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ROUTES OF DRUG ADMINISTRATION .pptx
This document discusses various routes of drug administration including parenteral routes like intravenous, intramuscular, subcutaneous, and intradermal. It describes techniques for aspirating drugs from ampoules and vials and administering drugs via these parenteral routes. It also discusses inhalational routes using devices like metered dose inhalers, dry powder inhalers, nebulizers, and incentive spirometers. The benefits and risks of different administration routes are outlined.
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ROUTES OF DRUG ADMINISTRATION .pptx
- 1. ROUTES OF DRUGADMINISTRATION
- 2. • List thevarious routes of drug administration • Describe the techniques of aspiration of drug from ampoule and vial • Describe the techniques of I.V, I.M, S.C, I.D administration and their benefits and risks • Describe the parts, principles, advantages and disadvantages of MDI, DPI, Spcaer, Spirometry, Nebulizer.
- 4. PARENTERAL ROUTES • IV •IM • SC • ID • INHALATION
- 6. 1. Aspirate fromampoules and vials 2. Identify right patient 3. Consent 4. Explain the procedure 5. Instuctions to patient
- 7. Aspirating from ampoules Materials-- syringe of appropriate size, needle of required size, ampoule with required drug, gauze. Technique • wash your hands • put the needle on the syringe • remove the liquid from the neck of the ampoule by flicking it • file around the neck of the ampoule • protect your fingers with gauze if ampoule is made of glass • carefully break off the top of the ampoule • aspirate the fluid from the ampoule • remove any air from the syringe • after injecting the drug- clean up, dispose of working needle and syringe safely, and wash your hands
- 8. Aspirating from vial Materials-- vial with required drug, syringe of appropriate size, needle of required size, disinfectant, gauze. Technique • wash your hands • disinfect the top of the vial • use a syringe with a volume of twice the required amount of drug and attach the needle • suck up as much air as the amount of solution needed to aspirate • insert needle into vial and turn-upside down • Pump air into vial • Aspirate the required amount of solution and 0.1 ml extra. make sure the tip of the needle is below the fluid surface. • Pull the needle out of the vial. • Remove possible air from the syringe • After injecting the drug - clean up , dispose of working needle and syringe safely and wash our hands
- 9. INTRAVENOUS ROUTE Veins inantecubital region • Cephalic • Basilic • Median
- 11. Checklist for Intravenousroute of administration Materials needed 1. Non sterile gloves 2. Medication syringe (withoutair)with needle(gauss25 short and thin 3. Alcohol swab 4. Sterile gauge Safety concerns 1. Check the pt details 2. Check the prescription
- 12. Communication with ptand privacy considerations • Introduce yourself • Communicate to the pt what procedure u are going to do • Draw bed side curtains Procedure • Site preparation • Perform hand hygeine and wear gloves • Select appropriate site for iv injection • Site should be free of any rashes, lesions or moles • Clean the site using alcohol swab in firm circular motion • Allow the site to dry
- 13. Process of injecting •Pull the cap from needle. keep the cap aside, don’t throw it away. • Stabilize the vein by pulling the skin taut in the longitudinal direction of the vein using non - dominant hand • Insert needle at an angle of 25 - 35 degrees. • Puncture the skin and move the needle slightly into vein • Hold the syringe and needle steady. • Aspirate briefly if blood appears,hold the syringe steady, you are in the vein. If it does not come try again; loose the torniquet. • Inject very slowly • Check for pain, swelling, hematoma. If in doubt whether you are still in vein, aspirate again. • withdraw needle swiftly.
- 14. • Carefully placethe cap back on the needle. • Discard the syringe in dustbin for sharp waste. • Press the sterile gauge onto the opening • Secure with adhesive tape. • Remove the gloves. • Perform hand hygiene. Evaluate pts response • Evaluate pt for any side effects
- 15. INTRAVENOUS - Advand Disadv Advantages: 1. Large quanitiy solutions - bolus, infusions, dilutions. 2. Drug goes directly into the blood stream - Bioavailability - 100% 3. The effects are produced immediately (great value in emergency). Disadvantages: 1. Once the drug is administered by this route, its action cannot be halted. 2. Self-medication is difficult. 3. Toxicity 4. Expertise needed. 5. Thrombophlebitis 6. Necrosis due extravasation
- 16. Thrombophlebitis Symptoms: • Redness, swelling,painand heat around cannula site • Tender and painful to touch • Reduced flow of infusion- or has stopped altogether Interventions: • Stop infusion • Remove cannula • Take swab if infection • Apply warm moist compress till pain resolved • Elevate or rest arm
- 17. Extravasation into tissues Causestissue necrosis and pain. Symptoms: • Pain, Tightness, reduced IV rate, “halo” of fluid in tissue Interventions: • Stop infusion, disconnect tubing and aspirate from the extravasated part with 5ml syringe aseptically • If unsuccessful - remove cannula and mark site of oedema
- 18. DRUGS GIVEN BYIV ROUTE 1. Chemotherapy drugs such as doxorubicin, vincristine, cisplatin, and paclitaxel. 2. Antibiotics such as vancomycin, meropenem, and gentamicin. 3. Antifungal drugs such as micafungin and amphotericin. 4. Analgesic medications such as hydromorphone and morphine 5. Adrenaline, Hydrocortisone in Anaphylaxis
