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

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

Subcutaneous

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

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

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

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

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

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

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

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

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

Intraosseous Follow same procedures as IV administration