Parenteral Medication Administration PDF

Parenteral Medication Administrati on NURS 1090 Routes for Parenteral Medications Administration Intradermal Subcutaneous Intramuscular Intravenous (will talk about weeks 12 & 13) Why Administer Medications by Injection? Patient is NPO Only form the medication is available in...

Parenteral Medication Administrati on NURS 1090 Routes for Parenteral Medications Administration Intradermal Subcutaneous Intramuscular Intravenous (will talk about weeks 12 & 13) Why Administer Medications by Injection? Patient is NPO Only form the medication is available in Increased efficacy of the medication Ability of the medication to work more efficiently  Intradermal Administration (ID) Medication placed just below the skin – into the dermis Absorbed slowly (potent medications) Few blood vessels in this layer Examples TB, allergy testing Subcutaneous Administration (subcu or sq) Medication placed into the loose connective tissue under the dermis Absorbed faster than ID, but slower than IM Subcutaneous tissue contains a limited number of capillaries and no vital organs  Intramuscular Administration Placing of medication into the muscle Provides for quicker absorption of medication Muscular tissue has many blood vessels Allows medication to be absorbed into the system more quickly  Preventing Infection Sterile/Aseptic Technique Always used when preparing and administering medications by injection Injections are an invasive procedure Once skin is pierced it becomes a portal of entry for microorganisms What measures can be implemented to prevent infection?  Preventing Infection Prevent needle contamination  avoid letting needle touch any surface Prevent syringe contamination  avoid touching length of plunger  avoid touching inner part of barrel  keep tip of syringe covered with needle Prevent medication vial contamination Prepare skin properly  soiled skin should be washed with soap and water  use friction and a circular motion while cleaning with the alcohol swab  swab from center of site and move outward Equipment Needed (Same for all 3 Routes) Alcohol MAR Syringe swabs Non- Safety Medicati sterile Needle on gloves  Syringes Luer-lock - needle locks into place by twisting the needle onto the syringe Mostly what we use for injections Non-luer-lock (slip tip)- needle can be pulled straight off Small volume syringes Some insulin syringes Non-removable Some insulin or tuberculin syringes Syringes and Needles Parts of a syringe Parts of a needle Syringes and Needles: Which Parts Stay Sterile? Tip of barrel Inside of barrel Hub Shaft Needle **May handle ONLY outside of syringe and handle of plunger  Syringe Sizes 0.5 ml - 60 ml Never need to use larger than a 3 ml syringe for injections Average size adult can tolerate up to 3 ml injected into a large muscle. Usually never inject more than 3 ml.  Larger volumes create pain and discomfort  Types of Syringes HYPODERMIC ◦Tenths of milliliter INSULIN ◦measures in UNITS ◦0-100 units ◦ONLY/ALWAYS USE WHEN GIVING INSULIN SMALL VOLUME (1 mL) ◦Hundredths of milliliter Choose the syringe that is the closest to the volume you will be drawing into the syringe: Less than 1 mL: Tuberculin (TB) syringe More than 1 mL: Hypodermic syringe 1 mL: Can choose TB or Hypodermic Insulin Syringes Used ONLY for insulin Choosing the Correct Syringe Choose the syringe that is the closest to the volume you will be drawing into the syringe: Less than 1 mL: Tuberculin (TB) syringe or hypodermic syringe More than 1 mL: Hypodermic syringe 1 mL: Can choose TB or Hypodermic  Volumes of Medication That Can Be Given By Route Intradermal ◦0.01mL-0.1mL Subcutaneous ◦1-2mL Intramuscular ◦NO greater than 5 mL ◦If greater than 3mL, consider dividing into 2 doses What type of medication might come in a larger volume?  Intramuscular Volumes Larger muscles (Ventrogluteal, Vastus Lateralis) Typically 3 mL, but no more than 5 ml Children, older adults, and smaller adults – 1-2 mL Deltoid Up to 1ml only Do not give more than 1 mL as muscle is too small to tolerate more  Needle Sizes Gauge: Diameter - Length: How long is measured in gauge: how the needle? big around Determined by the size and 16 - 27 gauge weight of the patient and The larger the gauge number route of administration (ID, the smaller the needle SQ, IM) diameter Needle lengths vary from Example: #20 gauge needle is larger in diameter than a #22 1/4” - 3” gauge needle  Average Needle Lengths and Gauges: Intradermal, Subcutaneous & Insulin Intradermal ◦Length: 1/4” – 1/2” ◦Gauge: 25 – 27 Subcutaneous Insulin ◦Length: 1/2” – 5/8” Length: 1/2 “ ◦Gauge: 25 – 27 Gauge: 29 - 31 Must be used for insulin ONLY  Average Needle Lengths and Gauges: Intramuscular GAUGE for ALL – (19 – 25) ◦USUALLY 22 – 25 ◦DELTOID ◦LENGTH –1” to 1-1/2” ◦VASTUS LATERALIS ◦LENGTH –1” to 1-1/2” ◦VENTROGLUTEAL ◦LENGTH – 1” to 1-1/2”  Safety Needles Required by law (OSHA): All healthcare facilities must provide their employees with safety needles to protect themselves from accidental needle sticks Healthcare providers responsibility to use the equipment and use it correctly SQ, ID, IM, IV, Phlebotomy Examples of Safety Needles  Patient Safety Issue Labeling Syringes that are NOT labeled pose a significant safety risk associated with Syringes medication errors in the clinical area Best Practice – National Patient Safety Goal All syringes must be labeled with name of drug and dosage during the preparation process Institute for Safe Medication Practices www.ismp.org General Principles: Administering Any Injectable Medication Universal Steps: Review the MAR Note where last