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Oral (PO) Sublingual Via feeding tube › Esophagostomy › Gastrostomy › Jejunostomy Aural Topical Topical ophthalmic Transdermal Intranasal Inhalation Orogastric intubation › Nebulized or volatilized Nasogastric Intratracheal intubation Rectal (PR) o Intradermal (ID) o Subcutaneous (SC or SQ) o Intramuscular (IM) o Intravenous (IV) o Intraosseous (IO) o Intraperitoneal (IP) o Epidural/subdural o Intracardiac (IC) o Intramammary Patient Factors Health conditions › Symptoms › Absorption rate of drug required Temperament Ease of administration for client Drug Factors Formulation of drug Cost Systemic vs. local effect desired Does the medication require any special precautions to be followed during administration? › Examples: Potential side effects of drug? › Pain at injection site › Vomiting/GI upset/constipation Gather supplies Needles Syringe Medication to be injected For venipuncture only: Cotton ball with alcohol Needle gauge is determined by: › Route of administration › Consistency of drug › Patient size Two needles are required: › One to draw up the medication › One to administer the medication Why is this? Draw up exact amount of drug › May use a small gauge needle Aspirate all drug into the syringe (out of needle) › This prevents _______ _________ Remove needle and replace with appropriate needle Carefully ensure all air is out of the syringe by slowly depressing the plunger Ensure accurate amount of medication Supplied as: › Sterilized solutions › Sterilized suspensions › Powders that must be mixed, or _______________ with sterile solution May be stored in: › Vials (single or multi-dose) › Ampules › Fluid bags Indications for: › Desensitize skin/local nerve block › Allergy skin testing Skin is usually shaved Animals are usually sedated Drug does not go systemic › Only effects localized area Skin is pulled taught and a 25 to 27 gauge needle is attached to a syringe and inserted with the bevel up into the dermis. › If allergy testing: A 0.1 ml volume of allergen is injected. › If locally anesthetizing skin: dose of drug based on weight What two drugs commonly used? The injection site will look like a translucent lump if the injection is performed correctly › Referred to as a _________ Indications for IM injections: › Anesthetics/sedatives Convenient route of administration for ____________ animals › Pain medications › Heartworm treatment Appropriate route for injection of _______ volumes of medication Generally, more painful for animals than SC or IV. › Why? 1. Lumbosacral region Epaxial muscles ___________ to the dorsal spinous processes 2. Hind limb Semimembranosus/ semitendinosus muscles Quadriceps muscle Deep IM injection into the third to fifth lumbar region of the epaxials are used to administer ______________ heartworm treatment (Immiticide®). Quadriceps: most cranial aspect of limb Semis: small strap of muscle belly on the caudal aspect of limb Needle should always be directed away from the ___________ ____________. Isolate the muscle between the fingers and thumb of non-dominant hand. A 22 to 25 gauge needle attached to a syringe is embedded in the muscle at a ______ angle. Aspirate › What should you feel? › What do you do if you see blood in needle hub? Once in the muscle, inject the medication. Massage the site for a few seconds after the injection to help distribute the liquid. › Exception: Tissue trauma Nerve damage Drugs and/or fluids may be injected directly into a vein. IV route produces an ______________ response Indications for IV injections: › › › › › › Inducing anesthesia Chemotherapeutic agents Anti-convulsant drugs Vesicants Emergency/resuscitation drugs Large amounts of _________ needed Requires new needle for administration Cephalic is most common › Saphenous may be used if needed Jugular is never used unless a ________ ________ catheter is placed **If multiple drugs are prescribed or repeated access is needed, an intravenous catheter should be placed Pull up the drug (same as for IM injection) Expel all air bubbles from the syringe prior to inserting into the vein. › Prevents ________ ___________ Restrainer should occlude the vessel Swab the skin with an alcohol-soaked cotton ball (go with the fur). Insert a 20- to 25- gauge needle, bevel up into the vein. › Only go in until a flash is seen › Confirm placement by gentle aspiration Venipuncturist: communicate to restrainer “I’m in” or “ready to inject” Restrainer: release pressure from the vein › VERY IMPORTANT STEP Inject the medication into the vein › If large volume of drug or movement of needle: re-aspirate to confirm placement in vein Communicate with restrainer and remove needle Apply firm digital pressure to the injection site until hemostasis/coagulation occurs Hematoma formation Air-embolus Septicemia Perivascular injection of drug › Skin ____________ › Incorrect absorption rate