PARENTERAL MEDICATION Parental drug administration of any medication involves injecting a drug either directly into a skin (intradermal

), muscle (intramuscular), vein (intravenous), artery (intrarterial), abdominal cavity (intrperitoneal), heart (intracardiac) or into the fatty tissue beneath the skin (subcutaneous). The speed of absorption varies but is definitely faster than the usual oral administration. This type of drug administration is commonly used when more complete and faster absorption of a drug is needed. SYRINGE A syringe is a device used for injecting, removing or infusing fluids. They are most commonly known in health care settings for injecting medications and for use in removing blood from the body. Syringes can differ in size and type, and they can be made of glass or plastic. The syringe chosen usually depends on its intended purpose. The syringe consists of a plunger, barrel, hub, needle and the needle's protective cover. It is important that all parts of a syringe coming into contact with the body be kept free of contamination. y

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1. The Plunger The plunger is located at the end of the syringe and can be made of clouded or colored glass or plastic. Its purpose is to fill or empty the barrel. The plunger is pulled back to fill the barrel and is pushed forward for emptying. 2. The Barrel The barrel is the part of the syringe that contains the fluid, whether it is a medication, blood or a solution drawn from the body. It is usually calibrated in tenths (a tenth is equal to 0.1 milliliters) to make precise measurements of the quantity of the fluid that is to be given or removed. The barrel can range in size from 0.5 mL to 50 mL. 3. The Hub The lower end of the syringe, opposite the plunger, terminates into a needle hub. The hub consists of a needle adapter that allows the needle to be attached to the syringe. The hub also functions to lock the needle in place while using the syringe for its desired function. 4. The Needle The needle consists of the shaft, lumen and bevel. Needles vary in length, size of the shaft and size of the lumen. The shaft is the metal's length and is usually chosen depending upon the route and site of administration, physical mass of the client, and the thickness of the medication. The lumen, also known as the bore, is the hollow space within the needle. The diameter of the lumen is known by the needle's number gauge. The lumen is chosen with the same specifications as the shaft. The last part of the needle, the bevel, is the pointed end and determines the needle's sharpness. 5. Protective Cover/Cap The protective cover/cap is provided to maintain the needle's sterility. Needle sticks are a common way of transporting infections to health care providers and clients. The needle's bevel is covered to limit the amount of accidents that could happen involving needles and to ensure that only the intended client receives the needle stick. In an attempt to reduce contamination and increase safety, most needles are disposable. COMMON ROUTES OF ADMINISTRATION 1. INTRADERMAL ROUTE It is the administration of a small amount of fluid into the dermal layer of the skin. It is frequently done as a diagnostic measure, such as for tuberculin testing (screening test for tuberculosis referred to as a mantoux test) and allergy testing (placing very small amounts of the suspected antigen or allergen in a solution under the skin). Most common and recommended site for injection would be at the inner surface of the forearm. . Often the tuberculin syringe is the only syringe with fine enough calibrations to measure the minute dose that is used. A 26-gauge needle, which is one-fourth to one-half inch in length, is usually selected. The fluid is in a small welt, phleb or "wheal" (a small swelling of the skin due to the medication placed under the skin) just under the surface of the skin and between its layers.
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GUIDELINES IN ADMINISTERING INTRADERMAL INJECTION y Check the Doctor¶s Orders regarding the administration of intradermal medication. y Gather the equipments and medication required. y Perform hand washing. y Assemble needle and syringe and remember to adhere to strict aseptic techniques. y Check Expiration Date of Medication y Draw Medication into Syringe y Identify the patient and observe the 10 Rs of medicine administration. y Select Injection Site which is usually the palmer (inner) forearm or subscapular region of the back is selected. The site selected should be an easily obtainable area and relatively free from being rubbed by clothing. y Prepare Patient by placing the arm in a relaxed position, elbow flexed and palm facing upward, exposing palmer or inner arm area. y Clean the injection site in circular motion from inner to outer portion. y Remove protective cap. y Stabilize injection site. Apply downward pressure directly below and outside the prepared injection site using non- dominant hand. y Insert the needle almost parallel to the skin (15- 20 degrees) with bevel facing upwards. Stabilize the needle by placing your non-dominant hand¶s thumb on top of the inserted needle. y Inject Medication. It is not necessary to aspirate the syringe since no large vessels are commonly found in the superficial layer of the skin. Using dominant hand, push plunger slowly forward until the medication is injected and a wheal appears at the site of the injection. The appearance of a wheal indicates that the medication has entered the area between the intradermal tissues. If a wheal does not appear, withdraw the needle and repeat the procedure in another site. y Withdraw the needle at the same angle that it was inserted. y Cover the injection site without pressure. In case of skin testing, do not cover the injection site. Instead, mark the circumference of the wheal and record time 30 minutes post injection. y Evaluate the reaction of the medication. y Properly dispose used equipments. Separate equipments properly and dispose needles to designated needle container. y Record Administration of Intradermal Injection.

