Medication Administration PARENTERAL

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NurseFaith
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258717
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Medication Administration PARENTERAL
Updated:
2014-01-27 19:44:31
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parenteral
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parenteral
Description:
parenteral med
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  1. Intradermal Medications
    • Used for very small amounts of medication:
    • 0.01-0.1 ml

    Use a TB syringe with a needle between ¼ to ½” and 26 or 27 gauge. (can range form 3/8” – 5/8” and 25-27 gauge)

    Used for TB test and allergy tests.
  2. Procedure for Intradermal Medication Administration
    • •Select appropriate site.  The forearm is the
    • most common, though the back can be used.
    • •3-4 fingers below the antecubital space and one hand above the wrist is the appropriate site.
    • •Don gloves
    • •Support the elbow and forearm either on a flat surface or with your non-dominant hand.
    • •Cleanse site with alcohol and allow to dry. We do not blow on it or wave our hand over it to get it to dry.  It will dry quicker on a real person vs. the plastic.
    • •Put air into the syringe (draw up .04 so this way you can see how the increments on this syringe works- it goes to the 100ths)
    • •Remove needle cover by pulling it straight
    • out. No using teeth!
    • •Hold syringe between the thumb and forefinger.  Be sure the bevel is up.  (bevel is the flat part of the needle- we want to be sure the pointy part is entering the skin first). 
    • •This is the one injection that I do not hold the syringe like a dart because it prevents me from getting a small enough angle. 
    • •Stretch skin taut-this makes it much easier for this small needle to penetrate the skin
    • •With the needle almost against the patient’s skin, insert the needle, carefully at a 5°- 15° angle.  The needle tip is all that needs to go in (approximately 1/8”).  The
    • entire length of the needle does not.  Be careful not to push the needle all the way in, because it is so close to the surface of the skin it can actually break through and come back out of the skin. 
    • •Inject the medication slowly and a bleb or wheal should form (it does not form on
    • these manikins). You may feel some resistance.
    • •Remove needle
    • •Apply gentle pressure to site – Do Not massage
    • •Dispose of needle appropriately in the needle disposal box in the patient’s room
    • •Draw a circle around injection site
  3. Most common subcutaneous medications:
    • insulin, heparin, lovenox, fragmin and
    • allergy medications
  4. Subcutaneous administration facts:
    •Absorption occurs relatively slow because there are few blood vessels- therefore blood concentrations of the drug will be lower but the drug’s effects will last longer.

    •Be aware that if the patient exercises, warms, or elevates the site after an injection the absorption rate, as well as the drug’s effects, could markedly-and dangerously- increase (these things all increase absorption)

    • •Heparin, lovenox  and fragmin are anticoagulants or medications that prevent formation of clots. They are usually given to patients after surgery, if they are immobilized and more recently prophylactically on admission.  There are some differences with the administration of these, some specific guidelines
    • –Pick a site two inches away from the navel and away from any scar or bruise
    • –DO NOT rub

    ***ROTATE SITES
  5. SubQ Injection Procedure
    •Select correct needle size- you have the 1 ml or TB syringe in your nurse pak.

    •A needle that is from 3/8 to 1”, 25-30 gauge is appropriate. (most common is 3/8 – 5/8”)

    •If giving insulin, we would use the insulin syringe.

    •We are trying to get the medication into the subcutaneous layer of the skin so in order to do this we pinch the skin (prefer 1” fold) to pull it away from the muscle layer.

    •General rule of thumb:   needle length = ½ width of skinfold

    •***Whether we go at a 45°< or 90°< depends on the size of the skinfold- for a skinny patient a 45°<, a large patient 90°<. If you are giving the injection at 45°< the bevel of the needle must be up.

    •Don gloves

    •Cleanse site with alcohol and allow to dry. We do not blow on it or wave our hand over it to get it to dry. [circular fashion from center moving outward]

    •Put air into the syringe (draw up 0.78ml)

    •Remove needle cover by pulling it straight out.No using teeth!

    •Hold syringe like a dart and inject in to skinfold. (You can try either or both the 45° and 90° angles)

    •We DO NOT aspirate

    •Once you have injected the needle you can let go of the skinfold and use that hand to steady the barrel while you push in the medication. 

    •Inject medication slowly but steadily

    •Remove needle at the same angle you inserted it.

    •Apply gentle pressure.

