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Division 1
Introduction to Advanced
Prehospital Care
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Chapter 7
Intravenous Access and
Medication Administration
Part 1
Principles and Routes of
Medication Administration
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Topics
Aseptic Technique
Medication Administration Routes
Medication Package
Anatomy and Physiology Related to
Medication Administration
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Six Rights of Drug Administration
Right person
Right drug
Right dose
Right time
Right route
Right documentation
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Knowing all drug administration
protocols is essential.
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Always take appropriate body
substance isolation measures to
reduce your risk of exposure during
medication administration.
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Body substance
isolation equipment
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Medical Asepsis
It is important to keep the ambulance
and all the equipment clean.
Sterile
– Free of all forms of life
Medically clean
– Involves careful handling to prevent
contamination
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Treat all blood and body fluids as
potentially infectious.
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Needle Handling Precautions
Minimize the tasks performed in a
moving ambulance.
Immediately dispose of used sharps in
a sharps container.
Recap needles only as a last resort.
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Medication Administration
and Documentation
Record all information concerning the
patient and medication including:
– Indication for drug administration
– Dosage and route delivered
– Patient response to the medication
Both positive and negative
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Percutaneous drug administration is
drugs applied to and absorbed through
the skin or mucous membranes.
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Transdermal
Absorbed through the skin at a slow,
steady rate
Method:
– BSI
– Clean administration site
– Apply medication
– Leave medication in place for required
time. Monitor the patient for desirable or
adverse effects.
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Mucous Membranes
Absorbed through the mucous
membranes at a moderate to rapid rate
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Sublingual Medication
Administration
Place the pill or direct spray between the underside of the tongue and the
floor of the oral cavity.
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Buccal Medication Administration
Place the medication between the patient’s cheek and gum.
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Eye Drop Administration
Use a medication dropper to place the
prescribed dosage on the conjunctival sac.
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Nasal Medication Administration
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Aural Medication Administration
Manually open the ear canal and administer the appropriate dose.
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Pulmonary Drug Administration
Medications are administered into the
pulmonary system via inhalation or
injection.
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Small volume nebulizer
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Nebulizer with
attached face
mask, bag-valve
mask, and
endotracheal tube
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Metered dose inhaler
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Endotracheal Tube
Several medications can be
administered through an endotracheal
tube:
–
–
–
–
Lidocaine
Epinephrine
Atropine
Naloxone
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Enteral Drug Administration
The delivery of any medication that is
absorbed through the gastrointestinal
tract
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Gastrointestinal tract
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Oral Drug Administration
Any medication taken by mouth and
swallowed into the GI tract.
Be sure the patient has an adequate
level of consciousness to prevent
aspiration.
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Oral Drug Forms
Capsules
Tablets
Pills
Enteric coated/
time release
capsules and
tablets
Elixirs
Emulsions
Lozenges
Suspensions
Syrups
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Equipment for
Oral Administration
Soufflé cup
Medicine cup
Medicine dropper
Teaspoon
Oral syringe
Nipple
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
General Principles of
Oral Administration
Use appropriate BSI measures.
Note whether to administer medication with food
or on empty stomach.
Gather any necessary equipment.
Have patient sit upright when not
contraindicated.
Place the medication into your patient’s mouth.
Allow self-administration; assist when needed.
Follow administration with 4-8 ounces of water
and ensure that patient has swallowed the
medication.
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Gastric Tube Administration
Gastric tubes provide access directly to
the GI system.
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Confirm proper tube placement.
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Withdraw the plunger while observing for the
presence of gastric fluid or contents.
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Instill the medication into the gastric tube.
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Gently inject the saline.
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Clamp off the distal tube.
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Rectal Administration
The rectum’s extreme vascularity
promotes rapid drug absorption.
Medications do not travel through the
liver, and are not subject to hepatic
alteration.
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Catheter placement on needleless syringe
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Syringe attached to endotracheal tube
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Prepackaged enema container
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Parenteral Drug Administration
Drug administration outside of the
gastrointestinal tract
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Syringes and Needles
Syringe
Hypodermic needle
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Kinds of Parenteral
Drug Containers
Glass ampules
Single and multidose vials
Nonconstituted syringes
Prefilled syringes
Intravenous medication fluids
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Ampules and Vials
Ampules
Vials
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Information on Drug Labels
Name of medication
Expiration date
Total dose and concentration
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Obtaining Medication from a
Glass Ampule
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Hold the ampule upright and tap its
top to dislodge any trapped solution.
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Place gauze around the thin neck…
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
…and snap it off with your thumb.
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Draw up the medication.
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Obtaining Medication
from a Vial
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Confirm the vial label.
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Prepare the syringe
and hypodermic needle.
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Cleanse the vial’s rubber top.
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Insert the hypodermic needle into
the rubber top and inject the air
from the syringe into the vial.
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
The nonconstituted
drug vial actually
consists of two vials,
one containing a
powdered medication
and one containing a
liquid mixing solution.
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Nonconstituted drugs come in separate vials.
Confirm the labels.
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Remove all solution from the
vial containing the mixing solution.
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Cleanse the top of the vial containing the
powdered drug and inject the solution.
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Agitate or shake the vial
to ensure complete mixture.
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Prepare a new syringe
and hypodermic needle.
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Withdraw the appropriate
volume of medication.
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
In the Mix-O-Vial system, the vials are
joined at the neck. Confirm the labels.
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Squeeze the vials together to break the seal.
Agitate or shake to mix completely.
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Withdraw the appropriate volume
of medication.
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Prefilled or Preloaded
Syringes
Confirm medication indications and patient
allergies.
Confirm prefilled syringe label (name, dose,
and expiration date).
Assemble the prefilled syringe. Remove the
pop-off caps and screw together.
Reconfirm indication, drug, dose, and route
of administration.
Administer appropriately via the indicated
route.
Properly dispose of the needle and syringe.
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Parenteral Routes
Intradermal injection
Subcutaneous injection
Intramuscular injection
Intravenous access
Intraosseous infusion
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Intradermal
Injection
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Assemble and prepare
the needed equipment.
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Check the medication.
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Draw up the medication.
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Prepare the administration site.
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Pull the patient’s skin taut.
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Insert the needle, bevel up at
a 10-degree to 15-degree angle.
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Remove the needle and cover the puncture
site with an adhesive bandage.
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Monitor the patient.
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Subcutaneous Injection
45º
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Subcutaneous Injection Sites
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Prepare the equipment.
© Scott Metcalfe
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Check the medication.
© Scott Metcalfe
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Draw up the medication.
© Scott Metcalfe
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Prep the site.
© Scott Metcalfe
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Insert the needle at a 45-degree angle.
© Scott Metcalfe
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Remove the needle and
cover the puncture site.
© Scott Metcalfe
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Monitor the patient.
© Scott Metcalfe
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Intramuscular Injection Sites
Deltoid
Dorsal gluteal
Vastus lateralis
Rectus femoris
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Intramuscular Injection
90º
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Intramuscular Injection Sites
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Prepare the equipment.
© Scott Metcalfe
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Check the medication.
© Scott Metcalfe
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Draw up the medication.
© Scott Metcalfe
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Prepare the site.
© Scott Metcalfe
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Insert the needle at a 90-degree angle.
© Scott Metcalfe
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Remove the needle and
cover the puncture site.
© Scott Metcalfe
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Monitor the patient.
© Scott Metcalfe
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Summary
Aseptic Technique
Medication Administration Routes
Medication Package
Anatomy and Physiology related to
Medication Administration
Bledsoe et al., Essentials of Paramedic Care: Division 1
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