo, Navarro, Paras|3  MODULE 05 — DIFFERENT ROUTE FOR MEDICATION ADMINISTRATION contact the pharmacist. They would be the b. Report the refusal and reason given to the ones to determine possible substitutes for the head nurse drug c. Note it on the patient chart 7. Check the label on the medications three times 14. If the patient vomits within 20-30 minutes of taking before administering any drug the medication, the physician must be promptly a. After getting from the drawer, before notified preparation, and before giving to the patient a. Note the details on the patient’s chart 8. Do not touch tablets or capsules with your hands b. Save vomitus for inspection, if possible a. Pour the required number into the bottle cap 15. If the dosage is to be administered sublingually, then into the medication cup instruct the patient to place the tablet under the b. Unit dosage packages should not be opened tongue until the nurse is ready to administer the a. High chance na ma-metabolize agad ang dosage to the patient gamot kaya hindi pwedeng i-swallow c. For liquid medication, remove the cap and b. Buccal tablets are placed between the gum place it at eye level and fill it to the desired and the cheek preferably next to an upper level molar 9. Never prepare a dosage of medication which is c. The patient should also be advised not to discolored, has precipitated, and is contaminated chew the tablet or drink while the tablet is or outdated being absorbed a. Kahit hindi pa expired pero iba na ‘yung color, huwag mo nang ibigay. This means na nagkaroon na ng chemical reaction and might provide you with a different result 10. If the patient expresses any doubt about the medication, always recheck the order, drug label and dosage on the container 11. Elevate the head of bed to aid the patient in swallowing the medication a. Fowler’s position prevents aspiration 16. If the fluid intake and output are being monitored b. DO NOT give the medication when the patient (especially for patients with chronic and kidney is lying supine diseases), record the amount of fluid taken with 12. Stay with the patient as they swallow the the drug on the patient's intake sheet medication. a. This is done especially for those with kidney a. Provide necessary assistance, e.g., positioning diseases and/or obtaining fluids to aid in swallowing. 17. Following administration, be certain that the b. Instruct the patient not to chew any tablets or patient is comfortable, then immediately record capsules except those which are to be and document the procedure. chewed a. Make sure to include the name of the drug, c. Check or confirm if they really took the dosage, special factors related to oral medication administration (e.g. nasogastric tube 13. If the patient refuses the medication, determine clamped following administration), time of the reason why. a. Try to provide health teachings first NCM 0106 | Banaag, Diala, Mallari, Malonzo, Navarro, Paras|4  MODULE 05 — DIFFERENT ROUTE FOR MEDICATION ADMINISTRATION administration, and your name or initials as ○ Connect an asepto/bulb syringe on the administrator of the drug the tip of the NGT ○ Pump in air FOR PATIENTS WITH NASOGASTRIC TUBE ○ You will then expect to hear gurgling sounds on the left upper quadrant of Some patients with a nasogastric tube will have the abdomen (indicating NGT is orders for medication to be given through the tube intact), it is abnormal if no sound is ○ Liquid preparations of the drug should be heard used when available Aspirate a small amount of gastric Kapag solid, baka magkaroon ng contents blockage sa tube ○ Create negative pressure using the In other cases, the nurse will have to asepto syringe and release. This will reduce the tablet to fine powder as create a vacuum. possible using mortar and pestle and mix ○ If the pH level is acidic, it is placed it with copious amount of water appropriately (gastric region) Soft gelatin capsules may have a pinhole ○ If pH is not acidic, baka nasa pricked in one end and the liquid respiratory ( a complication) squeezed out into a plastic medicine The patency of the tube is also checked, particular container or cup and mix it with copious when the tube has not been connected to a amount of water suction device. ○ Most capsules which contain powder may be ○ Patency can be