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I.

ROUTE OF ADMINISTRATION
II. INTERVAL OF ADMINISTRATION
III. TIME OF ADMINISTRATION
IV. DURATION OF THERAPHY
V. TECHNIQUE OF ADMINISTRATION

The reasons :
1. Most Convenience (oral)
2. To maximize concentration at the site of action
3. Minimize it else where (topical)
4. To prolong the duration of drug absorption
5. Avoid the first pass effect
6. Economical
7. Safest

Dose of
Drug

I
N
P
U
T

Drug in Blood
at site of
Absorption

D
I
S
T
R
I
B
U
T
I
O
N

Drug in General
Circulation
Drug at sites
of Action
Pharmacologic Effect
Clinical Effect

Toxicity

Efficacy
Utility

L
O
S
S

Classification Of Route Drug Administration


- Enteral route : Oral Route
Sublingual Route
Buccal Route
Rectal Route
- Parenteral route

: Intravenous bolus (I.V.)


Intravenous Infusion (I.V.inf)
Intramuscular (I.M.)
Subcutaneous (S.C.)

- Other route

: Transdermal
Inhalation
etc

Enteral Route
Oral route
Drug administered orally pass through various part of GIT/oral cavity
- Esophagus
- Stomach
- Duodenum
- Jejunum
- Illeum
- Collon
Small intestine : transit time 3 4 hours
Absorption is not complete by the time The drug
leave small intestine
Destruction by digestive juice/digestive enzim
Oral cavity : saliva, mucin interact with drug

Esophagus

: pH = 5 6
Tablet or capsules may lodge in this area local irritation
Drug dissolution is very little

Stomach

: The fasting pH = 2 6
In the presence of food pH = 1.5 2
Basic drug solubilized increase

Duodenum

: pH = 6 6.5
Bicarbonat neutralized the acidic chyme
The complex fluid to dissolved drugs with limited
aqueous solubility

Jejunum

: Fewer contraction preferred in vivo drug absorption

Illeum

: pH = 7 (distal part 8)
Bicarbonat secretion acid drug will dissolved
Bile secretion to dissolved fats and hydrophobic drug

Collon

: pH = 5.5 7
Lumen content more viscous semisolid limited drug
absorption
Theophyllin and metoprolol absorbed
Levo dopa and lactulose metabolized by enteric bacteria
(aerobic micro organism)
Absorption of clindamycin and propanolol

Parenteral Route
Intravenous (I.V.)
- After injection distribused via the circulation to all part of body
- Aqueous solution
- Bioavailability is complete and rapid
- Drug delivery is controlled and achieved with an accuracy and
immediately
- Certain irritating solution of drug can be given
- Unfaforable reaction (high concentration of drug in plasma and
tissues)
Disadvantages : - once injected no retreat
- Drug in oily vehicle, precipitate blood constituent,
hemolized erythrocyte (should not be given)

Intravenous Infusion (I.V.inf) a drug slowly infusion


Intramuscular (I.M.)
- After Intramuscular injection diffuses from muscle into the
surronding tissue fluid the blood distributed via the circulation
- Different muscle tissue have different blood flow
- Aquaeous solution / suspension

Subcutaneous (S.C.)
- Injection under the skin
- The effect < I.V. and I.M.

Other Route
Transdermal Route
1. Mucouse membrane
- A drug applied to mucouse membranes of the conjunctive
nasopharinx, aropharinx, vagina, collon, urethra, and urinary bladder
- Primary for the local effect
- Absorption readily
2. Skin
- Few drugs readily penetrate the intact skin
- Absorption is dependent on the surface area, lipid solubility and vehicle
of the drugs
- The effect local or systemic
- Eye ; topically applied local effect

Inhalation Route
- Pulmonary absorption / respiratory tract
- Gas on volatile drugs
- Solution of drug atomized
- Avoidance of hepatic first-pass loss

Some Cracteristics of Common Routes of Drug


Administration
ROUTE
Enteral Routes
Oral (PO)

BIOAVAILABILITY

ADVANTAGES

DISADVANTAGES

Absorption may vary.


Generally, slower
absorption rate
compared to IV bolus
or IM injection.

Safest and easiest


route of drug
administration.
May use immediaterelease and
modified-release
drug products.

Some drugs may have


erratic absorption, be
unstable in the gastoin
testinal tract, or be
metabolized by liver
prior to systemic
absorption.

No first-pass effect.