injection was given Three safety checks with 5 rights Patient Assessment: Select appropriate injection site Inspect skin and avoid area with scars, bruises, inflammation, edema, etc Injection Sites Injection Site Selection: Intramuscular Ventrogluteal ◦Research – preferred site for most injections Vastus lateralis Deltoid Dorsogluteal - * Last choice ◦(Not mentioned in textbook)  Injection Sites: Ventrogluteal Fewer nerves or blood vessels & muscle well developed Landmarks: ◦Fewer nerves or blood vessels & muscle well developed Place heel of hand over greater trochanter ◦Right hand if patient on right side ◦…so you would be giving it in the left VG ◦Left hand if patient on left side ◦…so you would be giving it in the right VG Injection Sites: Ventrogluteal Point thumb toward groin (abdomen) Point index finger toward anterior, superior iliac spine Extend middle finger toward buttock You have now formed a V-shaped triangle Inject in to middle of the V  Injection Sites: Vastus Lateralis Easily accessible and well developed Landmarks Knee Greater trochanter Place one hand over knee Place one hand at the greater trochanter  Injection Sites: Deltoid Easily accessible--  But, close to the radial and ulnar nerves and brachial artery  Not well developed in most people  Never inject more than 1 ml  Use smaller gauge and shorter length needle Landmarks  Acromion process & Axilla  Place 1 finger directly on the acromion process  Site is then about 2-3 finger widths below the process  Injection site is in the middle of muscle  Injection Sites: Dorsogluteal Not commonly used  Use As Last Alternative Area has large arteries and sciatic nerve Thick layer of adipose tissue  Chance of giving medication subcutaneously instead of into muscle Landmarks  Posterior, superior iliac spine  Greater trochanter  Draw an imaginary line between the landmarks  Upper outer aspect of buttock is injection site General Principles: Intramuscular Administration Follow Guidelines and Competency Evaluation Sheet General Principles:  Hold skin taut (tight)  Dart syringe/needle at a 90- degree angle General Principles: Intramuscular Administration… cont, DO NOT RECAP NEEDLE Discard needle/syringe into the sharps container Position patient to a comfortable position Document on MAR Do not leave syringe/needle in bed  Intramuscular Administration: Z-track Used to prevent leakage of medication after administration minimize skin irritation with irritating medications administered IM Always change needle after preparation  Pull the skin and subcutaneous tissue to the side and inject  Aspirate (if facility policy) and inject slowly as you continue to hold tissue to the side – keep needle in for 10 seconds  Withdraw needle and release skin Intramuscular Injections and the Older Adult Older adult women have Be sure to insert larger amounts of needle at correct subcutaneous angle to ensure IM tissue in the delivery deltoid area  Injection Site Selection: Subcutaneous Sites Most common:  Outer, posterior aspect of upper arm  Abdomen  Anterior surface of thigh Alternative sites:  Upper back  Injection Site Selection: Subcutaneous Lift (pinch) skin with thumb and two fingers and raise the skin & fat away from the underlying muscle Cleanse area and let dry Dart needle at a 45 or 90 degree angle  Bevel must be up if giving at a 45 degree angle  To minimize pain and ensure optimal skin piercing No need to aspirate  Subcutaneous Injection and the Older Adult Age related changes in the skin Thinning of epidermis Dermal atrophy Decreased blood flow Decreased subcutaneous fat Subcutaneous Injections: Medication Considerations Anticoagulants ◦Abdomen is site of choice ◦Consistent absorption ◦Choose site at least 2 inches away from the umbilicus ◦Never massage after administering ◦To avoid bleeding, hematoma or bruising  Subcutaneous Injections: Medication Considerations Insulin ◦Do not rub or massage area ◦Apply light pressure to the area to prevent loss of leaking of insulin ◦Rotate sites of administration ◦Always use an insulin syringe (typically have an orange cap) Intradermal Injections Site selection Forearm: most common Inner aspect of forearm 3-4 finger widths below the antecubital space One hand width above wrists Relax the arm with elbow and forearm extended on a flat surface  Intradermal Injections With nondominant hand, stretch skin over site with forefinger and thumb  Older adults’ tissue may be thinner and less elastic  Insert needle slowly at a 5-15-degree angle  Keep bevel up  Insert until resistance is felt  Advance to no more than 1/8 inch below the skin and do not aspirate  Intradermal Injections Slowly inject medication. Resistance will be felt A small bleb or wheal will form under the skin Withdraw needle and apply gentle pressure Do not massage If a wheal (bleb) does not form: ◦The injection was given too deeply ◦The test must be readministered immediately FOR ALL INJECTIONS ALWAYS Use Sharps Container Always engage safety device NEVER RECAP Always use needless devices if possible Dispose in sharps container Injection Delivery Systems Vials Multi Dose Single Dose Ampules Carpujects Document EMAR Time of Administration Site of Administration Patient Response  Potential Complications of Parenteral Injections Nerve damage or paralysis of the extremity Lipotrophy subcutaneous fat breaks down at site of repeated injections Infection or abscess formation at site something was contaminated Damage to blood vessels Competency Evaluation Oral Medication Administration (Pill)  10 POINTS Injectable Medication Administration (IM or SQ)  10 POINTS PRACTICE….PRACTICE….PRACTICE