checked by aspirating a emptied of their contents small amount of gastric contents and by The resulting powder form (capsules or flushing the tube with a small amount of pulverized tablets) is mixed with a small normal saline (about 20-30 ml). amount of fluid ○ Always return fluid removed from the ○ 20—30 mL of water or normal saline stomach to maintain electrolyte balance This is then taken to the patient’s bed at SANDWICHING TECHNIQUE: After placement and 30—45 degrees (semi-Fowlers or sitting patency have been established, the previously position) to avoid aspiration during and prepared medication can be administered through following the administration of the drug a syringe barrel (without the plunger) connected to Before administering the medication, the nurse the tubing must check the patency and placement of the ○ Hold the barrel of the syringe approximately nasogastric tube to be certain that the medication 6 inches higher than the patient’s nose and administered through it will reach the stomach allow the medication to flow into the ○ Several techniques which can be used to stomach by gravity. determine the proper placement of the If it is hard to get the medication flowing nasogastric tube gently, insert the bulb or plunger into the X-ray (golden standard for checking syringe. placement and patency of NGT) ○ When the medication begins to flow remove ○ Not always applicable as it is not the plunger or bulb and allow the medication done frequently to flow by gravity. Auscultate for borborygmi sounds There might be particles stuck on the lining of the tube NCM 0106 | Banaag, Diala, Mallari, Malonzo, Navarro, Paras|5  MODULE 05 — DIFFERENT ROUTE FOR MEDICATION ADMINISTRATION ○ To maintain patency, flush it again RAPID ABSORPTION using 20-30 mL for children and ○ Liquid na siya in nature 30-35 mL for adults No more disintegration/dissolution ○ Clamping the tube is necessary (20–30 ○ Kaagad na siyang nasa circulation minutes) EMERGENCY ROUTE Otherwise, the medication, which has just ○ Kaagad siyang nagte-take effect (short been administered, will be withdrawn onset of action) from the stomach by the suction ACCURATE MEASUREMENT OF DOSAGE apparatus ○ Bioavailability is usually 100% Kung ang patient for suctioning ‘yung Kung gaano karami ‘yung in-inject mo, gastric area niya, i-hold muna ‘yung ganoon din karami ‘yung percentage na suctioning for another 30 minutes to nasa circulation facilitate medication absorption SPECIAL PATIENTS ○ The patient’s head should remain elevated ○ Can be used to unconscious, uncooperative, (semi to high-Fowlers) for 20-30 minutes and irrational patients following the installation of the medication Lessens risk for aspiration DISADVANTAGES II. PARENTERAL ROUTE STRICT ASEPSIS ○ Since the first line of defense (intact skin) will Has a breakage in the skin be compromised, the nurse must make sure Current usage that has restricted them to mean that the environment is properly disinfected “injections” (not just clean but sterile) ○ All the various ways by which a solution or LIMITED AUTONOMY suspension of a drug is injected beneath or ○ Limited opportunity for the patient to under the skin and deposited within the body medicate themself ○ Administration of drugs through the use of ○ Dapat licensed professional ‘yung the needle and syringe by injection (forcing a nag-a-administer fluid into a cavity, blood vessel or body IMPAIRED SKIN INTEGRITY tissues through a needle) ○ Breaking the continuity of the body’s defenses Injection of drugs requires skill and special care, against infection because parenteral administration is more ○ Always associated with physical discomforts hazardous than the oral dosage form May damage to the nerve endings ○ Mainly the result of rapidly and efficiency with Painful kasi may itutusok sa intact area which drugs are absorbed from most Kaya need i-maintain ang asepsis injection sites technique para yung pain naroon lang ○ Once a drug is injected, it is usually difficult to sa punctured area keep being fully absorbed and from EXPENSIVE producing all of its effects including adverse ○ Compared to oral medications ones ○ Mas maselan ‘yung parenteral administration; may special instruments din ADVANTAGES na kailangan (e.g. syringe, IV line) SPECIAL INSTRUCTIONS FOR DISCHARGE PATIENTS NCM 0106 | Banaag, Diala, Mallari, Malonzo, Navarro, Paras|6  MODULE 05 — DIFFERENT ROUTE FOR MEDICATION ADMINISTRATION ○ Requires rigid instructions to the patients in ○ Needle: 25—27 gauge (gauge going up = case they will be discharged lumen is getting smaller) May be difficult for the client to follow ○ Syringe: 1 mL calibrated in 0.01 mL increments (walang background knowledge) (tuberculin) ○ Nursing Responsibility: identify whether the PURPOSE patient is out-patient or in-patient prior to ○ For skin testing if the patient is allergic or not suggesting a medication route DIFFICULT TO TROUBLESHOOT ○ In case of error, it is difficult to take back the medicine because of its rapid absorption in the bloodstream ○ Nursing Responsibility: immediately report to physician if there’s an error in administration CONTRAINDICATIONS The area must be hairless and free from extra keratinization and calluses (makapal) Do not inject on sites with signs of inflammation PROCEDURE such as redness, heat, edema, tenderness or pain Presence of scar tissue (do not inject in this area 1. Check with the patient before starting testing to be because of the fibrotic tissues) sure that they have not taken antihistamine or anti-inflammatory agents (such as aspirin, TYPES OF PARENTERAL ROUTES OF ibuprofen, and corticosteroids) for 24—48 hours ADMINISTRATION prior to administration a. This might mask the anticipated result A. INTRADERMAL INJECTION 2. Wash your hands and assemble the needed equipment Made into the dermal layer of the skin just below a. 1cc tuberculin syringe with a 26—27 gauge, 5/8 the epidermis or 1/4 inch needle, alcohol swabs, vial or Small volumes, usually 0.01—0.1 mL, are injected to ampoule, and medication card produce a wheal 3. Locate the antecubital space The absorption from intradermal sites is slow, a. Select a site, 1 to 2 finger-widths (young child) making it the route of choice for allergy sensitivity or 3–4 finger-widths (adult) distal to this tests, desensitization injections, local anesthetics landmark and vaccinations b. Select a site without skin blemishes and with SITE little hair ○ Preferred areas are lightly pigmented, thinly 4. Cleanse the site with an alcohol swab circular keratinized, and hairless such as the ventral motion (inner to outer) midforearm (most common), clavicular a. Do not use iodine solution to cleanse the skin area of the chest, and scapular area of the since the residual iodine may interfere with back interpretation of the skin test EQUIPMENT b. Allows the skin to dry thoroughly NCM 0106 | Banaag, Diala, Mallari, Malonzo, Navarro, Paras|7  MODULE 05 — DIFFERENT ROUTE FOR MEDICATION ADMINISTRATION 5. Holding the patient’s forearm in one hand, stretch ○ Kaunti lang ‘yung blood vessels sa area kaya the skin taut matagal ‘yung absorption 6. Position the syringe with the bevel of the needle ○ If the circulation is adequate, the drug is pointing upward so that the needle is almost flat completely absorbed from the tissue against the patient’s skin Many drugs cannot be administered by this route a. Use a 15-degree angle; almost see-through since no more than 2 mL can ordinarily be and parallel to the skin deposited at a subcutaneous site b. Kung hindi naka-bevel up, i-a-absorb lang ng ○ More than 2 mL may cause displacement of other tissues ‘yung in-inject mo adipose tissue (lipodystrophy) 7. Insert the needle through the epidermis ○ If 3 mL, administer mo ‘yung 2 mL sa isa then a. The point of the needle is almost visible ‘yun 1 mL sa kabila through the skin ○ The drugs must be quite soluble and potent 8. Gradually inject the medication enough to be effective in small volume a. Observe for the development of a small blister without causing significant tissue irritation (wheal) Drugs commonly injected into the subcutaneous 9. When the wheal appears, withdraw the needle. tissue are heparin and insulin a. When the intradermal injection is given for ○ Stable and predictable absorption of insulin diagnostic purposes (e.g. to determine will support optimal blood glucose control sensitivity to allergens), a control wheal is also SITE made. ○ Locations are chosen for adequate fat pad i. The solution injected is the same fluid size without the allergen and the wheal is ○ Include the abdomen, upper hips, upper back, made on the opposite