Download Parenteral Medication Administration

Parenteral Medication
Administration
1413
Ethical – Legal Factors
• Right to refuse
• Liability
– Nerve Damage
– Into a vein or artery
– Infiltration / Extravasation
– Tissue Damage
– Unapproved site
• Dorsal Gluteal may be unacceptable at your
facility
Minimize Discomfort
• Position muscle for relaxed tone
• Distraction with conversation &
instructions, visual imagery,
relaxation techniques
• Dart-like quick entry for smooth
tissue separation (it’s in the wrist
action!!)
What are other ways to
Minimize Discomfort
Safety Considerations
• When preparing multiple injections, always label
the syringe immediately
– Keep the medication container with the syringe
– Do not rely on memory to determine which solution is
in which syringe
• Carefully monitor the patient for any adverse
effects for at least 5 minutes after administration
of any medication
• Handle multi-dose vials carefully and with
aseptic technique so that medicines are not
wasted or contaminated
What’s Sterile
• When can contamination occur?
• How can contamination be avoided?
What do you need to know
about Injection Sites?
Injection Sites - Deltoid
Location: upper arm
Landmarks: Acromion Process, axillary fold
Muscle mass: triangle apex at axillary line and
base of triangle 2-3 finger breadths below
acromion process.
Injection area: in the middle of the triangle / into
belly of the muscle mass. Avoid Brachial artery
& Radial nerve (BARN)
http://www.austincc.edu/health/rnsg/skills/injectio
nSites.htm
Deltoid
• Should not be
used in infants or
children because
of the muscle’s
small size.
• Injection volume
should not
exceed 1ml in
the adult
• Use a 23-28
gauge, 5/8 to 1
inch needle
• Rarely used for
hospitalized
patients.
Primarily used for
immunizations.
Injection Sites - Ventrogluteal
Location: lateral (ventral) side of the hip
Landmarks: Iliac crest, anterosuperior illiac
spine, greater trochanter of femur
Muscle mass: Gluteus medius and
minimus
Injection area: opposing palm of hand over
greater trochanter, middle finger pointed
toward the iliac crest, index finger toward
anterosuperior iliac spine. Inject into the
triangle created by these fingers. No major
vessels / nerves.
Ventrogluteal
Vastus Lateralis
Location: anterolateral aspect of the thigh
Landmarks: greater trochanter, lateral femoral
condyle
Muscle mass: vastus lateralis muscle
Injection area: between one handbreadth
below the greater trochanter and one
handbreadth above the knee. Width of area
is from the midline on the anterior surface of
the thigh to midline on the lateral thigh. Best
to inject into outer middle third of the thigh.
No major vessels or nerves to avoid.
Vastus Lateralis
•
•
Identify the greater trochanter
and the lateral femoral
condyle
Select the site using the
middle third and the anterior
lateral aspect of the thigh.
Dorsal Gluteal
Most Dangerous site,
Trend is away from use
• Location: Upper lateral aspect of the buttock
• Landmarks: Posterior superior iliac spine,
greater trochanter
• Muscle mass: Gluteus maximus muscle
• Injection area: Draw an imaginary line between
the anatomic landmarks listed above.
Administer the injection lateral and slightly
superior (2 inches) to the midpoint of this line.
Avoid the sciatic nerve & superior gluteal artery
Dorsal Gluteal
Z - track
• Seals the medication into the muscle tissue.
• Minimizes subcutaneous tissue irritation from
tracking of the medication as the needle is
withdrawn.
• Used more frequently now to decrease
discomfort and pain.
• Used for irritating medications (Vistaril) and
tissue staining meds (iron dextran –Imferon).
• Use in ventrogluteal or dorsogluteal sites
Z - track: An intramuscular injection technique
designed to deposit medications deep into muscle tissue
Release the lateral slide of tissue ONLY after needle has been
completely withdrawn.
Subcutaneous (SC or SQ)
• Common drugs given SQ:
– Anticoagulants
– Insulin
– Erythropoitic agents
– Some Analgesics (-caine type drugs)
Injection Technique Anticoagulants
• Heparin
– Always lookup and read about med prior to
administration
– Check dosage carefully: some policy req. 2nd nurse
– Requires drawing up from vial; needs air lock
– Abdomen SQ area only; deep into tissue
– No aspiration; no massage after withdrawal due to
risk of precipitating bleeding
– Rotate sites
Anticoagulant Injection Technique
• Lovenox
(enoxaparin sodium)
– Look up med prior to
administration
– Commonly dispensed
in pre-filled syringe
– Safety syringe: firmly
depress plunger
AFTER removal from
tissue to activate
safety seal
• Lovenox Bruise – site correct??
What do you think of this site for
heparin?
Intradermal
• Drugs that are intradermally injected are agents
for diagnostic determinations, desensitization, or
immunization.
• For this route of administration, 0.1 ml of solution
is the maximum volume that can be
administered.
• Document date, time, and location of ID site in
med record; include projected date to be “read’
Patient education: may sting like an ant bite
ANY QUESTIONS SO FAR?