Some drugs may be

Rapid absorption
Buccal or
sublingual (SL) from lipid-soluble

swallowed.
Not for most drugs or

drugs.

drugs with high doses

Rectal (PR)

Absorption may vary


from suppository.
More reliable
absorption from
enema (solution).

Useful when patient


can not swallow
medication.
Used for local and
systemic effects.

Absorption may be
erratic.
Suppository may migrate
different position.
Some patient discomfort.

ROUTE

BIOAVAILABILITY

ADVANTAGES

DISADVANTAGES

Drug is given for


immediate
effect.

Increase chance for


adverse
reaction.
Possible
anaphylaxis.

Intravenous Complete (100%)


infusion (IV systemic drug
inf)
absorption.
Rate of drug
absorption
controlled by
infusion pump.

Plasma drug levels


more precisely
controlled.

Requires skill in
insertion of
infusion set.
Tissue damage at
site of

Intramuscul
ar
injection
(IM)

Easier to inject
than
intravenous
injection.
Large volumes may
be used

Parenteral
Routes
Complete (100%)
Intravenous systemic
(IV)
drug absorption.
Rate of
bioavailability
considered
instantaneous.

Rapid from aqueous


solution.
Slow absorption
from
nonaqueous (oil)
solution.

May inject large


fluid volumes.
May use drugs with
poor lipid solubility
and/or irritating
drug.

injection
(infiltration,
necrosis,
or sterile Abscess).
Irritating drugs may
be very painful.
Different rates of
absorption
depending upon

ROUTE
Other Routes
Transdermal.

BIOAVAILABILITY

ADVANTAGES

DISADVANTAGES

Slow absorption,
rate may vary.

Transdermal
delivery system
(patch) is easy to
use.
Used for lipidsoluble drugs with
low dose.

Some irritation by
patch of drug.
Permeability of skin
variable with condition,
anatomic site, age,and
gender.
Type of cream or
ointment base affects
drug-release and

Increased
absorption with
occlusive dressing.

absorption.
Inhalation

Rapid absorption.
Total dose
absorbed is variable.

May be used for


Local or systemic
effects.

Particle size of drug


determines anatomic
placement in
respiratory tract.
May stimulate cough
reflex.
Some drug may be
swallowed.

SITE OF ROUTE ADMINISTRATION


RODA
SITES
- Oral
- Peroral (per os)
- Sublingual
- Parenteral
* Intravenous
* Intraarterial
* Intracardiac
* Intraspinal/intrathecal
* Intraosseous
* Intraarticular
* Intrasynovial
* Intracoutaneus/Intradermal
* Subcutaneous
* Intramuscular
- Epicutaneous (Topical)
- Transdermal
- Conjunctival
- Intraoccular
- Intranasal
- Aural
- Intrarespiratory

- Mouth
- GI tract system via mouth
- Under the tongue
- Other sites than GI tract (by injection)
* Into vena
* Into artery
* Into the heart
* Into spine
* Into bone
* Into joint
* Synovial fluid cavity
* Into skin
* Under skin
* Into muscle
- Skin surface
- Skin surface
- Conjunctiva
- Eye globe
- Nose
- Ear
- Lung

THE USAGE OF DOSAGE FORMS


Route Of Drug Administration
Oral
Sublingual
Parenteral
Epicutaneous/Transdermal
Rectal
Conjunctival
Intraoccular/Intraaural
Intranasal
Intrarespiratory
Vaginal
Urethral

Dosage Form
Solid and Liquid dosage form
Tablet, trochition and lozenges
Solution, suspension
Ointment, Cream, Paste, Powder, Aerosol,
Lotion,Transdermal, Disc, and Solution
Attachment
Solution, Ointment, Suppositoria
Ointment
Solution, Ointment
Solution, Spray, Inhalant, Ointment
Aerosol
Solution, Ointment, Emulsified foam,
Tablet, Insert, Suppositoria, Sponge
Solution, Suppositoria

DRUGS THAT ARE USED SPECIFICALLY


1. SUBLINGUAL TABLET
For cardiac diseases : angina/asthma (nitroglycerin, isoprenalin)
2. CHEWING TABLET
Drugs for gastritis
3. LOZENGES
Mouth freshener (anti inflammation)
4. TABLET
Tablets that are destroyed in intestine :
* Unchawed tablet
* Without milk, alkaline drinks, or antacid
5. DRUG THAT NEED EXCESSIVE DRINK (200 ml 300 ml)