arm for lateral upper arms, and lateral thighs comparison EQUIPMENT 10. Using a blue or black ballpen, mark the wheal that ○ Needle: 25–27 gauge which is usually 1/2 to was formed 5/8 inches in length a. Write the time the medication was injected ○ Syringe: 1–3 ml/cc (usually 0.5–1.5 ml and the time for you to check the skin test injected) result, which is 30 minutes after the injection 11. Chart the name of the medication, the amount given, the time and the location of the test and control sites. a. Always observe the patient for local (redness, itchiness) and systemic reactions (anaphylaxis) B. SUBCUTANEOUS INJECTION Made into the loose connective tissue between the PROCEDURE dermis and the muscle layer Absorption is slower and drug action is generally 1. Identify the patient and explain the procedure longer with subcutaneous injections a. Make sure to check the 10 Rs NCM 0106 | Banaag, Diala, Mallari, Malonzo, Navarro, Paras|8  MODULE 05 — DIFFERENT ROUTE FOR MEDICATION ADMINISTRATION 2. Position the patient for maximum comfort, ○ The injection deposits the medication deep privacy, and exposure of the injection site within the muscle mass 3. Identify the anatomical landmarks by inspection Absorption is more rapid than from the and palpation subcutaneous injections because muscle tissue 4. Identify the injection site has a greater blood supply a. In an ideal site, you should be able to pinch at Site selection is especially important with IM least 1-inch subcutaneous tissue between the injections thumb and forefinger ○ Incorrect placement of the needle may cause 5. Cleanse the injection site with an antiseptic damage to the nerves or blood vessels solution using a circular motion working from the ○ A large, healthy, and free of infection or site outward. wounds area should be used a. Place the swab between the fingers of the hand not holding the syringe 6. Remove the protective needle cap 7. Grasp the skin firmly between the thumb and forefinger to elevate the subcutaneous tissue 8. Holding the syringe firmly and at 45-degree angle to the skin (for straight and shorter needle, 90-degree can be used), thrust the needle into the tissue 9. Once the needle is inserted, release the grasp on the patient’s tissue gently 10. If no blood appears in the syringe, slowly introduce the medication. a. Allows time for distention of space within the SITE tissue to accommodate the fluid (prevents ○ Locations are chosen for adequate muscle lipodystrophy) and prevent the forcing of size and minimal major nerves and blood medication back up the needle tract vessels in the area. 11. When the syringe is empty, smoothly and quickly ○ Include ventrogluteal, dorsogluteal, deltoid, withdraw the needle and use the swab to and vastus lateralis (pediatrics) immediately place pressure over the puncture They associate fetal movement in kicking site. motion during pregnancy hence the most a. Unless contraindicated, as in heparin developed muscle of fetus will be the administration, massage the injection site to vastus lateralis facilitate the absorption of the medication EQUIPMENT 12. Position the patient comfortably ○ Amount appropriate syringe 13. Chart date, time, route, and site of injection and ○ Needle: 20–23 gauge, 1–1.5 inches in length the dosage of the medication C. INTRAMUSCULAR INJECTION Penetrating a needle through the dermis and subcutaneous tissue, into the muscle layer NCM 0106 | Banaag, Diala, Mallari, Malonzo, Navarro, Paras|9  MODULE 05 — DIFFERENT ROUTE FOR MEDICATION ADMINISTRATION 9. If no blood appears in the syringe, slowly introduce the medication. a. Allows time for distention of space within the muscle to accommodate the fluid and prevent the forcing of the medication back up the needle tract into the subcutaneous tissue. b. Another way to ensure that the medication does not leak out of the injection site is to draw an air bubble of 0.3 ml into the syringe after the medication is injected, the bubble follows the medication into the needle tract and subcutaneous tissue c. Z-TRACK METHOD i. A type of IM injection technique used to prevent tracking (leakage) of the medication into the subcutaneous PROCEDURE tissue (underneath the skin) 1. Identify the patient and explain the procedure ii. Pinch then twist to create a letter Z, 2. Position the patient