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2. INTRAMUSCULAR ROUTE It is the preferred route of administering medication when fairly rapid-acting and long-lasting dosage of medication is required. Some medications that are irritating to the subcutaneous tissue may be given into the deep muscle tissue. Injection of medication into muscle tissue forms a deposit of medication that is absorbed gradually into the bloodstream. An intramuscular injection is the safest, easiest, and best tolerated of the injection routes. GUIDELINES IN ADMINISTERING INTRAMUSCULAR INJECTION y Check the Doctor¶s Orders regarding the administration of intramuscular medication. y Gather the equipments and medication required. y Perform hand washing. y Assemble needle and syringe and remember to adhere to strict aseptic techniques. y Check Expiration Date of Medication y Draw Medication into Syringe y Identify the patient and any problems that may interfere with the administration of the medication; and observe the 10 Rs of medicine administration. y Identify medication site and position patient. 1. Gluteus Medius It is the preferred site for administration of the intramuscular injection. The gluteal muscles are thick in nature and are utilized frequently in daily activities, thus causing complete absorption of drugs. (a) Using care in choosing the location for administering the injection will minimize the possibility of hitting a bone, large blood vessel, or the sciatic nerve. (b) To identify the injection site, draw an imaginary horizontal line across the buttocks from hip bone to hip bone. Then divide each buttock in half with an imaginary vertical line. The four imaginary sections of the buttock are referred to as quadrants. The proper location for an injection is in the upper outer quadrant of either buttock.

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(c) Remember, if an injection is given outside of the upper outer quadrant, irreparable injury may be done to the sciatic nerve or the needle may penetrate the gluteal artery and this can cause significant bleeding from the vessel. (d) Expose the buttocks to make sure you do not make an error in determining the location of the injection. The patient will lie face down with toes together and heels apart. This position relaxes the muscles of the buttocks.

2. Vastus Lateralis It is a part of the quadriceps group of four muscles of the upper leg, is located on the outer, lateral thigh. The injection site is about a hand's width above the knee to a hand's width below the groin (hip joint). Injections outside this area may hit a bone, a nerve, or blood vessel.

(a) The volume of medication given in this site can be up to two milliliters injection in an adult.

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(b) The needle length must not be less than one inch and should not exceed one and one-half inches for adults. A one and one-fourth inch needle is commonly used. (c) To administer an injection, make sure the patient's lateral thigh is completely exposed so you can visualize the injection site. The patient should be lying on his back (supine) or seated. (d) Do not inject into the areas close to the knee or hip bone. (e) There are no main blood vessels or nerve trunks in the lateral thigh injection site. There is a cutaneous nerve (lateral femoral) superficially located and sometimes damage to these nerves is reported. 3. Deltoid Muscle The injection site in this area is a rectangular area bounded on the top by the lower edge of the shoulder bone (the acramion process), on the bottom by the armpit (the axilla), and by the lateral one-third of the arm.

(a) The safe area for injection is generally defined as about three fingerbreadths below the shoulder joint. (b) The needle length of one inch is normally used because of the size of the deltoid muscle. (c) The volume of medication given in this site can be up to a maximum of one milliliter per injection for an adult. A volume of 0.5 milliliter or less is more commonly used.

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(d) The shoulder should be completely exposed so you can determine the exact location of the injection. The clothing should not be rolled up to attempt to administer an injection. (e) Ensure that the patient is in a standing or sitting position, with the arm at side and muscles relaxed. Direct the patient to hang the arm loose. y Prepare Injection Site. Clean the skin at the injection site thoroughly with antiseptic cotton. Use a circular motion from the center of the injection site outward. Place the cotton between the last two fingers for use later when you complete the injection. Remove Needle Guard or Cover. Pull the cover straight off, rather than using a twisting motion or a sideward motion because you may bend the needle. (a) Avoid bending or touching the needle. (b) Place the needle cover on a clean, flat surface. Stabilize Injection Site. Firm the tissue at the injection site with the hand that is free by pinching the skin with the thumb and forefinger so that it is taut. Insert Needle Into Patient at Site Selected for Injection. (a) Hold the barrel of syringe firmly between the thumb and index finger of the dominant hand. (b) Move the needle tip to about one-half inch from the injection site, with the bevel up, and position the needle at a 90degree angle to the skin surface. (All intramuscular injections are inserted at a 90-degree angle into the muscular layer below the skin.) (c) Plunge the needle firmly and quickly into the muscle to the depth of the needle with a steady straightforward motion. A quick insertion of the needle will minimize the pain for the patient. Aspirate syringe. (a) Release the hold on the skin. (b) Move the free hand to the plunger of the syringe. (c) Pull back the plunger until slight resistance is felt. (d) Check for blood entering the syringe. If blood appears in the syringe, do not administer the medication. Inject the medication. (a) Stabilize the syringe with the non- dominant hand. (b) Place the thumb of the dominant hand on the plunger and the index and middle fingers under the hook of the syringe barrel. (c) Push the plunger into the syringe barrel with a slow, continuous downward movement as far as the plunger will go.