Sulfa group

Metronidazol

Erythromycin

Amoxicillin

Aspirin

6. DRUGS THAT ARE WITHOUT EXCESSIVE DRINK


Anti gastritis drug/antacid suspension
7. DRUGS THAT ARE TAKEN WITHOUT MILK
- Vitamin C+ Ferrous
- Antienteretis
- Enteric coated tablet
- Tetracycline
8. PEDIATRIC DRUG ADMINISTRATION
Tablet / powder dissolved into :
- Honey
- Sugar water
- Jelly
- Corn oil

Determained by: Half life time ( t ) of drugs


a. Ultra fast

b. Fast
c. Slow
d. Very slow

Amoxicillin, Cloxacillin, Flurosemide,


Penicillin
Paracetamol, Ampicillin, Hydrocortison
Doxicillin, Griseo fluvine, Proctolal
Barbiturate, Diazepam, Digitoxin
Phenilbutazon

STANDARD ADMINISTRATION TIMES


DAILY
.. times a day
Once
: 10.00 (morning)/22.00 (night)
Twice
: 10.00 , 14.00
Three times : 10.00 , 14.00, 18.00
Four times : 10.00, 14.00, 18.00, 22.00
EVERY
Every .. hours
12-hourly : 10.00, 22.00
8-hourly : 06.00, 14.00, 22.00
6-hourly : 06.00, 12.00, 18.00, 24.00
4-hourly : 06.00, 10.00, 14.00, 18.00. 22.00, 02.00

Base on :
1. Chemical properties of drugs
Exp : Anticholinergic drugs reduce secretion and peristaltic of intestinal.
These drugs should be taken one hour before meal.

2. Physiological properties of G.I.T.


Exp : Gastric pH
absorption
G.I. Mortility absorption

3. Possible interaction :
Interaction between drug
Drug that interact with antacid in stomach
Exp : Amoxicillin, Ampicillin, Cloxacillin, Nitrofurantoin
Interaction Drug and Food
Drug interferred by gastric chyme
Exp : Ampicillin, Amoxicillin, Erythromycin, Lincomycin
(Should be taken during empty stomach)

4. Drugs that synchronized with chyme (food)


Exp : Doxycycline, Doxycycline hyclate, Erthromycin, ethylsuccinate,
Griseofulvin.
(should be taken with meals)

5. Stomach-irritating drugs
Exp : Aminophylline, Acetyl salicilic acid, Codein, Phenylbutazon
EXAMPLE OF ADMINISTRATION TIME OF THE INTERACTIVE
DRUGS
R/
R/

Ampicillin 500 mg cap No. XV


S 3. dd.cap.I (1) hac ------- 1 hour before meal
Antacid tab No.XX
S3.dd.tab.I (1) hpc ------- 1 hour after meal

Standard administration times


Abbreviation

qd* = quaque die = each day


bid* = bis in die = twice a day
tid* = ter in die = three times a day
qid* = quater in die = four times a day
hs = hora somni = at bed time
q12h = quaque duodecin hora = each twice hours
q8h = quaque octo hora = each eight hours
q6h = quaque six = each six hours
q4h = quaque quattour = each four hours
q3h = quaque tres = each three hours
ac
pc

= ante cibos
= past cibos

Administration times

Usually accepted to mean 10:00 AM


10:00 AM, 2:00 PM
10:00 AM, 2:00 PM, and 6:00 PM
10:00 AM, 2:00 PM, 6:00 PM, and 10:00 PM
Usually accepted to mean 10:00 PM
10:00 AM and 10:00 PM
6:00 AM, 2:00 PM, and 10:00 PM
6:00 AM, 12:00 AM, 6:00 PM, and 12:00 PM
6:00 AM, 10:00 AM, 2:00 PM, 6:00 PM, 10:00 PM,
and 2:00 AM
3:00 AM, 6:00 AM, 9:00 AM, 12:00 AM, 3:00 PM,
6:00 PM, 9:00 PM, and 12:00 PM
before meals (approximately 30 45 minutes)
after meals (approximately 1 hour)

* Exceptions:
1.

Steroids perhaps should be administered near 7:00 or 8:00 AM when on a qd schedule.

2.

Oral hypoglycemic agents and insulin (7:00 AM and/or 4:30 PM) when ordered bid.

3.