for maximum comfort, securing the medication privacy, draping, and exposure of the injection 10. Smoothly and quickly withdraw the needle and site only use the swab to immediately place the pressure 3. Identify the anatomical landmarks by inspection over the puncture site. and palpation a. Unless contraindicated, massage the 4. Identify the injection site injection site to facilitate the absorption of the 5. Cleanse the injection site with an antiseptic medication solution using a circular motion working from the 11. Position the patient comfortably site outward 12. Chart the date, route and site of injection and the a. Place the swab between the fingers of the name and the dosage of the medication hand not holding the syringe 6. Remove the protective needle cap D. INTRAVASCULAR METHOD 7. Holding the syringe firmly and perpendicularly to Can either be intravenous and intra-arterial the skin, thrust the needle into the muscle at a Places the drug directly into the bloodstream by 90-degree angle. passing all barriers to drug absorption a. Do not insert the needle up to the hub but Large volumes of medications can be administered leave 1⁄4 to 1⁄2 inch to allow identification in into the vein case the needle should break ○ Usually less irritation 8. Holding the syringe with the left hand, aspirate by ○ Onset of action is the most rapid of all pulling back on the plunger with the right hand. parenteral routes a. If blood appears in the syringe, remove the Drugs may be given by: needle, replace it with a sterile needle, and ○ Direct injection with a needle and syringe relocate another area before repeating the ○ More commonly, drugs are given procedure intermittently or by continuous infusion NCM 0106 | Banaag, Diala, Mallari, Malonzo, Navarro, Paras|10  MODULE 05 — DIFFERENT ROUTE FOR MEDICATION ADMINISTRATION through an established peripheral or central 2. Prepare the prescribed drug in the syringe venous line 3. Always observe aseptic technique in preparing ○ Implantable venous access device, also and administering drugs referred to as “implantable subcutaneous 4. Explain the procedure to the patient port” 5. Always check the needle of the intravenous PURPOSE infusion if it is in the vein before administering the ○ To provide a rapid onset of drug action drug by any of the following method: SITE a. Bring the IV bottle lower than the patient’s ○ Accessible peripheral veins (e.g. cephalic or arm cubital vein of arm, dorsal vein of hand/foot) b. Pinch the IV tubing EQUIPMENT c. If the needle is in the vein, the nurse must ○ Ordered drug, syringe and needle, IV fluid, observe for the backflow of the blood in the cotton swab with alcohol, medication card distal portion of the IV tubing ○ Needle 6. Record the drug after its administration Adults: 20–21 gauge, 1–1.5 inches 7. Observe the patient for possible untoward reaction Infants: 24 gauge, 1 inch Children: 22 gauge, 1 inch INTRAVENOUS PUSH OR BOLUS Larger bore for viscous drugs, whole 1. Close the IV tubing by: (as the case may be) blood, or fractions (G18–16; necessitates a. Pinching the tubing above the injection site the location of a bigger vein) b. Closing the flow regulator or clamps 2. Clean the injection port (rubberized portion) with a PROCEDURE cotton swab with alcohol 1. Apply a tourniquet and put pressure to occlude 3. Insert the needle into the injection port and inject blood flow the drug slowly for a period of 1 to 7 minutes. a. Will cause a bulging effect on the area Observe the patient for any untoward reaction 2. Cleanse the area using aseptic technique (circular 4. When the administration is completed, withdraw motion) the needle and open the clamp of the tubing 3. Insert butterfly or a catheter, and feed up into the 5. Regulate the IV fluid through its proper rate of flow vein until blood returns (there should be a 6. Chart the procedure including the time, name and backflow) dosage of drug and the patient’s response to the a. This means that the needle is inside the vein administration 4. Remove tourniquet 5. Stabilize the needle and dress site INCORPORATION 6. Monitor the flow rate, distal pulses, skin color, ○ Method used when the drug is mixed to an IV temperature, and insertion site line whether an ongoing or follow-up line 7. Consult agency policy regarding the addition