- 19. SUBCUTANEOUS Sites - Abdomen,arm, thigh Advantages: • safe and easy route • Slow and sustained absorption • Self medication possible • Foul smelling and irritating drugs can be given
- 21. Disadvantages: • Painful • skinpigmentation • Large volume of drug cannot be given • Hypersensitivity reactions • Infection, irritation and skin necrosis at injection site
- 23. Checklist for subcutaneousroute of administration Materials needed 1. Non sterile gloves 2. Medication syringe (without air)with needle (gauge 25 short and thin 3. Alcohol swab 4. Sterile gauge Safety concerns 1. Check the pt details 2. Check the prescription
- 24. Communication with ptand privacy considerations • Introduce yourself • Communicate to the pt what procedure u are going to do • Allay hisher apprehensions if any • Draw bed side curtains Procedure • Site preparation • Perform hand hygeine and wear gloves • Select appropriate site for sc injection • Site should be free of any rashes, lesions or moles • Clean the site using alcohol swab in firm circular motion • Allow the site to dry
- 25. Process of injecting •Pull the cap from needle. keep the cap aside, don’t throw it away • Using a nondominant hand, pull taut the skin of the site of injection. • Using a dominant hand hold the syringe between the thumb and fore finger • Insert needle in the base of skin-fold at an angle of 20-30 degrees. • Release skin. • Aspirate briefly if blood appears, withdraw needle, replace with new one, if possible,and start again and inject slowly • Withdraw needle quickly.
- 26. • Carefully placethe cap back on the needle. • Discard the syringe in dustbin for sharp waste. • In case any blood oozes,pat with a dry sterile gauze piece. • Communicate to the pt about completion of procedure. • Remove the gloves. • Perform hand hygiene.
- 27. DRUGS GIVEN BYS.C. ROUTE • Insulin • heparin • vaccines • hormones ( s.c. depot preparations) • Morphine
- 28. INTRA MUSCULAR SITES: • skeletalmuscles - deltoid, triceps, gluteus maximus, rectus femoris
- 29. Advantages • Intramuscular routeis reliable. • Absorption is rapid. • By pass first pass metabolism • Oily injections and aqueous suspensions can be given Disadvantages • Intramuscular injection may be painful • May even result in an abscess. Local infection and tissue necrosis are possible. • Nerve injury should be avoided—irritant solutions can damage the nerve, if injected near a nerve. • Self administer not possible
- 30. Checklist for intramuscularroute of administration Materials needed 1. Non sterile gloves 2. Medication syringe (without air)with needle (gauge 21-22 short and thin) 3. Alcohol swab 4. Sterile gauge Safety concerns 1. Check the pt details 2. Check the prescription
- 31. Communication with ptand privacy considerations • Introduce yourself • Communicate to the pt what procedure you are going to do • Draw bed side curtains Procedure Site preparation • Perform hand hygiene and wear gloves • Uncover the area to be injected (lateral upper quadrant major gluteal musce, lateral side of upper thigh, deltoid muscle) • avoid atrophied or emaciated muscles. At the site of inj, there should be no necrosis or abrasions • Clean the site using alcohol swab in firm circular motion • Allow the site to dry
- 32. Process of injecting •Pull the cap from needle. Keep the cap aside, don’t throw it away • Tell the patient to relax the muscle. • Insert needle in at an angle of 90 degrees. • Aspirate briefly if blood appears, withdraw needle, replace with new one, f possible, and start again and inject slowly • Withdraw needle quickly.
- 33. • Carefully placethe cap back on the needle. • Discard the syringe in dustbin for sharp waste. • In case any blood oozes, pat with a dry sterile gauze piece. • Communicate to the pt about completion of procedure. • Remove the gloves. • Perform hand hygiene.
- 34. DRUGS GIVEN BYI.M ROUTE • Antibiotics - penicillin G benzathine penicillin, streptomycin • Biologicals - immunoglobins, vaccines, and toxoids • Hormonal agents - testosterone, medroxyprogesterone • NSAID injections - Diclofenac • Multivitamins - B12, B1
- 35. INTRADERMAL SITES: • The innersurface of the forearm • Upper back below the scapula
- 36. Checklist for intradermalroute of administration Materials needed 1. Non sterile gloves 2. Medication syringe (withoutair)with needle (gauge 26 - 27 short and thin 3. Alcohol swab 4. Sterile gauge Safety concerns 1. Check the pt details 2. Check the prescription
- 37. Communication with ptand privacy considerations • Introduce yourself • Communicate to the pt what procedure u are going to do • Allay hisher apprehensions if any • Draw bed side curtains Procedure Site preparation • Perform handhygeineand wear gloves • Select appropriate site for intradermal injection • Site should be free of any rashes, lesions or moles • Clean the site using alcohol swab in firm circular motion • Allow the site to dry
- 38. Process of injecting •Pull the cap from needle. Keep the cap aside, don’t throw it away • Using a nondominant hand, pull taut the skin of the site of injection. • Using a dominant hand hold the syringe between the thumb and fore finger with the bevel of needle facing up. • Needle is kept at an angle of 5-15degrees to skin surface (almost parallel). • Insert needle about ¼ inch inside the skin such that whole of bevel is under the skin.
