1. Parenteral
HENDERSON

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

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

4. 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

5. 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.

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

7. 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.

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

9. 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.

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

11. 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.

12. 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

13. 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

14. 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.