Antibiotics should be spread evenly over 24 hours. An approximate schedule to avoid meals might be 4:0
AM, 10:00 AM, 4:00 PM, and 10:00 PM.

4.

Antihypertensive agents should be spread over the 24 hour period

5.

Anticoagulants should be scheduled so as to follow measurement of the patients clotting time.

FIX TIME OF ADMINISTRATION


- In the morning

: Steroid
Diureticum
Antihypertensi

- In the night

: Contraceptive agent
Hypnotic agent

- During meal

: Drug irritating stomach


Drug that sensitive to gastric pH
Drug absorption increase

- During episode

: Antiasthmatic drug
Drug for migraine
Angina pectoris drugs

- Empty stomach

: 1 hour before meal 1h.a.c


2 hour after meal 2h.p.c

Symptomatic therapy : > three days <


Causative therapy

: should be enough

DRUG DOSAGE FORMS


ROUTE OF ADMINISTRATION
SPECIFIC- DRUG MEDICATION
PARENTERAL DRUG MEDICATION

THE APPLICATION OF OPTHALMIC OINTMENT / EYE DROP


1. The hand holds the ointment after washed first to be
clean
2. Open the tube's cap then discard the first 1/4 inch
length of the ointment, because this portion is often dry.
3.

With one finger, press downward the


meanwhile the patient is staring upward

lower

lid

4. Press and rub the eye ointment as long as 1/4 - 1/2 inch
onto the inner side of the lid without touching it nor eye
globe.
5. Close the eye and rotate the eye globe in all direction
(possibly the vision will become slightly blurred ).
6. Cap the tube immediately without touching the tips of
cap nor tube.

1. Cough out the sputum as much as possible.


Aerosol is shaked before use
2. Place it as the recommendation of the
manufacterer. It is usually set upside down.
3. Place the oral edge of tube inside the mouth, face
upward by moving head posteriorly.
4. Breath out slowly, empty the lung volume as much
as possible.
5. Press the tube content in order to spray meanwhile
immediately
inhalate it deeply with tounge
position remains still below.
6. Hold the breath within 10 - 15 seconds.
7. Then, expire the air through nares.

1. Cough out the sputum as much as possible.


2. Place the capsule into the inhaler container as the
manufacturer's recommendation
3. Breath out slowly, empty the lung volume as much as
possible.
4. Place the oral tip of tube inside the mouth.
5. Face upward by moving head posteriorly.
6. Breth in deeply through inhaler
7. Hold the breath for 10 -15 seconds
8. Exhale the breath through nares.

1.Sit with your head facing upward, or pad


your shoulder with a pillow under.
2.Insert the tip of dropper asdeep as 1cm into
the nares.
3.Drip
some
drops
recommended.

of

the

drugs

as

4.Nod downward your head so that the head is


over the knee.
5.Sit up repetitively for several times so that
the drop can enter the pharynx.

Nod down the head slightly.


The other nose is closed by pressing the
nacres with your finger.
The sprayer is inserted into the opened
nacres by pressing the vial, so that its
content will be out and inhale gently, then
do the same as the abovementioned.

The best is the head in slanting position


Gently the upper part of the ear lobe is slightly

attracted upward (in adult) and the middle one


in children in order to let the opening is seen
clearly.

Drip some ear drops and wait for approximately

5 minutes before doing the same into another


one.

In some products, it is recommended to close

the ear opening with cotton ball.

Suppositoria

is prepared to be out of the


container. When it is too flaccid, it would better
be cooled first, whereas if it is too hard, heat it
by placing it inside your fist.

Lay down with slanting position and one of the

lower extremities is abducted to the abdomen.

Insert

gently the suppositoria into the anal


opening meanwhile it is rotated foreward with one
of your hands. Keep lying for several minutes.

INTRAVAGINAL
MEDICATION
In general, intravaginal medication is limited to
the localized application for which ointments or
tablets are available to insert into vagina and
usually by the time of going to bed, such as
metronidazole and primaricin for vaginitis
caused by trichomonas and candida.
The drugs may be used in the form of swabbing
liquid, others in the forms of spermaticide (to kill
spermatocyte), foam tablet,and cream.

THE TOPICAL DRUGS USED FOR SKIN IN GENERAL


INCLUDE :
1.

WATTER (SOLUTION)

2.

ALCOHOL (TINCTURE)

3.

POWDER

4.

WET POWDER (SHAKED POWDER)

5.

CREAM

6.

PASTE

7.

