Download Page 1 of 5 Parenteral Medication Administration Parenteral Route

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Parenteral Medication Administration
 Parenteral Route
 Medications that are administered by any route other than through the digestive system.
 Commonly used to refer to the administration of medications by injection with the use of a needle and
syringe.
 Invasive procedure that must be performed using aseptic technique
 Sub-Q = Subcutaneous
 IM = Intramuscular
 ID = Intradermal
 IV = Intravenous
 Angle of injections
 Parts of a Syringe
 Barrel
 outer calibrated portion
 holds med
 Plunger
 inner device to eject med
 Tip
 end that holds the needle
 Luer-lok
 Plain
 Overview of Syringes
 Syringe sizes
 Ranges from 1 to 60 ml
 capacity
 Units, ml (cc)
 Safety Features – vary according to manufacturer
 Retractable
 ____________________________
 Syringe Types
 Hypodermic
 TB
 Insulin (low dose and high dose)
 Cartridge
 Prefilled syringe
 Example: Pediarix - DTaP, HepB, and IPV in 1
prefilled, prelabeled syringe
 Reading a Syringe
 Parts of a Needle
 Hub
 fits onto tip of syringe
 Shaft
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 Connects to the hub
 Bevel
 Slanted tip of needle
 Needle Sizes
 Gauge (g)
 the smaller the gauge number, the larger the lumen or width
 Length (inches)
 3/8 to 2 inches (longer not standard)
 Selection of gauge/length
 Dependent on the age of the pt, muscle size, site, type of injection, type of medication
 ID: 25-27 gauge, 3/8-5/8 inch
 Sub-Q: 25 gauge, 1/2-5/8 inch
 Deltoid IM: 20-25 gauge, ½ - 1 ½ inch (depends on age and solution)
 Other IM: 18-25 gauge, ½ -2 inch (depends on age and solution)
 Medication containers
 Ampules
 Break ______________ from you
 Always use hand protection
 Use filter needle to draw up medication, then change needles prior to injecting
 Vials
 Rubber topped
 Wipe top with alcohol
 Inject air equal to medication amount you are giving prior to drawing up the med
 If opening a multidose vial, be sure to mark date and initials on vial
 If using an open multidose vial, be sure to check date vial was opened.
 Mix-o-vial
 Sterile areas
 ________________________________
 Shaft
 Needle
 Medication
 Injection Assessment
 Five rights +2 x3
 Review order
 Review drug
 Last site?? (important in rotating sites)
 Pt’s age, knowledge, size
 Blood glucose? pain scale? reaction to past doses?
 Pt Teaching
 Why
 What to expect
 Possible side effects
 Rotation of sites
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 May have to instruct pt to give injection at home
 Always provide written, illustrated instructions
 Intradermal Injections
 Intradermal Sites
 Usually done for TB testing or allergy testing
 Forearms and upper back – due to potency of meds, injected into dermis where blood supply is reduced
and drug absorption occurs slowly
 Area should be lightly pigmented, free of lesions, and hairless
 Intradermal injection
 Must form a bleb or wheal
 Angle of injection: ________________________degrees
 Bevel up, produce a bleb – don’t aspirate or massage
 Nurse should be able to see injection site for changes in color and tissue integrity
 Injected site must be “read” within a prescribed time
 Subcutaneous Injections
 Used for meds that do not need to be absorbed as quickly as those given IM.
 May respond more rapidly to a subcutaneous injection than to po med
 Only small doses can be given (<______________ mL)
 Insulin
 Hormone used to treat diabetes
 Administered by injection – protein would be destroyed by GI tract
 Insulin prepared in 100 units per milliliter of solution – use 50 or 100 unit scaled syringe (orange)
 Insulin Classification
 Classified by rate of action: Different onset, peak, and duration of action:
 Rapid
 Intermediate
 Long acting
 Must know insulin classes and differences
 Sliding Scale
 Insulin is ordered by specific dosages at select times, by carbs, or by a sliding scale.
 Physician orders different insulin doses based on a client’s blood glucose reading or carb intake
 Some institutions have standard sliding scales
 Before Mixing
 Check compatibility of the 2 medications or medication and the diluent
 Regular insulin can be mixed with any other type of insulin
 Before mixing insulin, each vial should be rolled between both hands for at least ________ minute.
Shaking may affect the accuracy of the dose
 resuspends the insulin
 helps warm medication
 Opened insulin can be stored safely for one month at room temperature
 Insulin requires refrigeration if being stored for more than one month
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 Mixing of Medications
 Always mix ______________________________
 If both cloudy, order doesn’t matter.
 Do not cross contaminate
 Need to verify dose of clear insulin with another nurse and
again verify dose after mixing.
 Injection Sites: Subcutaneous
 Injecting Subcutaneously
 If 2 inches of tissue can be grasped, the needle should be
inserted at a _____________ degree angle
 If 1 inch of tissue can be grasped, the needle should be
inserted at a 45 degree angle
 Avoid the belt line
 Insert needle quickly and smoothly
 Divert client attention with conversation
 Rotate sites (use each site no more than q 6 – 7 weeks)
 Intramuscular Injections
 Method to administer medication into the deep muscle tissue
 Muscle tissue is richly supplied with blood vessels – medications absorbed in 10 – 30 minutes
 Adults can tolerate up to 3 – 5 ml into a large muscle – less irritated than subq tissue
 Z-track
 Used for irritating medications
 Lessens bruising
 Given more slowly (1 ml/10 seconds)
 Skin must remained pulled until after med is injected
 What’s a Z track?
 Muscles for IM/Z-track
 Vastus lateralis –
 Easily accessible
 Common site in children ____________
 Location:
 One handbreadth above the knee
 One handbreadth below the greater trocanter
 Medial lateral portion of thigh
 Deltoid – 1-3 inches below the acromion process, or inverted triangle with site toward the bottom of the
triangle
 Only small volumes (<1cc)
 Don’t use oil or irritating meds
 Ventrogluteal
 Heel of hand on greater trochanter with 1st finger on superior iliac spine, thumb toward groin. Site
between index and second finger
 Preferred site in adults
 Less painful
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 Evaluation
 Ask about site
 Numbness, burning, tingling
 Ask about response
 ie pain decrease?
 Any questions?
 Documentation - MAR
 Name of med
 Dosage
 With heparin and insulin, who you
_____________________________
 Route
 Location of injection
 Time administered
 Initials/signature
 Documentation – Nurse’s Note
 Time and type of patient’s complaint
 Med administered
 Outcome of Tx
 Signature
 0800 – Ruth Smith complained of pain at her surgical site. She described it as “sharp and stabbing” and
rated it 8 on the pain scale. Site appeared dry with no redness. Sutures intact. PRN Demerol 0.5cc IM
was given in the right ventrogluteal.------------------------------------------------------Tom Thompson, RN
 0830 – Ruth Smith stated her pain level was at 2. She denies any itching or nausea. ----------------------------------------------------------------------------------------------------------------------------Tom Thompson, RN