PARENTERAL MEDICATIONS

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CHAPTER 34

• PARENTERAL MEDICATIONS

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Parenteral Administration

• The major equipment used in parenteral medication
  administration will be a needle and syringe.
  Various types of needles and syringes are
  available.

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Parenteral Administration Equipment

• Syringes
• Parts of the syringe
• Barrel
• Plunger
• Tip
• Calibrated in mL, cc, units (U), and maybe minims
• Most commonly used are syringes that hold 1 mL or
  equivalent and up to 3 to 5 mL.

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Parenteral Administration Equipment

• Needles
• Shaft
• Depends on where giving medication
• Lengths vary from 0.5 to 2.5 inches
• Tip is beveled
• Filtered needles
• Gauge
• Width of needle
• Most injections use 18-27 gauge
• Smaller the number larger the needle

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Parenteral Administration Equipment

• Needles
• Several factors are thought of when trying to
  select correct size needle.
• Type of med
• Where giving injection
• How much is being given
• Viscosity of med
• The persons size

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Parenteral Administration Equipment

• Modified Safety Injection
• To avoid needlestick injuries
• Three different safety injection devices
• Those with plastic shields cover needle after use
• Those with retractable needles
• Gas pressured devices that inject med without
  needle
• Most health agencies use one or more
• If devices not available use one of two methods
• Use the scoop method
• Deposit in biohazard container

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Parenteral Administration Equipment

• If needlestick happens need to
• 1. Report to supervisor
• Document the injury in writing
• Identify the patient
• Obtain HIV and Hep B client status if legal
• Obtain counseling
• Receive the appropriate post exposure prophylaxis
• Be tested for antibodies at appropriate times
• Monitor for s/s and obtain medical f/u

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Drug Preparation

• Ampules
• Sealed glass container
• Neck is etched in order to break
• Should use filtered needle to get med

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Drug Preparation

• Vials
• Glass or plastic container with rubber stopper
  that is self sealing
• Single dose or multi dose
• May have to reconstitute by adding a diluent
  before administration
• Usually with sterile saline or sterile water
• Drug label will lists following
• Type of diluent to use
• Amout of diluent
• Dosage per volume after reconstitution
• Directions for storage
• Store appropriately if multi-dose vial
• Initial, date, and time vial if multi dose vial

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Drug Preparation

• Prefilled Cartridges
• May come with an attached needle
• May use a Tubex or Carpuject

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Drug Preparation

• Combining Medications in One Syringe
• Need to extract exact amount of each
• Verify medications are compatible
• If meds precipitate do not use discard entire
  syringe

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Injection Routes

• Intradermal Injections
• Commonly used for diagnostic purpose
• Small volume 0.01 to 0.05 mL
• Injected between layers of skin
• Common site if forearm
• Can also use back and upper chest
• Use tuberculin syring-holds 1 mL calibrated in
  0.01 mL increments
• Needle 25 to 27 ga and from 5/8 to ½ inches in
  length
• SKILL 34-1

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Injection Routes

• Subcutaneous Injections
• Administered into the subcutaneous tissue between
  the skin layers and the muscle
• Absorbs fairly rapidly
• Insulin given in insulin syringe
• Heparin given in tuberculin syringe
• 25 gauge needle ½ to 5/8 inches in length
• Obese person angle will be at 90
• Thin or average person will use a 45
• May bunch up skin or spread taut
• depending on client
• Bunch up preferred method on babies, children and
  thin adults

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Injection Routes

• Intramuscular Injections
• Administer up to 3 mL into one muscle
• Irritating medications
• Five common injection sites
• Dorsogluteal
• Primary muscle used the gluteus maximus
• Not to children less than 3 years of age or not
  walking
• Not identified correctly can damage sciatic nerve
• Explanation of how to locate site
• Ventrogluteal
• Uses the gluteus medius and gluteus minimus
• No large nerves or blood vessels
• Less fatty tissue
• Also used in children
• Explanation of how to locate site