OINTMENT

Back and chest


Genitalia
Scalp
Hand and arm
Skin fold
Lower extremities
Face

All types
Powder, watered powder, cream
solution.
Powder, watered powder, cream
solution.
Water (solution), alcohol, cream.
Powder, water solution, alcohol,
ointment, wet powder, paste,
cream.
Watered powder (solution),
alcohol, ointment, wet powder,
cream.
All types except for eye skin.

The choosing of drugs is on the basis of the


skin disorders, thus the wet condition of the
skin disorders needs application of wet
preparation, while the dry skin uses

Vesicles, edema, erythrema


Crust, itching infection
Water (solution) - wet compression
Powder, lotion, sprays Cream (o/w)
Cream (w/o) and and ointment

Desquamation, erythrematous, itching,


drying

Parenteral medication can be undertaken :


1. By injection with syringe
2. Through infusion liquid (more than 10 ml
volume)
THE ADVANTAGES OF PARENTERAL MEDICATION :

1. The drug action can be reached rapidly, strong, and


complete
2. No irritation or not destroyed by gastric acid
3. can be administered to the patients with
unconsciousness or swallowing unability
THE DISADVANTAGES OF PARENTERAL MEDICATION :
1. In general, it is expensive and impractical
2. Easy to contaminate
3. Able to damage blood vessel, tissue, and nerve
4. The administration methods should be adjusted, because
of being slow and rapid

Conclusively, parenteral medication are based on 2


main considerations :
1. Expectation of rapid drug action
2. the required drugs are in the form of parenteral
dosage forms
Intravenous administration is one of the most
important clinical treatment compared to the other
parenteral administrations, because :
1. Injected directly toward the blood vessel
2. Rapid and immediate onset
3. Inversely, giving danger such as anaphylactic
shock or severe anaphylactic reactions.

Intravenous administration needs the skillfulness, great


attention, and precatiously with antiseptic techniques
and also need close monitoring of drug action.
Physicians judge the decision of intravenous medication
based on as follows :
1. whenever other routes of administration are considere
impossible whereas the terapy management must be
implemented promptly. For example :
* Methicillin in stomach will be broken down by acid,
whereas via intramuscular method is impossible
because of large volume required, then the chosen
appropriate
method is intraveous route.
* The multiple drug medication in large volume is
impossible to give intramuscularly
regarding to
giving rise painfulness; similarly, subcutaneous
method will result in wider inflammation.
* In very irritative drug by intramuscular and
subcutaneous method, it can be diluted into infussion.

In the specific clinical settings, the rapid


administration is required for patients with
serious condition.
In patients with high tendency to be hemorrhagic
(thrombocytopenia or hemophilia and
anticoagulant administration), intramuscular and
subcutaneous medication will cause
formation
of hematoma which is painful and extensive or
bleeding.
For supplementary nutrition, in patients with
GI disturbances, peroral intake is not
adequate,
and so does patient with gastrointestinal postoperative condition.
* Patients with vomiting and nausea at certain
level, such as severe hyperemesis gravidarum,
unconsciousness, or swallowing unability.

INTRODUCTION TO INJECTION DRUGS


Injection drug is a sterilized preparation in the forms of :
1.Liquid, consisting of :
Solution, the active ingredient disolves in it and the
available packaging is in ampule or vial.
Suspension, unsoluble active ingredient, is suspended
thoroughly in the suspension using suspension agent.
Emulsion, the liquid containing the mixture of water and oil.

2. Dry Powder, including :


Soluble Ingredient, mixed with solvent before use, this
ingredient is not long-standing that breaks down in the
solution.
Insoluble Ingredient, mixed with liquid when it will be used,
because it is not long-standing in solution, but broken down.
Delaying the drug absorption into the blood
vessels, in the reason to lengthen the drug action,
suspension or solution in bean oil or sesame oil is
frequently
used, for examples, penicillin and
sexual hormone suspension, given intramuscularly.

THE CONTAINER OF INJECTION


DRUGS
1. AMPULES
It is made from glass or plastics with
various sizes, from 1 ml (adrenalin) up to
10 ml (aminophyline) generally for once
usage.

Glass

Plastic

THE PREPARATION TO USE :


With clean hands, align the fine wound line on the
ampule neck, then using alcohol cotton clean it and
break it ; if the ampule head is made from plastics,
rotate the ampule head untill it is separated
completely.

