Parenteral HENDERSON

What does parenteral mean? Medications given by INJECTABLE ROUTE. I.D.- Intradermal S.C. / S.Q.- Subcutaneous I.M.- Intramuscular IV- Intravenous

What is an injection? Uses a syringe to penetrate one or more layers of the skin to bypass alimentary canal (digestive system).

Why is parenteral dosing routes necessary? Correct electrolyte and fluid imbalance Dehydration Saline Provide basic nutrition TPN (total parenteral nutrition) For patients without a functioning GI tract For patients with a bowel obstruction For patients with certain pediatric GI disorders For patients recovering from short term bowel surgery Vehicle for medications

I.D.- Intradermal Drug is injected into the superficial layer of the skin Only a very small volume (0.2mL) can be administered this way. Typically only seen during diagnostic tests (Tuberculin skin test to see if you have ever been exposed to tuberculosis)and a limited number of vaccines (small pox vaccine). Absorption is slow, and therefore onset of action is slow.

Intradermal Continued… Injection sites vary all over the body. Usually upper back and arms.

S.C./ S.Q.- Subcutaneous Injections given into the loose tissue beneath the skin in small volumes (2mL). Typically injection sites are the outer surface of the arm or thigh. Response is more rapid with S.C. than I.D.

Subcutaneous continued… Most Common Medications to be administered subcutaneously: Insulin Morphine Vaccines Epinephrine (epi-pen) Narcotics Antiemetics

I.M.- Intramuscular Injections given into the muscle mass Absorption is more rapid than by S.C. Typical injection sites are: deltoid (2-3 finger lengths below the distal and superior part of the arm) which can take MAX volume of 2mL in an adult. Gluteal medial muscle (posterior hip) which can take MAX volume of 5mL in an adult.

Intramuscular continued… Most common medications given IM are: Benzodiazepines Sex Hormones Amoxicillin Mood Stabilizers Vaccines Influenza Hep. A Rabies Gardasil

I.V.- Intravenous Administration into the veins for rapid effects. Usually solutions and some emulsions are used during this method NEVER SUSPENSIONS! Injections sites: Peripheral for patients who require short term IV therapy and used for drugs that don’t irritate the veins (Isotonic Solutions) Dorsal Forearm surface.

Intravenous continued… Central: Given to patients requiring long-term IV therapy Given to patients who are receiving irritating drugs or hypertonic solutions Given if a peripheral line cannot be placed to maintained Less Common sites include: Intra-arterial (artery) Intra-cardiac (heart) Intra-articular (joint) Intra-spinal (spinal cord)* Intra-synovial (lining of joint cavity) Intrathecal (brain-spinal cord)* * Indicates injection must be preservative-free

Common Parenteral Fluids Dextrose D5W- 5% dextrose in water D10W- 10% dextrose in water Sodium Chloride NS (Normal Saline) 0.9% sodium chloride Used in reconstitution of most antibiotics

Common Parenteral Fluids Continued… Note: Hypotonic solutions have a lower osmotic pressure than a surrounding medium or red blood cells, thus causing the red blood cells to burst. When the solution outside of the red blood cells has a lower osmotic pressure than the cytoplasm of the red blood cells, the solution is hypotonic with respect to the cells. The cells take in water in an attempt to equalize the osmotic pressure, causing them to swell and potentially burst. ½ NS (hypotonic used for true dehydration when your body loses water but not electrolytes) 0.45% Sodium Chloride Sterile water for Injection is NOT isotonic, it is commonly used for reconstruction. Ringer’s solutions a solution of several salts dissolved in water for the purpose of creating an isotonic solution relative to the bodily fluids of an animal.