Parenteral Medication

Administration
 Parenteral Medication Administration
Definition:

 Parenteral administration involves giving drug by a route through injection into the body tissue

Purpose
 To get a rapid and systemic effect of the drug.
 To obtain maximum effect of the drug
 Some medicines that cannot be administered orally due to poor absorption in G.I. tract
 To obtain a local effect at the site of the injection e.g. local anaesthesia, diagnostric tests.
 To restore blood volume by replacing the fluid e.g. in shock.
 
Purpose
 To get a rapid and systemic effect of the drug.
 To obtain maximum effect of the drug
 Some medicines that cannot be administered orally due to poor absorption in G.I. tract
 To obtain a local effect at the site of the injection e.g. local anaesthesia, diagnostric tests.
 To restore blood volume by replacing the fluid e.g. in shock.
 
 Intraspinal or intrathecal-when medicines are introuduced into the spinal cavity.
 Intraosseous-when drugs/fluids are introduced into the bone marrow.
 Intraperitoneal – when medicines are introuduced into peritoneal cavity.
 Infusion-when large quantities of medicines or fluids are to be introduced into the body.
I. Intradermal Injections
 

Intradermal (ID) injections are usually used for skin testing (allergy and tuberculin). Injected into the dermis,
where blood supply is limited. The inner aspect of the forearm and upper back are the common injection sites.
ID injections are given using a tuberculin syringe with a 27G needle, 3/8 or 5/8”. Amount to administer
is 0.01-0.1 ml. If a bleb does not appear or blood appears at the insertion site, the medication may have entered the
subcutaneous layer
 Purpose:
To introduce drug, Vaccine, Sera or toxic into the dermis
1) To test for allergic Mani gestation
2) To develop immunity
3) To diagnose cock disease condition

Equipment
Tray Containing Sterile mixer with 2cc syringe or tuberculin syringe and needles of gauge
 No 200 26 3/8 of an inch in length Contain with clean cotton swabs
 Container with methyl spirit 70 %
 Distilled water ampoule
 Ample file
 Drug
 Kidney tray, paper bag
 A bowl with pad and water
 A towel
 Procedure:
1. Check the orders
2. Explain to the client
3. Assemble the equipment
4. Make the client sit up or lie down
5. Recheck medication for dose and expiry date
6. Wash hands and dry
7. Moisten the cotton swab with spirit and wipe the rubber cap
8. Pick up the syringe from sterile minor holding the in flange of the vial

9. Fix the wide bore needle filmy on to the syringe by holding the hub of the needle
10. Draw 0.02 to 0.03 ml of the
drug
11. Change to finer gauze needle

12. If the drug is in ampoule lightly tap the tip of the ampoule and wipe the neck of the
ampule cut with ampoule file and break the tip from ampoule holding with dry
cotton
14.Select the site and clean with spirit swab 14: Expel air from syringe
15. Stretch the skin tight with left thumb and index finger

16. Introduce the needle bevel side up at 150 angle until the bevel completely covered by skin
17. Inject the drug to raise 5mm or wheel
18. With-draw the needle
19. Rinse the syringe and needle with water and place in the bowl
20. Observe the client for reaction up to 30 mts
21. Record in the chart
 Subcutaneous Injections
Subcutaneous injections are made when the needle passes through the dermis and delivers
medication into the subcutaneous tissue. The amount of medication administered via this route is usually a
maximum of 2mls. Drug absorption from the subcutaneous tissues is slow
Sites for subcutaneous Injections

ADMINISTRATION OF MEDICINE BY SUBCUTANEOUS INJECTION PROCEDURE

PURPOSE:
To introduce drug into the subcutaneous tissue for slow absorption
 EQUIPMENT:
Trolley or Tray containing

 Sterile minor with syringes and needles gauze No. 25 and ½ in length.
 Container with clean cotton swabs Container with ethylated spirit 70%
 Distilled water Ampoules
 The drug Ampoules file
 A bowl with pad and water
 Towel
PROCEDURE:
Check the order for injection and make a card

 Assemble the equipment

 Explain to the patient
 Help patient to be in position
 Select medication and check the order, dosage and end of date
 Wash and dry hands
 Moisten the cotton swab with spirit and wipe the rubber cap of the vial
 If the drug is in the ampoule, lightly tap the tip of ampoule and wipe the neck of the ampoule and break the tip from
ampoule holding with dry cotton.