2. VIAL
It is made from glass with rubber cap fixed with film
metal surrounding the bottle lip, generally can be
used repetitively.
The filling of drug solution into syringe is as follows :
Solution :
Suck the air as much as needed
Make the vial rubber clean using sterilized alcohol cotton
Prick the syringe into the vial while the upside-down
position of the vial .
Press the air into the vial then directly pump-in the
solution as much as needed, the needle should be
always in the solution border.
Make the syringe free from air and clean it, wash the
hands.

HYPODERMIC EQUIPMENTS
SYRINGE is an equipment to get water or solution into
the body or body cavities.
HYPODERMIC SYRINGE is syringe to use for
subcutanous, intramuscular, and intravenous methods. It
is a sucking type and characterized by the main
components including a metal piston and a tube made
from glass with various sizes.
1. Tuberculin syringe : small size with capacity no more
than 1 ml .
0.1 - 0.001 ml.
Hypodermic Syringe : Larger size with capacity 2 - 50 ml.

DISPOSABLE SYRINGE :

Made from plastics with larger size than


Tuberculin syringe (5 ml) for once use
only, packed with sterile state and
separated needle.
In general, it is used the administration of
antibiotics,
antihistamine,
heparin,
tranquilizer, vitamin, etc.

HYPODERMIC NEEDLES
This needle typically is made from stainless steel,
hyperchromed steel, carbon steel, chromium,
platinum, silver or gold.
The
1.
2.
3.

form of hypodermic needles based on :


Length
Thickness needle
Sectioning: sharp-angle sectioned needle

Needle Size
The
1.
2.
3.
4.

choosing of needle size on the basis of


Safety
Flow volume
Patient's convenience
Penetration depth

The unit of needle size is GAUGE referring to the outer


diameter of canula or needle shaft.
In general the size is 1 - 27 gauge, with the length not
less than 1/4 inch and more than 3.5 inches.
For several biopsies and spinal tranfusion, the needles
are 16 - 19 gauge in size and 0.5 - 3.5 inches in length
For local anesthesia, the needles are from 26 gauge
with 1/2 inch to 20 gauge with ? inches.
For intravenous transfusion, the needles are from 19
gauge with 1.25 inches to 15 gauge with 2.5 inches.

There are also many other utilities :


1.
2.
3.
4.
5.
6.
7.

Caudal needle
Epidural needle
Intravenously anesthetic needle
Blood transfusion needle
Spinal needle
Biopsy needle
Cerebral angiographic needle

ROUTES OF ADMINISTRATION IN
INJECTION DRUGS
1. INTRADERMAL OR INTRACUTANEOUS
Dosage form : Solution and Suspension
Volume

: 100- 200 I.U per I.C

Purpose

: Tuberculine Test and Immunization

Equipments : Disposable syringe with small,


short
size needle, Desinfected cottons

2. SUBCUTANEOUS OR HYPODERMAL INJECTION


Dosage form

: Solution or oil

Volume

: No more than 2 ml

The injection under skin should be conducted with nonirritant drugs which are soluble either in water or oil, but the
effect is not as rapid as IM or IV method. It is easy to do by
patients themselves, such as insulin administration.

3. In BCG administration for infants, injection via dermal


and subcutaneous methods may develop
lymphadenitis.

This

method

administration

is

also
of

used
heparin

in

the
and

epinephrine suspensions.
Skin has poor blood vasculature, thereby the
drugs that will be absorbed by blood vessels and
the nonsoluble drugs diffuse into lymphatic
vessels.

INJECTION TECHNIQUES
1.
2.

Wash the hands thoroughly


Localize the injection site on the lateral surface of upper arm,
anterior surface of thigh or abdominal region.
3. Clean the skin area with desinfectant
4. Pinch the skin as thick as the skin itself
5. Prick the needle into the skin on the base of skinfold with the angle of
20 - 30 degrees
6. The pinch is then released
7. Re-suck the syringe to ascertain that it did not prick the blood vessel
(if there is blood in it, repeat the procedure)
8. Inject the drug slowly and gradually within 0.5 - 2 minutes; if too
quick, possibly edema or collapse of blood vessel develops
9. The needle is immediately removed, cover the injection site with
adhesive plaster.
10. Observe the patient condition; attention should be given that the
repeated injection may appear overdosis.

