Download INTRANASAL MEDICATION ADMINISTRATION (DROPS, SPRAY

INTRANASAL MEDICATION ADMINISTRATION
(DROPS, SPRAY, JELLY OR TOPICAL SOLUTION, DDAVP LIQUID)
PURPOSE
Procedure to guide clinicians in the safe and effective administration of medications (nose drops, spray, jelly or
topical solution and DDAVP intranasal liquid) via intranasal route. For intranasal medications to be given using
an atomizer, refer to Intranasal Drug Delivery via Atomizer policy and procedure.
POLICY STATEMENTS
Administration of intranasal medications requires a prescriber’s order. The order must meet safe prescribing
practices as described in Medication Order Requirements Policy.
Health care providers administering any medication are responsible for knowing the classification of drug to be
administered, its mode of action and side effects in order to provide safe care.
The “Rights of Medication Administration” are consistently used by all health care providers when
administering medications.
SITE APPLICABILITY
Applicable to all clinical areas.
PRACTICE LEVEL/COMPETENCIES
RNs, RPNs and LPNs may administer intranasal medications that are within their scope and competencies to
administer.
EQUIPMENT
o
o
o
o
o
o
medication (note: DDAVP is kept refrigerated)
dropper (for drops)
administration tube (rhinyle) for DDAVP
1 mL syringe (if child not able to self-administer DDAVP)
tissue
emesis basin as required
PROCEDURE
Rationale
1. CHECK chart for prescriber's order which specifies
the drug name, indication, dosage, route, if one or
both nostrils are to be used, and frequency of
administration.
Medication orders that meet safe prescribing
practices promote patient safety.
NOTE: for DDAVP, the order must specify dosage in
___micrograms AND 0.___mL
2. GATHER needed equipment and supplies.
Facilitates completion of task in timely manner.
3. IDENTIFY patient using 2 unique identifiers and
Failure to correctly identify patients prior to
ENSURE patient and family understand what
procedures may result in errors.
medication is being given and why and how, any
Reduces child and family’s anxiety. Evaluates and
possible side effects and that questions are answered.
reinforces understanding of previously taught
information and confirms consent for medication
administration.
4. PERFORM hand hygiene and DON clean gloves.
Routine Infection Control Practices; reduces
transmission of microorganisms.
5. OBTAIN help of second nurse as needed.
6. HAVE child blow nose to clear passageway. For
Clearing nasal passage of secretions/mucus
infants and toddlers, a bulb syringe may be used to
provides more effective medication delivery and
clear nares as indicated.
absorption.
LastReviewDate
CM.03.08
BC Children’s
Feb 08, 2013
Disclaimer Message
Refer to online version – Print copy may not be current – Discard after use
Create Date
Hospital Child & Youth Mar
Health
Policy and Procedure Manual
01, 1984
Page 1 of 4
The following information, i.e. guideline/educational material/policy or procedure, has been developed for use only within BC Children's Hospital (BC Children's) and BC Women's Hospital and Health Centre (BC Women's).
Agencies other than BC Children's or BC Women's should use this information as a guideline for reference purposes only. All materials are the property of BC Children's and BC Women's and may only be reprinted in whole or
in part with our expressed permission. Contact [email protected] with questions.
Date/Time Generated
Oct 19, 2016 20:29
Generated By
Anonymous
INTRANASAL MEDICATION ADMINISTRATION
(DROPS, SPRAY, JELLY OR TOPICAL SOLUTION, DDAVP LIQUID)
NOTE: Ensure there are no contraindications to blowing
nose such as increased intracranial pressure or
maxillofacial trauma.
7. ADMINISTER intranasal drug as per the following
Routine Infection Control Practices; reduces
instructions, then DISPOSE used supplies and
transmission of microorganisms.
equipment in appropriate container, REMOVE gloves
and PERFORM hand hygiene.
For nasal drops
a. SHAKE container as needed and draw up amount
needed into dropper.
b. PLACE pillow under neck and shoulders and assist
patient to tilt head over back edge of pillow.