of ○ NURSING RESPONSIBILITY medications through bottle or bag, piggyback Check for patency of the line (observe technique, and IV push phlebitis [infection; redness and heat] and infiltration [edema and coolness]) SPECIAL CONSIDERATIONS Check for placement of IV tubing ○ Put bottle below the patient’s level to 1. Wash hands thoroughly facilitate backflow NCM 0106 | Banaag, Diala, Mallari, Malonzo, Navarro, Paras|11  MODULE 05 — DIFFERENT ROUTE FOR MEDICATION ADMINISTRATION 2. Connect the bottle containing the medication to INITIAL LINE OR FOLLOW-UP LINE an intravenous administration pack 3. Place a needle, usually 20G, on the end of the 1. Remove the metal cover from the IV bottle tubing designed for it 2. Clean the rubber stopper of the IV bottle with an 4. Invert the bottle and run a small amount of fluid in alcohol swab the tubing to remove the air 3. Inject the prepared drug into the larger hole of the 5. Take the administration set-up to the bedside and rubberized stopper since the smaller hole serves invert the bottle next to the primary intravenous as an airway administration set-up 4. Invert the bottle several times to mix the IV solution 6. Clean the injection site on the primary set with and the drug alcohol and insert the needle, being careful not to 5. Label the IV bottle with a card indicating the name puncture the tubing of the primary set of the drug, dosage, time of administration and the 7. Tape the needle securely in place signature of the nurse 8. Open the clamp on the piggy set and establish the 6. If it is an initial line, run a small amount of fluid to correct flow rate remove the air on the tubing 9. Check the flow rate frequently to reestablish the a. If the bottle is used as follow-up, close the flow once the piggyback set-up has emptied clamp of the IV tubing and remove the a. Regulate both the IV and the side drip that will bottle that was consumed. facilitate both entries b. Insert the tip of the IV tubing into the hole 10. Complete the charting of the information to the of the rubber stopper of the IV bottle drug administration including the drug, its dosage, intended for follow-up amount of fluid, administration time and the 7. Open the clamp and regulate the proper flow rate patient’s response to the procedure. a. Be certain to chart the amount of fluid infused ONGOING LINE on the intake and output record (I&O) 1. Close the clamp of the IV tubing 2. Remove the needle of the syringe and inject the prepared drug into the injection port of the drip chamber 3. Invert the bottle several times to mix the drug and the IV fluid 4. Label the bottle with card containing the name of the drug, dosage, time drug was administered and the signature of the nurse 5. Open the clamp and regulate the proper flow rate PIGGYBACK OR SIDE-DRIP 1. Prepare the medication to be administered in the required amount of fluid or obtain the medication already prepared ADMINISTRATION THROUGH A SPECIAL CHAMBER (SOLUSET, BURETOL, VOLUMETRIC) NCM 0106 | Banaag, Diala, Mallari, Malonzo, Navarro, Paras|12  MODULE 05 — DIFFERENT ROUTE FOR MEDICATION ADMINISTRATION 1. Clamp the administration tubing below the drip chamber 2. Allow 10-15 ml of the fluid being administered intravenously to flow into the drug administration chamber (soluset) 3. Close the clamp between the bottle and the administration chamber 4. Cleanse the injection site on the administration chamber with alcohol 5. Inject the medication to be administered into the chamber 6. Open the clamp between the bottle and the drug administration chamber and add the appropriate amount of fluid to the administration chamber 7. Clamp the tubing above the administration chamber 8. Gently agitate the drug administration chamber to mix the fluid 9. Open the clamp below the chamber 10. Establish the flow rate appropriate to permit administration of the required amount of medication within the specified time period 11. Once the medication has been administered, open the clamp above the administration chamber to resume administration of the fluid ordered 12. Chart the procedure including the time, dosage and patient’s reaction to the procedure REFERENCES Asynchronous Lecture: Routes of Medication Administration Module: NCM 0106 - Module 05 NCM 0106 | Banaag, Diala, Mallari, Malonzo, Navarro, Paras|13