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Injection Routes

• Intramuscular Injections
• Vastus Lateralis
• Uses the vastus lateralis
• Larege nerves and blood vessels usually not
  present
• Especially desirable on infants and small
  children and thin debilitated patients
• Explanation of how to locate site
• Rectus Femoris
• Preferred site for injections of infants
• Patient should be in sitting or supine position
• Explanation of how to locate site
• Deltoid
• Least used muscle
• Used only for adults
• Limited to 1 mL of med
• Risk of damage to radial nerve and artery if not
  well identified
• Explanation of how to locate site

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Injection Routes

• Intramuscular Injections
• Z-Track
• Can be used for drugs that are very irritating
• Given at a 90 angle
• Manupilate upper tissues to help seal medication
  in the muscle
• Has a zig zag technique

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Reducing Injection Discomfort

• Can use substance like EMLA
• Use smallest gauge possible
• Change needle before administering
• Site free of irritation
• Rotate sites
• Use ice pack to numb area
• Insert and withdraw needle w/o hesitation
• Instill medication slowly and steadily
• Use Z-track method if possible
• Apply pressure when withdrawing the needle
• Massage the site if not contraindicated
• Have patient use relaxation techniques
• Patient teaching guidelines

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ADMINISTERING INSULIN

• Insulin
• Is a hormone
• Required to bond with blood glucose
• As of today administered by sub q injections or
  IV
• Measured in units
• Have to use insulin syringe
• Volumes held by insulin syringes 0.3, 0.5, and 1
  mL
• Standard dosage 100 Units per mL
• Low doses use a 30 to 50 U syringe
• Standard doseage in 1 mL syringe is 100 U

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ADMINISTERING INSULIN

• Insulin
• May receive one or more doses per 24 hrs
• Need to rotate sites to avoid lipoatrophy or
  lipohypertrophy

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ADMINISTERING INSULIN

• Preparing Insulin
• Various types of insulin with different onsets,
  peaks, and durations
• READ THE VIALS CAREFULLY
• Some insulins have additives that will separate
  when left standing
• Need to make sure that mix the insulin before
  drawing up if not a clear insulin

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ADMINISTERING INSULIN

• Mixing insulins
• Insulins tend to bind and equilibrate when mixed
  together
• Most insulins should be combined just before
  administering
• Should be injected within 15 minutes of being
  drawn
• Each will act separately
• Regular insulin a short acting insulin mixed with
  intermediate insulin such as Humulin N or Novolin
  N
• There are some combination insulins such as
  70/30, 50/50, 75/25 either Humulin or Novolin
  (these are the names used depending on the
  company that made it)

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ADMINISTERING INSULIN

• Mixing insulins
• Nursing Guidelines
• Roll the vial of mixed insulin (if clear do not
  have to roll the vial)
• Cleanse the rubber stopper of vials
• Instill the amount of air that you are going to
  withdraw from each vial making sure to instill
  the air in the cloudy first
• Then when you instill the air in the clear vial
  you will invert the vial and withdraw the exact
  amount making sure there are no air bubbles in
  the vial
• Withdraw the needle from this vial and insert it
  into the second vial the cloudy mixture and
  withdraw the correct amount needed
• Ask another nurse to verify the vials that your
  are withdrawing from and the amounts
• Administer the insulins within 15 minutes of
  drawing them up

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ADMINISTERING HEPARIN

• Heparin
• Anticoagulant
• Administered sub q or IV
• Special considerations when giving injection
• Supplied in multi-dose vials or prefilled
  syringes
• Small doses may have to use a tuberculin syringe
• To prevent bruising
• Replace the needle after withdrawing the heparin
• Rotate the sites
• DO NOT ASPIRATE WHEN INJECTING
• DO NOT MASSAGE THE SITE

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Nursing Implications

• Nursing diagnosis
• 1. Pain
• 2. Anxiety
• 3. Fear
• 4. Risk for trauma
• 5. Knowledge deficit
• 6. Ineffective management of therapeutic
  regimen individuals