RESTRAIN patient as necessary.
c. HOLD dropper 1 cm (1/2 inch) above nares and
INSTILL prescribed number of drops one side at a
time or to affected side only. DIRECT drops away
from center of nose and instill either directly up and
back, or toward outside of the nose. ASK patient to
breathe through the mouth.
Ensures fine particles are mixed before
administration.
Provides optimal access to nasal passages and
minimizes unpleasant sensations associated with
medicated nose drop administration.
Keeping dropper above nares prevents
contamination of dropper from nasal mucosa.
Directing drops away from nasal septum decreases
irritation.
d. INSTRUCT patient to keep head tilted back for at
Aids in optimal absorption of medication through the
least 1 minute or hold infant/small child in position as nasal membranes and prevents leakage of
long as tolerated.
medication from nares.
e. WIPE excess medication from patient's nares and
Ensures maximum absorption of medication.
face with a tissue. INSTRUCT patient/family not to
blow patient's nose for several minutes.
f. INSTRUCT patient to expectorate any medication that Decreases amount of medication inadvertently
drains into throat or mouth.
delivered to the GI tract.
For jelly or topical administration
a. PLACE medication into nostril and instruct patient to Ensures absorption of the medication.
sniff it into back of nose.
NOTE: this form of delivery may not be effective for
infants and young children as they are not able to follow
these instructions.
For nasal spray
a. SHAKE container as needed.
Some materials may be activated by shaking the
container.
b. HOLD patient's head upright and press one finger
Aids in maximum inhalation of medication delivered
against side of nose to close one nostril.
to nostril.
c. INSERT tip of bottle into opposite nostril and squeeze Directing spray away from nasal septum decreases
bottle while patient inhales. Try to direct spray away irritation.
from center of nose and spray either directly up and
LastReviewDate
CM.03.08
BC Children’s
Feb 08, 2013
Disclaimer Message
Refer to online version – Print copy may not be current – Discard after use
Create Date
Hospital Child & Youth Mar
Health
Policy and Procedure Manual
01, 1984
Page 2 of 4
The following information, i.e. guideline/educational material/policy or procedure, has been developed for use only within BC Children's Hospital (BC Children's) and BC Women's Hospital and Health Centre (BC Women's).
Agencies other than BC Children's or BC Women's should use this information as a guideline for reference purposes only. All materials are the property of BC Children's and BC Women's and may only be reprinted in whole or
in part with our expressed permission. Contact [email protected] with questions.
Date/Time Generated
Oct 19, 2016 20:29
Generated By
Anonymous
INTRANASAL MEDICATION ADMINISTRATION
(DROPS, SPRAY, JELLY OR TOPICAL SOLUTION, DDAVP LIQUID)
back, or toward outside of the nose.
d. INSTRUCT patient to try and hold breath for a few
Aids in delivery and absorption of medication.
seconds and then exhale through mouth.
e. REPEAT with other nostril.
Medication is delivered to both nostrils.
f. INSTRUCT patient not to blow nose and avoid
Aids in effective delivery and absorption of
sneezing immediately after medication administration. medication.
g. RINSE canister tip with hot water and replace cap.
Decreases contamination of tip with nasal flora,
reducing spread of microorganisms.
For DDAVP (desmopressin acetate) nasal liquid administration
Intranasal DDAVP is used in the management of Diabetes Insipidus. Due to an increased risk of hyponatremia
with the intranasal formulations, it is no longer indicated for the treatment of Primary Nocturnal Enuresis
(bedwetting).
a. DRAW up DDAVP as described in patient instruction
sheet. The dose is very small and should only
occupy 1/10 to 1/3 of the rhinyle. DOUBLE CHECK
that correct amount is drawn up into rhinyle with
second RN.
b. POSITION patient on pillow with head tilted slightly to
one side (tilted to right for right nostril and tilted to left
for left nostril). Older children may sit with head tilted
backward.
c. INSTRUCT patient on technique to follow for instilling
medication into nostril(s) (per patient instruction
sheet) and OBSERVE each administration for
accuracy of dosage and application.
d. If the patient is not able to self-administer the
medication, the syringe method may be used by the
nurse or caregiver to administer the dose. FILL a 1
mL syringe with a small amount of air, ATTACH a BD
adapter (reorder number PS# 00019487) to the
rhinyle, INSERT the rhinyle approximately ¼ inch into
the nostril, and inject the DDAVP into the nostril with
a small ‘puff’ of air from the syringe.
e. INSTRUCT patient to NOT inhale during the
administration.
f. RINSE the rhinyle under running water and shake
thoroughly until no more water is left. Allow to air dry.
