Administration of Parenteral Medications UNIT 13 Administration of Parenteral Medications

Key Terms Aspirate Assessment Hematoma Hemophiliac Palpate Rapport Taut Wheal

Routes of Injection Intravenous (IV): Fastest effect Intramuscular (IM): Next fastest effect Subcutaneous (sq): Slower effect

Advantages of the Parenteral Route Effective delivery when oral route is difficult or impossible Delivery of precise amount of medication to targeted area (continues)

Advantages of the Parenteral Route Not altered by gastric acids Does not irritate digestive system Not lost as a result of vomiting

Disadvantages Risk of infection due to Incorrect preparation of equipment Poor technique Allergic reactions may occur more quickly or be more severe than with oral medications (continues)

Disadvantages Discussion Questions: What actions should the medical assistant take to minimize the risk of infection when administering parenteral medications? What are some concerns if a medication that is intended for IM use is given IV? (continues)

Disadvantages Failure to aspirate may result in IM injection being given IV IM medication may be given sq, possibly resulting in sterile abscess (continues)

Disadvantages Possibility of injury due to Needle breaking Striking bone Damage to tissue, nerves, veins, or other blood vessels

Preparing the Patient Establishing rapport Be courteous and professional Give patient chance to ask questions Provide privacy NEVER tell patient injection will not hurt Educate about side effects

Patient Assessment Age and size Physical and mental condition Body size may determine size of needle or amount of medication to be injected Physical and mental condition Consider other conditions such as hemophilia or pregnancy (continues)

Patient Assessment Injection Site Sex Look for site with good circulation that is free from lesions, scars, or inflammation Sex Men generally are more muscular than women Men generally have tougher skin than women (continues)

Patient Assessment Discussion Question: Why would you not choose to give an injection into a paralyzed area?

Angles of Injection

SQ Injection Sites Abdomen Upper thigh Upper arms Lower back Upper buttock

Intradermal Injection Sites Inner forearm Middle of back Vastus lateralis Preferred site for infants and children Also used for adults Injection site depends on age of patient

IM Injection Sites Dorsogluteal Vastus lateralis “Upper outer quadrant” of buttock Used for most adult deep IM injections Contraindicated for infants Vastus lateralis Preferred site for infants and children Also used for adults Injection site depends on age of patient (continues)

IM Injection Sites Warning! (continues) The dorsogluteal site is used only as a last resort for children. Improper site selection may result in damage to the sciatic nerve or gluteal blood vessels. Use extreme caution in elderly, emaciated, or nonwalking patients. (continues)

IM Injection Sites Ventrogluteal Deltoid May be used for any age Relatively free of major nerves and vessels Deltoid Used for adults and children Contraindicated for infants (continues)

IM Injection Sites Warning! Improper injection technique into the deltoid may result in damage to the brachial and axillary nerves and blood vessels, the radial nerve, acromion, or the humerus.

Administration Guidelines Select appropriate needle/syringe unit Properly prepare supplies, medication, and patient For sq and IM injections, use quick, dartlike motion Aspirate (continues)

Administration Guidelines Remove needle quickly and smoothly Massage site for most injections Observe patient for reactions Document properly Warning! Do NOT massage the site after administration of insulin, heparin, or Imferon. (continues)

Administration Guidelines Discussion Questions: What should you do if you find blood in the syringe upon aspiration? Why would you not massage the site after administration of insulin, heparin, or Imferon?

Z-Track IM Injections Used for medications that can be irritating to subcutaneous tissue May be used to decrease pain caused by certain medications Recommended site is dorsogluteal

Z-Track Guidelines Change needle after drawing medication into syringe Pull skin laterally away from injection site Wait 10 seconds to remove needle after injection Remove needle at same angle as insertion Do NOT massage site (continues)

Z-Track Guidelines Discussion Question: Why should you change the needle after preparation of medication prior to administration of a Z-track injection?

Insulin Guidelines NEVER shake bottle Use correct insulin syringe Rotate sites Do NOT massage site Ensure insulins are compatible prior to mixing (continues)

Insulin Guidelines Discussion Question: Does all insulin have to be kept refrigerated?

IV Therapy Administration of fluids, solutions, electrolytes, nutrients, or medications by the venous route Advantages Direct medication route Immediate delivery, absorption into bloodstream Reliable for unconscious, nauseated, or vomiting patients (continues)

IV Therapy Disadvantages Thrombophlebitis Fluid overload Hematoma Clotting Pain and discomfort Hypersensitivity reaction Fluid overload Air embolism Septicemia Infection Infiltration Phlebitis