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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