1. Administration of Parenteral Medications
UNIT 13
Administration of Parenteral Medications

2. Key Terms Aspirate Assessment Hematoma Hemophiliac Palpate Rapport
Taut
Wheal

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

4. Advantages of the Parenteral Route
Effective delivery when oral route is difficult or impossible
Delivery of precise amount of medication to targeted area
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5. Advantages of the Parenteral Route
Not altered by gastric acids
Does not irritate digestive system
Not lost as a result of vomiting

6. 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
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7. 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?
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8. Disadvantages
Failure to aspirate may result in IM injection being given IV
IM medication may be given sq, possibly resulting in sterile abscess
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9. Disadvantages Possibility of injury due to Needle breaking
Striking bone
Damage to tissue, nerves, veins, or other blood vessels

10. 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

11. 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
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12. 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
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13. Patient Assessment Discussion Question:
Why would you not choose to give an injection into a paralyzed area?

14. Angles of Injection

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

16. 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

17. 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
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18. 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.
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19. 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
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20. 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.

21. Administration Guidelines
Select appropriate needle/syringe unit
Properly prepare supplies, medication, and patient
For sq and IM injections, use quick, dartlike motion
Aspirate
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22. 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.
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23. 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?

24. 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

25. 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
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26. Z-Track Guidelines Discussion Question:
Why should you change the needle after preparation of medication prior to administration of a Z-track injection?

27. Insulin Guidelines NEVER shake bottle Use correct insulin syringe
Rotate sites
Do NOT massage site
Ensure insulins are compatible prior to mixing
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28. Insulin Guidelines Discussion Question:
Does all insulin have to be kept refrigerated?

29. 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
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30. IV Therapy Disadvantages Thrombophlebitis Fluid overload Hematoma
Clotting
Pain and discomfort
Hypersensitivity reaction
Fluid overload
Air embolism
Septicemia
Infection
Infiltration
Phlebitis