- 39. • Slowly injectthe drug while watching for bleb to appear. • Withdraw the needle at the same angle as while inserting • Carefully place the cap back on the needle. • Discard the syringe in dust bin for sharp waste. • In case any blood oozes, pat with a dry sterile gauze piece. • In case it was intradermal inj for Mantoux test circle the injection site for identification. • Communicate to the pt about completion of procedure. • Remove the gloves. • Perform hand hygiene. • Evaluate pts response • Evaluate the pt within appropriate time frame like for montoux test, local anaesthetic agents
- 40. I.D INJECTIONS -EXAMPLES • Tuberculin injection • Local anesthetics • BCG vaccine • Allergy sensitivity tests
- 43. INTRA ARTERIAL For contrastmedia in angiography; • anticancer drugs can be infused in femoral or brachial artery to localise the effect for limb malignancies
- 44.
- 45. INTRAVENOUS CANNULAS • Itconsists of a beveled siliconized stainless steel needle and an outer cannula ( sheath) made of PTFE (Poly Tetra Fluoro Ethylene). • The needle snugly fits into the outer sheath. • They are available in two forms. 1. with wings and an injection port (VENFLON) 2. without wings and without injection port (ANGIOCATH)
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- 48. NEEDLEs • No. 12-16: Aspiration of thick fluids or pus, • bone marrow aspiration • No. 18: Blood collection from donors, I. V. fluids, • aspiration of fluids from body cavities • No. 20 - 21: Blood collections (small amounts, routinely), l.V. Fluids • No. 22 - 23: l.M. injections, F.N.A.C. • No. 24: l.M. injections in children • number 18 needle has a thickness of 1/l8 of an inch.
- 49. INSULIN syringe • Itis a 1ml syringe made of plastic or glass with a white or red piston. It is available in graduations of 40, 80 or 100 units. It is available with or without a 26 number needle attached. It is disposable, sterile and ready to use.
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- 52. PNEUMATIC / JETNEBULISER
- 54. WORKING PRINCIPLE Bernoulli principle- compressed gas (air or oxygen) is passed through a narrow orifice, creating a low-pressure area at the adjacent liquid feed tube. This evacuates the solution, with the drug being drawn up from the fluid reservoir and shattered in the gas stream through fine droplets. LIQUID DRUG IS CONVERTED TO VAPOUR FORM BY HIGH SPEED COMPRESSED AIR.
- 56. DRUGS GIVEN BYNEBULIZERS • Glucocorticoids • bronchodilators • antibiotics (Tobramycin, Aztreonam, Colistin, Ciprofloxacin, Levofloxacin, Amikacin, etc) • mucus hydration agents • mucolytic agents
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- 61. RINSE THE MOUTHAFTER USE OF STEROID INHALER
- 63. DRUGS GIVEN BYMDI INHALERS • Bronchodilators • Steroids
- 64.
- 68. The spacer connectsto the inhaler mouthpiece, and the medicine goes into the spacer tube first. This allows you to breathe in the medicine more easily. Using a spacer wastes a lot less medicine than spraying the medicine directly into your mouth.
- 69. ARRIVAL OF COLDPROPELLANT MDI SPRAY ON THE PHARYNX STIMULATES COUGH AND THE PATIENT STOPS INHALING THE DOSE MOMENTARILY. RESULTS IN INEFFECTIVE ENTRY OF DRUGS INTO THE LUNGS
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- 71. PRINCIPLE The formulation typicallyconsists of micronized drug blended with larger carrier particles, dispensed by a metering system. An active or passive dispersion system entrains the particles into the patient’s airways, where drug particles separate from the carrier particles and are carried into the lung.
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- 80. PRINCIPLE • Incentive spirometryis designed to mimic natural sighing or yawning by encouraging the patient to take long, slow, deep breaths. • This is accomplished by using a device that provides patients with visual or other positive feedback when they inhale at a predetermined flowrate or volume and sustain the inflation for at least 5 seconds.
- 81. INDICATIONS • To preventatelectasis in patients: 1. Upper-abdominal or thoracic surgery 2. Lower-abdominal surgery 3. Prolonged bed rest 4. Surgery in patients with COPD 5. Patients with neuromuscular disease 6. Patients with spinal cord injury 7. Restrictive lung defect
- 83. HOW TO USE •The patient is instructed to hold the spirometer in an upright position, exhale normally, and then place the lips tightly around the mouthpiece. • The next step is a slow inhalation to raise the ball (flow-oriented) in the chamber to the set target. • At maximum inhalation, followed by a breath-hold and normal exhalation. • Ten breaths every one to two hours while awake • Ten breaths, 5 times a day (OR) • Fifteen breaths every 4 hours
- 84. Disadvantages • Ineffective unlessperformed as instructed • Hyperventilation/respiratory alkalosis • Fatigue • Infection if not properly stored