1. Module: Session: Advanced Care Paramedicine Medication Routes 6 4a

2. Routes Parenteral administration of medications is typically done through:  Subcutaneous  Intramuscular  Intravenous  Endotracheal  Intraosseous  Inhalation

3. Subcutaneous

4. Prepare equipment  Syringe  Needle  Alcohol swab  4 X 4 gauze  Medication Explain procedure Confirm allergies Examine medication, confirm that it is the desired med, expiry date, cloudy/discolored? “Shake down” the ampule Break top off ampule using 4 X 4 gauze Draw medication into syringe and expel excess air

5. Subcutaneous Choose suitable site Pinch up the skin Insert needle at a 45º angle Aspirate the syringe to confirm placement  If blood is aspirated, withdraw needle and start over Inject medication slowly Remove syringe and dispose of Sharps Apply pressure over site Observe patient for effects Document

6. Intramuscular Prepare equipment  Syringe  Needle  Alcohol swab  4 X 4 gauze  Medication Explain procedure Confirm allergies Examine medication, confirm that it is the desired med, expiry date, cloudy/discolored? “Shake down” the ampule Break top off ampule using 4 X 4 gauze Draw medication into syringe and expel excess air

7. Intramuscular Choose suitable site Hold skin tight Insert needle at a 90º angle Aspirate the syringe to confirm placement  If blood is aspirated, withdraw needle and start over Inject medication slowly Remove syringe and dispose of Sharps Apply pressure over site Observe patient for effects Document

8. Intravenous Bolus Prepare equipment  Syringe  Needle  Alcohol prep  Medication Explain procedure Confirm allergies Examine medication, confirm that it is the desired med, expiry date, cloudy/discolored? Load medication Select appropriate IV port (closest to cannulation site) Clean port with alcohol prep

9. Intravenous Bolus Insert needle into port Pinch off IV tubing proximal to port Administer medication as required (Bolus, Slow IVP…) Release IV tubing Remove needle Monitor patient for effect Document

10. Intravenous “Piggyback” Prepare Equipment  Medication  IV solution  Extra tubing  Needle  Label  Medication Explain procedure Confirm allergies

11. Intravenous “Piggyback” Prepare medication in IV solution as required Label medication and [ ] of drug Attach needle to tubing and insert into patient’s IV port Tape connection to IV line for security Begin administration  May need to place bag higher then the IV bag to allow gravity to work Observe patient for desired effect Document

12. Endotracheal Prepare equipment Hyperventilate the patient Remove BVM for ETT Inject medication directly into ETT Flush if Required Replace BVM and ventilate Monitor patient for desired effect

13. Intraosseous Follow same procedures as IV administration