Parenteral Medication Administration

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Parenteral Medication Administration

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Ethical Legal Factors

• Right to refuse
• Liability
• Nerve Damage
• Into a vein or artery
• Infiltration / Extravasation
• Tissue Damage
• Unapproved site
• Dorsal Gluteal may be unacceptable at your
  facility

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Minimize Discomfort

• Position muscle for relaxed tone
• Distraction with conversation instructions,
  visual imagery, relaxation techniques
• Dart-like quick entry for smooth tissue
  separation (its in the wrist action!!)

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What are other ways to Minimize Discomfort
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Safety Considerations

• When preparing multiple injections, always label
  the syringe immediately
• Keep the medication container with the syringe
• Do not rely on memory to determine which solution
  is in which syringe
• Carefully monitor the patient for any adverse
  effects for at least 5 minutes after
  administration of any medication
• Handle multi-dose vials carefully and with
  aseptic technique so that medicines are not
  wasted or contaminated

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Whats Sterile

• When can contamination occur?
• How can contamination be avoided?

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What do you need to know about Injection Sites?
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Injection Sites - Deltoid

• Location upper arm
• Landmarks Acromion Process, axillary fold
• Muscle mass triangle apex at axillary line and
  base of triangle 2-3 finger breadths below
  acromion process.
• Injection area in the middle of the triangle /
  into belly of the muscle mass. Avoid Brachial
  artery Radial nerve (BARN)
• http//www.austincc.edu/health/rnsg/skills/injecti
  onSites.htm

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Deltoid

• Should not be used in infants or children because
  of the muscles small size.
• Injection volume should not exceed 1ml in the
  adult
• Use a 23-28 gauge, 5/8 to 1 inch needle
• Rarely used for hospitalized patients. Primarily
  used for immunizations.

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Injection Sites - Ventrogluteal

• Location lateral (ventral) side of the hip
• Landmarks Iliac crest, anterosuperior illiac
  spine, greater trochanter of femur
• Muscle mass Gluteus medius and minimus
• Injection area opposing palm of hand over
  greater trochanter, middle finger pointed toward
  the iliac crest, index finger toward
  anterosuperior iliac spine. Inject into the
  triangle created by these fingers. No major
  vessels / nerves.

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Ventrogluteal
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Vastus Lateralis

• Location anterolateral aspect of the thigh
• Landmarks greater trochanter, lateral femoral
  condyle
• Muscle mass vastus lateralis muscle
• Injection area between one handbreadth below
  the greater trochanter and one handbreadth above
  the knee. Width of area is from the midline on
  the anterior surface of the thigh to midline on
  the lateral thigh. Best to inject into outer
  middle third of the thigh.
• No major vessels or nerves to avoid.

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Vastus Lateralis

• Identify the greater trochanter and the lateral
  femoral condyle
• Select the site using the middle third and the
  anterior lateral aspect of the thigh.

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Dorsal Gluteal Most Dangerous site, Trend is
away from use

• Location Upper lateral aspect of the buttock
• Landmarks Posterior superior iliac
  spine, greater trochanter
• Muscle mass Gluteus maximus muscle
• Injection area Draw an imaginary line between
  the anatomic landmarks listed above. Administer
  the injection lateral and slightly superior (2
  inches) to the midpoint of this line.
• Avoid the sciatic nerve superior gluteal artery

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Dorsal Gluteal
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Z - track

• Seals the medication into the muscle tissue.
• Minimizes subcutaneous tissue irritation from
  tracking of the medication as the needle is
  withdrawn.
• Used more frequently now to decrease discomfort
  and pain.
• Used for irritating medications (Vistaril) and
  tissue staining meds (iron dextran Imferon).
• Use in ventrogluteal or dorsogluteal sites

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Z - track An intramuscular injection technique
designed to deposit medications deep into muscle
tissueRelease the lateral slide of tissue ONLY
after needle has been completely withdrawn.
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Subcutaneous (SC or SQ)

• Common drugs given SQ
• Anticoagulants
• Insulin
• Erythropoitic agents
• Some Analgesics (-caine type drugs)

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Injection Technique - Anticoagulants

• Heparin
• Always lookup and read about med prior to
  administration
• Check dosage carefully some policy req. 2nd
  nurse
• Requires drawing up from vial needs air lock
• Abdomen SQ area only deep into tissue
• No aspiration no massage after withdrawal due
  to risk of precipitating bleeding
• Rotate sites

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Anticoagulant Injection Technique

• Lovenox (enoxaparin sodium)
• Look up med prior to administration
• Commonly dispensed in pre-filled syringe
• Safety syringe firmly depress plunger AFTER
  removal from tissue to activate safety seal

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• Lovenox Bruise site correct??

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What do you think of this site for heparin?
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Intradermal

• Drugs that are intradermally injected are agents
  for diagnostic determinations, desensitization,
  or immunization.
• For this route of administration, 0.1 ml of
  solution is the maximum volume that can be
  administered.
• Document date, time, and location of ID site in
  med record include projected date to be read

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Patient education may sting like an ant bite
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ANY QUESTIONS SO FAR?