    •This is one of the big differences with heparin and lovenox- we do not rub the site

    •Lovenox- air bubble or air lock is nitrous oxide which goes in last and seals off the med so it does not leak out. Works similarly to z-track sealing it in which helps since you can not rub area

    •Dispose of needle appropriately
  6. Intramuscular Facts
    •Allows for rapid absorption

    •IM injections require a larger needle to get deep into the muscle.  Generally 21-25 gauge, 1-11/2” though we can go up to 3” [for obese patients especially in gluteus]

    •Encourage the patient to relax the muscle you’ll be injecting – injecting into a tense muscle causes more bleeding and pain
  7. Intramuscular Medication Administration Procedure:
    •Choose appropriate site (will do in a minute)

    •We will go at a 90°< in order to reach the muscle layer.

    •Don gloves

    •Cleanse site with alcohol and allow to dry. We do not blow on it or wave our hand over it to get it to dry. 

    •Put air into the syringe

    •Remove needle cover by pulling it straight out. No using teeth!

    •Pull skin taut- this will stabilize the area and make it easier for the needle to break the skin.

    •Hold syringe like a dart and inject straight in.

    •If you have chosen the correct needle size for the patient the entire length of the needle should go in even though sometimes people tend to only put the needle in part way. 

    •Once they have injected the needle you can let go of the skin and stabilize the syringe.

    •Aspirate or pull back on plunger for 5-10 seconds- this is checking for any blood which would mean that you are in a blood vessel.  What happens if you get blood? 

    • •Make sure you are not pulling back on the entire syringe, moving the needle part way
    • out as you aspirate. (when you are nervous you may tend to start pulling back on the syringe and start to pull the needle out part way- make sure you are not doing this).

    •Inject the medication slowly [approximately 10 seconds / ml] but steadily.

    •Wait around 10 seconds before removing the needle

    •Remove needle at same angle of insertion

    •Apply gentle pressure to site

    •Unless contraindicated by the medication, gently massage the relaxed muscle to distribute the drug better,  increase absorption and reduce pain.

    •Dispose of needle appropriately

    •*EBP: now states that aspiration is not necessary for immunizations
  8. Sites for Intramuscular Injection
    • Deltoid
    • Rectus Femoris
    • Vastus Lateralis
    • Ventral Gluteal
    • Dorsal Gluteal
  9. Deltoid IM Site:
    •Used for small medication volumes (0.5- 1 ml)

    •Don’t use if younger than 3 years old

    •Palpate lower edge of the acromion process.  Go 3-4 finger widths below this and that is the injection site

    •If that muscle is developed it is where the arm bows out.

    •Have patient flex his elbow and support the lower arm
  10. Rectus Femoris/Vastus Lateralis Sites:
    •Lay one hand below the greater trochanter and one hand above the knee on the anterior of the thigh. This middle third is the rectus femoris (rarely used).

    •Using the same landmarks as the rectus femoris slide the hands laterally (to the outside of  the leg).  This lateral middle third is the vastus lateralis.

    •Have patient point toes in to rotate hips internally to relax this muscle.
  11. Ventral Gluteal Injection Site:
    •Preferred injection site since it is away from all major blood vessels and nerves.  This is the hardest site for students  to learn and remember the landmarks.

    •Locate the greater trochanter and the anterior superior iliac spine (you need to know this terminology, though it is the hip bone).

    •Have patient lie facedown, or stand with his toes pointed inward, or lie on his side with upper leg drawn up in front of the lower one to relax the muscle.

    •***If giving the injection in the left leg, use right hand and visa versa.

    •Place the palm of your hand on the greater trochanter.  Have the index finger point towards the anterior superior iliac spine. (If you have small hands and you move your hand up so your finger actually touches the anterior superior iliac spine you may end up too high so keep your palm on the greater trochanter.  The same is true if you have big hands- you may have to pull your palm down a little so you are not too high).  Point your thumb towards the abdomen and spread other fingers back along the iliac crest towards the buttock. 

    •The injection site is in the center of the triangle formed by the index and middle fingers.
  12. Z-track Injection Method
    •This is a slight variation on the IM injection. 

    •It is used to prevent leakage back up in to the subcutaneous tissue or dermis by sealing the medication in the muscle therefore preventing swelling or induration or staining.

    •Pull the skin laterally and hold it there while administering the medication. 

    •The other steps are the same as above. The only difference is that once you inject the patient you can not let go of the skin to use both hands to help aspirate.
  13. Consequences of improper site selection/needle length
    •Nerve and/or blood vessel damage

    •Tissue damage in surrounding area

    •Hitting bone

    •Trauma and pain

    •Needle length guidelines have been revised for pediatric patients due to over-penetration

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