3. INTRAMUSCULAR INJECTION
Dosage form
or

: Solution, suspension in water


oil

Volume
: No more than 4 ml
In injection into muscles, the soluble drug
resorption will last within 10 - 30 minutes.
The adventages :
Easy, safer, good tolerated, rapid resorption,
and rarely develops necrosis. For very irritative
drugs, this intramuscular method is preferred
than subcutanous method.

Injection Procedure
Localize the muscle to choose:
Ventro Gluteal : thicker, no main nerve fibers and
blood vessels. Choose the upper lateral quadrant,
in Medial Gluteal, take attention on ischiadic
nerves and Superior Gluteal Artery.And patient
position should be facing laterally, facing
downward, or standing.

It is not performed to infants and


young children.

Vestus Lateralis :
Middle aspect of thigh :
very poor nerve fibers and blood vasculature.
Position : supine, or sitting
Volume : 2.5 - 3 ml
Deltoid muscle :
Easy, with position of facing laterally, sitting,
or standing, needs attention that the area is
very limited and the existence of large bone,
blood vessels, and nerve fibers.

Drug Volume :
No more than 2 ml.
Wash hands thoroughly
Make the patient ensure and explain the procedure
Rub disinfectant on the skin
Ask the patient to let the muscles relaxed, because if the
muscle is in contraction will the drug liquid flow into the
surrounding tissue leading to irritation and pain sensation.
6. Shoot the needle in perpendicular position (90 degrees) to
the skin surface
7. Re-suck to ensure if it shot blood vessel (if it did so, repeat
the procedure from point 4, or replace with new syringe, if
any)
8. Inject the drug by pressing the pump slowly and gradually
to diminish pain sensation
9. Remove the needle quickly
10. The injection site is press using the other hand with
sterilized cotton, fix it with plaster
11. Observe the patient's reaction, necessarily keep the patient
calm
12. Clean the hands and used equipments
1.
2.
3.
4.
5.

4.
INTRAVENOUS
ADMINISTRATION

DRUG

Materials :
Syringe filled with air-free drug liquid,
Needle of 20 gauge, long and moderate thickness
Disinfectant
Cotton, plasters, and tourniquet
Injection Procedure :
1. Wash the hands thoroughly
2. Ensure the patient and explain what will be done
3. Localize the injection site, choose forearm slightly lower from
cubital fossa. The vein lies more superficially and is not covered
and easy to legate.
4. The patient is asked to be relaxed with fisting the related hand.
5. Tourniquet is set up, then see the vein to be swollen while
giving disinfectant on to the skin area.

Injection Procedure :
6. Vein is stabilized by replacing the pressing hand to the
skin in line with the vein longitudinal axis, using the other
hand.
7. Direct cardially the needle to vein with 35 degree of angle,
shoot the needle slowly into 3-5 mm depth of vein
8. Do aspiration, if there is blood inside the syringe, it means
that the needle has aimed to the vein, instead, try again.
9. Tourniquet then is removed
10. Inject the drug slowly, observe the pain sensation, swelling
or hematoma; if the needle is still in vein, try to suck again.
11. The needle then should be removed immediately while the
injection site is press with cotton and subsequently cover
it with plaster.
12. Observe the patient's reaction, meanwhile wash your
hands and clean the used equipments

INTRAVENOUS
FLUID

ADMINISTRATION

OF

Intravenous fluids refers to fluid that is


administered intravenously in large amount
through infusion.
It is estimated that about 40% of the drug
administration at hospitals were conducted by
injection and it is likely increasing recently.

THE CONTAINER OF INFUSION FLUID

1. It is made from glass, consisting of 2 types


based on the difference in air ventilation :
a. Air ventilation is outside of the bottle, at the tip of
infusion set through filter at a bottle spike.
b. Air ventilation through the tube in the bottle, the
tube
opening is able to be passed through.

2. The container is made from felxible plastics


polyvinyl chloride or semi rigid polyolivin.
The
supporting
equipments
for
infusion
administration are infusion set that is to move the
fluid into blood vein. It should meet the requisites
of being sterilized, free-pirogen, and disposable
Though it is produced by a variety of
manufacturers, the main components and parts
are the same, including :
1. Spike as the breaker against rubber seal in
the
spike hole.
2. Drip chamber

The purpose of intravenous fluid


adminstration in some clinical settings
is :

To correct the imbalanced body fluid (as replacement)


To correct the imbalanced body electrolytes
To provide basic nutritional elements
Voluminous
parenteral
hyperalimentation
that
overwhelming the normal nutrition
As the carrier of other drug administration

NAME
1.