Rhinyle has gradation marks for dosage accuracy.
Because dose is so small, double checking for
accuracy ensures correct amount of medication is
obtained.
Ensures medication delivery via nasal mucosa.
Ensures accurate dosing and correct application.
Alternate method of drug delivery for patients unable
to self administer dose.
DDAVP must be absorbed from the nasal passages.
Inhalation could cause the medication to go into the
upper airway or back of the throat.
Water will dilute dose if present in rhinyle
DOCUMENTATION
DOCUMENT on appropriate record(s):
o date and time
o drug, dose, route
o individual administering medication
o patient's response to procedure
o unexpected outcomes and related treatment
o patient/family education
o any other pertinent actions or observation
REFERENCES
LastReviewDate
CM.03.08
BC Children’s
Feb 08, 2013
Disclaimer Message
Refer to online version – Print copy may not be current – Discard after use
Create Date
Hospital Child & Youth Mar
Health
Policy and Procedure Manual
01, 1984
Page 3 of 4
The following information, i.e. guideline/educational material/policy or procedure, has been developed for use only within BC Children's Hospital (BC Children's) and BC Women's Hospital and Health Centre (BC Women's).
Agencies other than BC Children's or BC Women's should use this information as a guideline for reference purposes only. All materials are the property of BC Children's and BC Women's and may only be reprinted in whole or
in part with our expressed permission. Contact [email protected] with questions.
Date/Time Generated
Oct 19, 2016 20:29
Generated By
Anonymous
INTRANASAL MEDICATION ADMINISTRATION
(DROPS, SPRAY, JELLY OR TOPICAL SOLUTION, DDAVP LIQUID)
Brusby, A. New Safety Information regarding the antidiuretic drug desmopressin (DDAVP® Spray and
DDAVP® Rhinyle Solution). Health Canada alert issued July 15, 2008.
Compendium of Pharmaceuticals and Specialties, online version (e-CPS). DDAVP® Rhinyle Nasal Solution.
© Canadian Pharmacists Association, Revised June 19, 2008.
Harder, N. (2013). Medication Administration, Intravenous Therapy, and Nutritional Support. In Ateah, C.A.,
Scott, S.D. and Kyle, T. (Ed.), Canadian Essentials of Pediatric Nursing (pp.337-365), Philadelphia, PA:
Wolters Kluwer Health/Lippincott Williams & Wilkins.
Hockenberry, M.J. and Wilson, D. Wong's Nursing Care of Infants and Children, eighth edition. St Louis,
Missouri, 2007, Mosby Elsevier.
Lang, C.: Intranasal Medication. In Trivits Verger, J and Lebet, RM, editors: AACN Procedure Manual for
Pediatric Acute and Critical Care. St Louis, Missouri, 2008, Saunders Elsevier.
McConnell, E.A. (1993). Clinical Do's and Don'ts: How to Instill Nose Drops. Nursing. 23(7):18.
LastReviewDate
CM.03.08
BC Children’s
Feb 08, 2013
Disclaimer Message
Refer to online version – Print copy may not be current – Discard after use
Create Date
Hospital Child & Youth Mar
Health
Policy and Procedure Manual
01, 1984
Page 4 of 4
The following information, i.e. guideline/educational material/policy or procedure, has been developed for use only within BC Children's Hospital (BC Children's) and BC Women's Hospital and Health Centre (BC Women's).
Agencies other than BC Children's or BC Women's should use this information as a guideline for reference purposes only. All materials are the property of BC Children's and BC Women's and may only be reprinted in whole or
in part with our expressed permission. Contact [email protected] with questions.
Date/Time Generated
Oct 19, 2016 20:29
Generated By
Anonymous