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(d) Make sure that all the medication is injected. Any medication that is left in the needle at the end of the injection may dribble into the subcutaneous tissue as it is withdrawn. Tissue injury may result. Withdraw the needle. (a) Place the cotton you are holding just above the injection site with the nondominant hand. (b) Remove the needle straight out in same direction as the injection with a quick, outward motion. Massage Injection Site. Massage helps to disperse the medicine so that it can be absorbed more quickly. Cover Injection Site. Place an adhesive bandage over the injection site to protect clothes from possible bloodstains and protect the injection site from possible infection. Evaluate the reaction of the medication. Properly dispose used equipments. Separate equipments properly and dispose needles to designated needle container. Record Administration of Intramuscular Injection.

3. SUBCUTANEOUS ROUTE The subcutaneous route of administration is commonly ordered for medication that requires a slower absorption rate than IM injections provide. Small volumes of medication that are voluble and non irritating to body tissues are administered by this method. A variety of medications such as insulin and some immunizations are given subcutaneously. GUIDELINES IN ADMINISTERING SUBCUTANEOUS INJECTION y Check the Doctor¶s Orders regarding the administration of subcutaneous medication. y Gather the equipments and medication required. y Perform hand washing. y Assemble needle and syringe and remember to adhere to strict aseptic techniques. y Check Expiration Date of Medication y Draw Medication into Syringe y Identify the patient and any problems that may interfere with the administration of the medication; and observe the 10 Rs of medicine administration. y Identify medication site and position patient. The most widely used and usually the preferred site is the lower abdomen, about an inch away from the belly button. Another site is the front of the thigh, about half way down and right in the middle. Finally, you can use also the fleshy back of the upper arm.
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Prepare the Injection Site. Clean the site with antiseptic cotton using a circular motion from the center point outward about two inches. Remove Needle Guard. The needle cover should be pulled straight off. Any twisting motion or a sideward motion may bend the needle. Do not touch the needle. Lay the needle cover on a clean, flat surface. Stabilize Injection Site. Pinch up tissue on the upper arm or upper thigh, which ever you have chosen. (a) Pinch the skin gently between the thumb and index finger to form a fold of skin without touching the injection site. (b) The fold of tissue helps determine the exact size of needle needed. Measure from the fold's base to its crest and select a needle close to the length of the fold. Insert needle. (a) Hold the barrel of the syringe between the thumb and the index finger with bevel up. (b) Insert the needle at a 45-degree angle to the skin. All subcutaneous injections are inserted at a 45-degree angle into the fatty tissue below the skin. (c) Insert the needle only to three-fourths of the length of the needle using a firm, quick, forward thrust to minimize discomfort. (d) Release the skin. Release the pinched skin while stabilizing the syringe barrel. Aspirate syringe. (b) Release the hold on the skin. (b) Move the free hand to the plunger of the syringe. (c) Pull back the plunger until slight resistance is felt. (d) Check for blood entering the syringe. If blood appears in the syringe, do not administer the medication. Inject the Medicine. Press the plunger into the barrel with the thumb slowly and steadily until all medication is expelled. Medication should be injected slowly. Rapid injection will put pressure on the tissue and cause pain. Remove the Needle. Place an antiseptic pad slightly above the injection site. Withdraw needle quickly at same 45-degree angle as inserted and bring pad down on injection site. Massage the Site. Gently massage the injection site with an antiseptic pad after you remove the needle unless medication guidance indicates otherwise. (a) Gentle pressure applied to the injection site will help seal punctured tissue and disperse the medication so that it is absorbed readily. Cover Injection Site. Place an adhesive bandage over the injection site to protect clothes from possible bloodstains and protect the injection site from possible infection. Evaluate the reaction of the medication. Properly dispose used equipments. Separate equipments properly and dispose needles to designated needle container. Record Administration of Subcutaneous Injection.

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