 Pick up the syringe from the sterile minor without contaminating. Hold it at flange
 Fix the needle of No. 25 gauze firmly on to the syringe by holding the hub of the needle

 Draw the required amount of medicine by pushing the air equal to the amount of the drug to the dread

 Change the 25 gauge needle to a finger gauze

 Hold the siring in horizontal position unit ready to inject
 Check the name of the patient and the order
 Locate the side and clean area of skin about the inch radius with spirit
 Expel air from the syringe but avoid accumulation of medicine at the tip of the needle
 Stretch the skin and thrust the needle quickly at 45° angle to the site
 Hold the needle at the hub with left hand withdraw piston slightly with right hand and confirm that it is in the
subcutaneous
 Inject medicine slowly holding at the hub of the needle
 With draw the needle quickly, lightly pressing the surrounding ate a with cotton swab
 Message the area gently, if not contra indicated
 Place the patient in comfortable position
 Observe the patient for reaction
 Record in chart

Intramuscular Injections

Intramuscular injections are made when a needle passes through the dermis, through the
subcutaneous layer and into the muscle. This is done to deposit medication deep into the muscle tissue. This route of
administration allows for rapid absorption of the medication and systemic reaction due to the fact that the muscle layer
is very vascular
Sites for Intramuscular Injections
1. Ventrogluteal Area
This injection site is free of major blood vessels and nerves with less fatty tissue distribution
It would never be used for children under three as the muscle has not fully
developed which occurs through walking. This site is accessible when the patient is sitting, prone,
supine or side-lying
 The site is located by placing the palm of the hand on the lateral
potion of the greater trochanter, with the index finger on the greater iliac spine and the middle finger extended to the
iliac crest. The injection is made in the center of the “V” that is formed between the middle and index finger
1. Vastus Lateralis Muscle
This site offers safe rapid absorption, as it is away from nerves and blood vessels. It is the site of
choice for children and healthy ambulatory adults.
The location of the injection is determined by putting one hand
breath above the
knee and one hand breath below the greater trochanter. Between
the two thumbs is
where the optimal injection site is.
1. Rectus Femoris Muscle
This muscle is located medial to the Vastus Lateralis Muscle, but doesn’t cross the
midline of it. The same location technique is used to determine the injection site on
the muscle as is used for the Vastus Lateralis Muscle.
1. Deltoid Muscle
This injection site is used to administer small amounts of medication (2cc’s or less) that are non-irritating. The risk of
using this site is to avoid the clavicle, humerus, acromion, brachial vein, brachial artery and radial nerve. This muscle is
easily assessed from a standing, sitting or prone position

The injection site is located by placing fingers on the patient’s shoulder. Locate the
acromion process landmark which is the lateral triangular projection of the spine of the
scapula, forms point of shoulder, and articulates with the clavicle. Once the acromion
process is located, place index and middle finger on the landmark, creating an inverted
triangle. The injection site is located 1-2 inches below the acromion process in the
center of the triangle.
 ADMINISTRATION OF MEDICINE BY INTRAMUSCULAR INJECTION PROCEDURE

PURPOSE:
To introduce drug into the muscular tissue for
a) Rapid absorption
b) Injecting fluids up to 10ml
c) Preventing irritation by certain chemicals when administered by other routes
Equipment:
Trolley or Tray containing
 Sterile minor with syringes and needles gauze No. 24 and 1 ½
in length.
 Container with clean cotton swabs Container with ethylated
spirit 70%
 Distilled water Ampoules
 The drug Ampoules file
 A bowl with pad and water
 Towel
Procedure
Check the order for injection and make a card
 Assemble the equipment
 Explain to the patient
 Help patient to be in position
 Select medication and check the order, dosage and end of date
 Wash and dry hands
 Moisten the cotton swab with spirit and wipe the rubber cap of the vial
 If the drug is in the ampoule, lightly tap the tip of ampoule and wipe the neck of the ampoule and break the tip from ampoule holding with dry
cotton.
 Pick up the syringe from the sterile minor without contaminating. Hold it at flange
 Fix the needle of No. 20 gauze firmly on to the syringe by holding the hub of the needle

