Parenteral Dosages Chapter 12 Copyright © 2020 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Route of administration other than gastrointestinal Parenteral Route Route of administration other than gastrointestinal Intramuscular (IM) Subcutaneous (subcut) Intradermal (ID) Intravenous (IV)

May be diluted and administered by themselves Parenteral Dosages Review Figure 12-1 to view intramuscular, subcutaneous, and intradermal injections, with comparison of the angles of insertion May be diluted and administered by themselves May be administered in conjunction with existing IV fluids May be administered in addition to IV fluids Ask these questions: What are parenteral dosages, and why are some medications given parenterally? How are parenteral medications administered? How can parenteral medications be administered intravenously? Copyright © 2020 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Copyright © 2020 by Mosby, an imprint of Elsevier Inc Copyright © 2020 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Parenteral Dosages Packaging of parenteral medications: Ampules Vials Mix-O-Vials Pre-filled Syringes An ampule is a single-dose container that must be broken at the neck to withdraw the drug. A vial is a glass or plastic container that is sealed with a rubber stopper. Vials generally contain more than one dose of medication. A Mix-O-Vial is used to package unstable drugs and allows the components to be combined just before administration. Pressure is applied to the top of the vial to release the stopper between the compartments and allow the drug to be mixed. A prefilled disposable syringe can be used to supply parenteral medications.

Guidelines for Syringe Selection Standard doses more than 1 mL Round to tenths and measure in 3 mL syringe 3 mL syringe is calibrated in 0.1 mL increments 1.53 mL is rounded to 1.5 mL Drawn up in a 3 mL syringe

Guidelines for Syringe Selection (Continued) Small (less than 1 mL), critical care, or children’s doses Round to hundredths and measure in 1 mL syringe 1 mL syringe is calibrated in 0.01 mL increments 0.257 mL is rounded to 0.26 mL Drawn up in a 1 mL syringe

Guidelines for Syringe Selection (Continued) Amounts of 0.5 to 1 mL calculated in tenths Can be accurately measured in either a 1 mL or 3 mL syringe

Remember Dosages measured in hundredths (such as 0.83 mL) and all amounts less than 0.5 mL should be prepared in a 1 mL syringe, which is calibrated in hundredths However, if the route is intramuscular (IM), you may need to change needles to achieve a more appropriate length

Tip Syringes Barrel Plunger Hypodermic Tuberculin Insulin Parts of a syringe Tip Barrel Plunger Types of syringes Hypodermic Tuberculin Insulin Syringes Copyright © 2020 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Intramuscular maximum dosage Injectable Solutions Intramuscular maximum dosage Average 150 lb adult = 3 mL Maximum for deltoid site is 2 mL Children age 6-12 years = 2 mL Children birth to age 5 years = 1 mL

Parenteral Injections Examples of parenteral dosage calculations Collecting data about the drug Selecting supplied dosage Calculating the amount to give Measuring the dose with appropriate equipment for medication administration

To protect both patient and nurse Needleless System Why does Occupational Safety and Health Administration recommend the administration of parenteral medications with a needleless system? To protect both patient and nurse Because the system provides a shield to cover device Copyright © 2020 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Calculation of Parenteral Drug Dosages For example: The order states Kantrex 200 mg IM q6 h. Kantrex is supplied 0.5 g/2 mL. How many milliliters will the nurse administer? Copyright © 2020 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Converting All Measures to Equivalents Measures For example: A physician orders atropine gr 0.01 IM stat. Atropine 0.4 mg/mL is available. Convert the physician’s order to milligrams. The physician’s order and the available drug must be in the same system of measurement before you can write a proportion for the actual amount of medication to be administered. Convert measures into the same system before writing the proportion problem. 1 gr = 60 mg 1 gr : 60 mg :: 0.01 gr : x mg x = 0.6 mg Copyright © 2020 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Parenteral Drug Dose Calculation: Alternative Formula Method For example: The physician orders morphine 30 mg IM q4 h prn for pain. Morphine gr i/5 mL is available. How many milliliters will the nurse administer? Copyright © 2020 by Mosby, an imprint of Elsevier Inc. All rights reserved.