2.
3.
4.

5.

6.

7.

AminoAcids (synthetic)
Aminosyn
Veinamine
Dextrose (Glucose,D5/W)
Dextrose&NaCl
Lactate's Ringer
(Harmann)
NaCl
KCl
CaCl2
Na Lactate
Pprotein (hydrolized)
Aminosol
CPH-5
Ringer's
NaCl
KCl
CaCl2
Natrium Lactate

CONCENTRATION PURPOSE
5.5-8%
8%
2.5 - 50%
5-20%
NaCl 0.11 - 1.9%

0.60%
0.03%
0.02%
0.30
5% casein&fibrin

0.86%
0.03%
0.033%
1/6M

Fluid &nutrition

Fluid & Nutrition


Nutrition & Electrolytes
Systemic alkalizer &
nutrient supplement

Fluid & nutrient


supplement

Fluid & nutrient


supplement

THE INTERMITTEN ADMINISTRATION OF


ANTIBIOTICS AND OTHERS
Such medication may be performed by one of the three
following methods :
A. Directly Intravenous Injection : volume of 1 - 5 ml
within 1 - 5 minutes.
Or inject the injector of the hanging infusion bottle into the
injection site. This method is appropriate for
limited
amount of drug and the drug which endanger if given in
multiple method.
B. Volume Control Method : it
refers to the infusion
adminstration with accurate dosage in expected flow
through volume control set consisting of a
calibrated
plastic chamber below the main infusion bottle which is
frequently along with free liquid administration.

THE PROCEDURE OF INTERMITTENT


ADMINISTRATION OF INTRAVENOUS LIQUID WITH
VOLUME CONTROL SET

1. Using aseptic technique, the spike of VC set is inserted


into
the main infusion bottle or separated bottle.
2. The tube line is emptied from air by opening the upper
clamp so that the liquid flows.
3. Open the clamp over the calibrated chamber to let 25 50 ml of liquid enter into it from the bottle.
4. Close the upper clamp.
5. Inject the drug through the connecting hole in
therubber
cap of the VC set.
6. Re-open the upper clamp to let the flow up to 50 - 150
ml, then close it.
7. Open the lower clamp to make liquid flows

The administration of this infusion drip is related to


the second liquid. Through venipuncture, the
drug flow will be regulated
in one intravenous
system.
This administration give rise the following advantages :
1. PB technique can avoid unnecessarily other venipuncture.
2. The drug solvability is achieved immediately in short time,
usually within 30 - 60 minutes.
3. The drug solution that can relieve irritation and obtain high
serum level rapidly is an important consideration for therapy
such
as
serious
infection,especially
in
antibiotic
administration.

consist of infusion bottles, including


a main bottle and a mini bottle
Peggy Back of 250 ml, and infusion
set.
The mini Peggy Backbottle
usually contains antibiotics, whilst
main bottle is similar to the
classical infusion set with a rubber
Y - shape channel apparatus below
the
clamp of the main bottle.
The second bottle is also provided
with the regulatory clamp, while
the other has not clamp but a tap in
the Y-shape channel apparatus to
regulate the flow by opening and
shutting automatically depending

To reserve air and control the number of dripping, the


bottles are connected to the drip chamber with a clamp,
further the chamber connected to the tip of needle
through 1.5 - 3 m of tube line. Below the drip chamber, a
clamp regulates the expected drops. The Procedures of
Preparation and Administration Of Intravenous Liquid
1. Prick the spike into the rubber bottle cap of the infusion set.
2. Hang the infusion bottles on a stand by the patient's bed, then
eject the air in the tube line by flowing the first liquid drop out,
regulated by the clamp.
3. Shoot the needle into vein (aseptically, see the previous mentioned
intravenous injection procedure), conducted by physician or nurse.
4. Loosen the clamp gently to flow the liquid till the expected number
of
drops by observing the drip in the drip chamber. Generally,
this medication lasts within 4 - 8 hours with the volume of 125
ml/hour.
5. The concomitant drugs given along with this infusion are : Dopamin,
Lidocaine, Insulin,and Heparin. In the administration of potent
drugs, the speed of dripping depends on the patient's
clinical
condition. The drip volume depends on the manufacturer's
recommendation, ranged: 10, 15, 20, 50, and 60 drops/ml.
In another setting, sterilized solid drug is administered through rubber hole in VC
set and dissolved with 50 - 150 ml main or reserved solution.