 Draw the required amount of medicine by pushing the air equal to the amount of the drug to the dread
 Change the 20 gauge needle to a finger gauze
 Hold the siring in horizontal position unit ready to inject
 Check the name of the patient and the order
 Locate the side and clean area of skin about the inch radius with spirit
 Expel air from the syringe but avoid accumulation of medicine at the tip of the needle
 Stretch the skin and thrust the needle quickly at 90° angle to the site
 Hold the needle at the hub with left hand withdraw piston slightly with right hand and
confirm that it is in the muscle
 Inject medicine slowly holding at the hub of the needle
 With draw the needle quickly, lightly pressing the surrounding ate a with cotton swab
 Message the area gently, if not contra indicated
 Place the patient in comfortable position
 Observe the patient for reaction
 Record in chart
 Intravenous Medication Administration
Intravenous (IV) medication administration refers to the process of giving medication directly into a patient's vein
Common sites of IV Injection
 Ventral aspect of elbow or forearm median cubical, basilica or cephalic veins.

 Dorsal aspect of hand – brachial, cephalic or metacarpal veins, In the infants the scalp vein is used.
Purpose:
 To restore the fluid volume in case of hemorrhage, dehydration etc.
 To meet the patient’s basic requirement (calorie, water, mineral, vitamins)
 To prevent and treat shock and collapse.
 To supply the body with an adequate amount of fluids, electrolytes and other nutrients. When the patient is
very weak and unable to take orally.
 To administer medicine.
 To save the patient in life threatening situations e.g. burns, septicemia, toxemia, etc .
 
 Equipment
A TRAY CONTANING
 Syringe and needles of various sizes according to the need in a covered tray (sterile)
 Transfer forceps in a jar containing antiseptic solutions.
 Sterile cotton swabs and gauze pieces in sterile containers.
 Methylated spirit in a container
 Bowl with water
 Tourniquet
 Drug order sheet
 Medication in ampoule or vial
 File to cut open the ampoules
 Small covered tray (sterile)
PROCEDU
1. Check physician’s order for name of medication, dosage, and route of administration.
RE
2. Collect information necessary to administer drug safely including action,
purpose, side effects, normal dose, time of onset, time of peak action and
nursing implications.
 3. If drug is to be given through existing IV line, determine type of additive in IV solution, if any
4. Assess condition of needle insertion site for signs of infiltration or phlebitis
5. Check patient’s history of drug allergies
6. Assemble supplies in medication room
7. Wash hands and don gloves
8. Prepare medication from vial or ampoule
9. Check patient’s identification by asking name and compare with medication card

10 . IV Push (existing line)

a. Explain procedure to patient and encourage patient to report symptoms of discomfort at IV site
b. Select injection port of IV tubing closest to patient. Whenever possible injection part should be a three-way port or other needleless device
c. Connect syringe to IV line:
 In needless system, remove cap of needless injection port, Clean port with antiseptic solution.
 Insert standard tip of syringe containing prepared medication.
 In needle system, select port indicating site for needle insertion. Clean port with antiseptic swab.
 Insert small gauge needle of syringe containing durg through center of port .
 b. Pull back gently on the syringe’s plunger to aspirate for a blood return.
e. After noting blood return, inject medication slowly over several minutes.
f. Observe IV site during injection for sudden swelling.
g. Release tubing after injecting medication, withdraw syringe and recheck
the fluid infusion rate.
11. Flush the three-way port in cases where medication is administered through
a three-way port in which fluids are not flowing:
a. Heparin flush method:
 Prepare a syringe with 1 mL heparin flush solution.
 Flush the IV line.
b. Saline flush method:
c. Prepare syringe with 2 mL of normal saline
d. Flush the IV line
1. Dispose off uncapped needles and syringe in proper container.
2. Remove gloves and wash hands.
3. Observe patient closely for adverse reactions during administration and
for several minutes thereafter.
4. Record drug, dose, route and time on medication forms.
5. Report any adverse reactions to nurse in-charge or physician.