Download parenteral administration of drugs

PARENTERAL
ADMINISTRATION OF
DRUGS
ROUTES OF ADMINISTRATION
• Oral (PO)
• Sublingual
• Via feeding tube
• Types
• Orogastric intubation
• Nasogastric intubation
• Rectal (PR)
ROUTES OF ADMINISTRATION
• Aural
• Topical
• Aerosol/Inhalant
PARENTERAL ROUTES
• Parenteral: definition
• Drugs administered with a needle and syringe
• Subcutaneous (SC or SQ)
• Intramuscular (IM)
• Intravenous (IV)
• Intradermal (ID)
PARENTERAL ROUTES
• Intraosseous (IO)
• Intraperitoneal (IP)
• Intra-arterial (IA)
• Epidural/subdural
• Intracardiac (IC)
• Intramammary
ROUTE OF ADMINISTRATION
• Depends on many factors:
• Health of patient
• Symptoms
• Absorption rate of drug
• Temperament
Ease of administration for Veterinary Professionals and clients
ROUTE OF ADMINISTRATION
• Drug Factors:
• Type of medication/fluid
• Formulation of drug
• Cost efficiency
• Systemic vs. local effect desired
• Special handling?
• Potential side-effects?
COMPARISON OF COMMON PARENTERAL
ROUTES OF DRUG ADMINISTRATION
SKIN LAYERS
• Epidermis – several layers thick, does NOT contain blood vessels
• Dermis – comprised of blood vessels, lymph, nerve fibers, and accessory organs
(glands and hair follicles)
• Subcutaneous layer (hypodermis) – comprised of connective tissue and large
amount of fat
• Muscle lies underneath all of these layers
BEFORE THE INJECTION
• Gather supplies
• Needles
• Syringe
• Medication to be injected
• Proficient person to restrain the patient
SYRINGES ARE AVAILABLE IN VARIOUS
SIZES
NEEDLES
• Needle gauge (size) is determined by:
• Route of administration
• Size of patient
• Consistency of drug being used
• At least TWO (2) needles required:
• One to draw up the medication
• One to administer the medication
• Why?
INJECTABLE DRUGS
• Supplied as:
• Sterilized solutions
• Powders that must be reconstituted with sterile solution (water or saline)
May be stored in:
Vials (single or multi-use)
Ampules
Fluid bags
INTRADERMAL INJECTIONS
• Most common uses:
• Desensitize skin
• Allergy testing
• Skin is usually shaved before administering an ID injection
• Drug is NOT dispersed throughout the body
ID INJECTION PROCEDURE
• Skin lifted or pulled taught
• 25- to 27-gauge needle attached to a syringe inserted with the bevel up into the
dermis
• Allergy testing: a 0.1 ml volume of allergen is injected
• Local anesthetic: dose of drug given by DVM
Injection site will have a translucent lump if injection is performed correctly
SUBCUTANEOUS INJECTIONS
• Vaccine administration
• Fluid administration
• Pain medications
• Antibiotic injections
• Insulin administration
• Absorption rate is slow compared to other routes
• Some medications/drugs are harmful if injected SC
SUBCUTANEOUS ADMINISTRATION
SC INJECTION SITES
• Dorsolateral region from neck to the hips is preferred site
• Dorsal region of neck and back should be avoided for drug
administration
• Cat vaccines: the __________________ should be avoided because of
the incidence/risk of vaccine-induced tumors
• Feline vaccines should be administered in as distal a portion of an
extremity as possible
SC INJECTION PROCEDURE
• Fold of skin is tented and the needle is inserted at the base of the tent.
• Aspirate!
• Why?
• After injection, briefly massage skin to facilitate drug distribution
INTRAMUSCULAR INJECTIONS
• Appropriate route for small volumes of medication
• Common uses of IM route:
• Sedatives/anesthetics
• Pain medications
• Heartworm treatment
• Conventional route of administration for fractious animals
• Generally more painful than SC or IV. Why?
IM ADMINISTRATION
IM INJECTION SITES
• Drugs most often administered in:
• Lumbosacral musculature lateral to the dorsal spinous processes
• Semimembranosus/semitendinosis muscles of the rear leg
• In the hind limb: the needle should enter the lateral aspect of the muscle and be
directed caudally.
• Why?
IM INJECTION SITES
AVOID THE SCIATIC NERVE!!!!
IM INJECTION SITES
• Deep IM injections in the third to fifth lumbar region of the ________________
are used to administer adulticide heartworm treatment (Immiticide).
IM INJECTION PRECEDURE
• Isolate the muscle between the fingers and thumb
• Use a 22 to 25 gauge needle attached to a syringe, and insert into the muscle at a
__________ angle
• Like with a SQ injection the needle hub is checked for blood before administration of the
medication. Why? How?
• Once in the muscle, inject the medication slowly
• Massage the site for a few seconds after injection to help distribute the medication
COMPLICATIONS OF IM INJECTIONS
• Tissue trauma
• Pain at the injection site
• Nerve damage
INTRAVENOUS ADMINISTRATION
• Drugs and/or fluids may be injected directly into a vein OR through
an IV catheter
IV route produces an immediate response
• Usually given slowly
• Common use of IV route:
•
•
•
•
Inducing anesthesia
Chemotherapeutic agents
Anti-convulsant drugs
Irritant drugs
INTRAVENOUS ADMINISTRATION
• Emergency/resuscitation drugs
• Large amounts of volume are needed
• Requires a new needle for administration
• Why?
IV INJECTION SITES
• DOG:
• Cephalic
• Lateral saphenous
CAT:
Cephalic
Medial saphenous
Femoral
IV INJECTION PROCEDURE
• Expel all air bubbles from the syringe prior to inserting the needle into the vein
• Restrainer should occlude the vessel with digital pressure or use a tourniquet
• Grasp the extremity and pull the skin taut in a distal direction
• Swab the skin and hair with an alcohol-soaked cotton ball
• Insert a 20- to 25-gauge needle, bevel up into the vein
IV INJECTION PROCEDURE (CONT’D)
• Usually blood will enter the hub of the needle at penetration of the vein
(flash), BUT placement is confirmed by aspirating.
• What should we see?
• Venipuncturist should communicate with the restrainer “I’m in”
• Restrainer should release pressure from the vein
• Inject the medication into the vein
• If large volume of drug or movement of needle:
IF USING A TOURNIQUET
• Most common:
• Nye tourniquet or Penrose drain/rubber material
• Can be very dangerous if used improperly
• Goal is to visualize and palpate the vein
• Must be able to remove before injecting!
POSSIBLE COMPLICATIONS WITH IV
INJECTIONS
• Injecting drug outside of the vein
• Hematoma formation
• Intra-arterial injection of drug
• Hitting a nerve (pain, lameness, paralysis)
• Air-embolus
• Phlebitis
• Septicemia