1. Parenteral Drug Administration

2. Parenteral Administration
Parenteral – came from the Greek words “para enteron” meaning “to avoid the intestine.”
Includes in its broadest sense, any drug (or fluid) whose delivery does not utilize the alimentary canal for entry into body tissues.

3. 1. Intradermal Administration
Parenteral Administration
1. Intradermal Administration
Action / Purpose
Local Effect
A small amount is injected so that volume does not interfere with wheal formation or cause a systemic reaction
Used for observation of an inflammatory (allergic) reaction to foreign proteins.
Ex: tuberculin testing
testing for drug and other allergic sensitivities
some immunotherapy for cancer.

4. Parenteral Administration
Intradermal Sites
Locations are chosen so that an inflammatory reaction can be observed. Preferred areas:
lightly pigmented
thinly keratinized
hairless
ventral mid forearm
clavicular area of the chest
scapular areas of the back

5. Intradermal Injection Sites
Parenteral Administration
Intradermal Injection Sites
Clavicular Area
Clavicular Area
Clavicular Area
Scapular Area
Ventral Mid Forearm

6. Skin Layers - Injection Site
Parenteral Administration
Skin Layers - Injection Site
Epidermis Layer
Dermis Layer
Subcutaneous Layer
Muscle Layer

7. Intradermal Equipment
Parenteral Administration
Intradermal Equipment
Needle:
26 to 27 gauge
Syringe:
1 ml calibrated in 0.01ml increments (usually 0.01 to 0.1 ml injected)

8. Intradermal Technique:
Parenteral Administration
Intradermal Technique:
Cleanse the area using a circular motion; observe sterile technique
Hold the skin taut
Insert the needle, bevel up, at a 10 to 15 degree angle; the outline of the needle under the skin should be visible.

9. Intradermal Technique
Parenteral Administration
Intradermal Technique
Inject the medication slowly to form a wheal (blister or bleb)
Remove the needle slowly; do not recap

10. Intradermal Technique
Parenteral Administration
Intradermal Technique
Do not massage the area; also instruct the client not to do so
Mark the area with a pen, and ask the client not to wash it off until read by a health care provider

11. Intradermal Technique
Parenteral Administration
Intradermal Technique
Assess for allergic reaction in 24 – 72 hours; measure the diameter of local reaction. For tuberculin, measure only the indurated area; do not include redness in the measurement

12. 2. Subcutaneous Injection
Parenteral Administration
2. Subcutaneous Injection
Definition
a small thin needle is inserted beneath the skin and the drug injected slowly.
The drug moves from the small blood vessels into the bloodstream.
Usually slower in onset than with the IM route
Purpose
It is done when a small amount of fluid is to be injected, the patient is unable to take the drug orally, or the drug is destroyed by intestinal secretions

13. Site for injection Abdomen Upper hips Upper back Lateral upper arms
Parenteral Administration
Site for injection
Abdomen
Upper hips
Upper back
Lateral upper arms
Lateral thighs
Note:
Stay 1 inch away from the last injection.
Stay 2 inches away from your navel or scars.
Do not use areas that are bruised, tender or swollen.
The injection site should always be rotated so that consecutive injections are never given into the same area

14. Equipment Needed Needle – 25 to 27 gauge, ½ to 5/8 inches in length
Parenteral Administration
Equipment Needed
Needle – 25 to 27 gauge, ½ to 5/8 inches in length
Syringe – 1 to 3 mL
2 alcohol wipes
Insulin syringe (for insulin use only)

15. Technique Wash and dry your hands
Parenteral Administration
Technique
Wash and dry your hands
Prepare the medicine to be administered

16. Parenteral Administration
Clean your skin with an alcohol pad. Start at the proposed site then wipe in a circular motion, moving outward with each circle to prepare an area 2-3 inches in diameter around the injection site. Let the alcohol air dry.
Gently pinch the skin at the injection site. Insert the needle through the skin at a 45 to 90 degrees angle so that the tip of the needle is under the skin and above the muscle layer.

17. Parenteral Administration
Release the skin and gently pull back on the plunger to make sure the tip of the needle is not in a blood vessel.
Note: DO NOT aspirate when using
Heparin
Slowly inject the medication. When all the medication is injected, pull the needle out and quickly press the alcohol wipes onto the site for 30 to 60 seconds. Do not rub the skin.

18. Parenteral Administration
Discard the syringe and attached needle into your puncture proof Sharps container. Do not recap the needle.
Wash and dry your hands

19. 3. Intramuscular Injection
Parenteral Administration
3. Intramuscular Injection
Definition
An intramuscular (IM) injection is a shot where the needle goes into the muscle layer under the skin in order to deliver medicine.
Usually more rapid effect of drug than with subQ route
Used for irritating drugs, aqueous suspensions, and solutions in oils.

20. Parenteral Administration
Purpose
IM injections are also used to deliver medications that would otherwise be absorbed too slowly or made ineffective if taken by mouth. Examples of such medications include:
Certain antibiotics
Certain contraceptive hormones
Most vaccines
Epinephrine injections for people with severe allergic reactions

21. Site for injection 1. Ventrogluteal Client Position: SUPINE LATERAL
Parenteral Administration
Site for injection
1. Ventrogluteal
Client Position: SUPINE LATERAL
Note:
Suited for deep IM or Z-track injection

22. Site for injection 2. Dorsogluteal Client Position: PRONE
Parenteral Administration
Site for injection
2. Dorsogluteal
Client Position: PRONE
Note:
Suited for deep IM or Z-track injection
Requires accurate site and technique

23. Site for injection Client Position: LATERAL, PRONE, SITTING, SUPINE
Parenteral Administration
Site for injection
3. Deltoid
Client Position: LATERAL, PRONE, SITTING, SUPINE
Note:
Readily accesible
Close to nerves

24. Site for injection 4. Vastus Lateralis
Parenteral Administration
Site for injection
4. Vastus Lateralis
Client Position: SITTING, SUPINE
Note:
Good site for infants
Free of major nerves

25. Parenteral Administration
Equipment Needed
Needle: gauge, 18 gauge for blood products; inches in length
Syringe: 1 to 3 ml (usually 0.5 to 1.5 ml injected)

26. Technique Same as subQ Insert needle 90° into the muscles
Parenteral Administration
Technique
Same as subQ
Insert needle 90° into the muscles

27. Technique Note: Prepare all equipment Use dart or pencil hold
Parenteral Administration
Technique
Note:
Prepare all equipment
Use dart or pencil hold
If blood is present during aspiration, DO NOT INJECT.

28. Technique Note: Break through the skin quickly to minimize pain
Parenteral Administration
Technique
Note:
Break through the skin quickly to minimize pain
Don’t change the direction of the needle as it goes in or comes out
Do not reuse disposable needles

29. Parenteral Administration
Z-track Technique
Prevents the medication from leaking back or entering into the subQ tissue.
Note:
Gluteal site is preferred
A: Pull skin and hold, insert needle
B: Holding skin to side, inject medication
C: Withdraw needle and release skin

30. 4. INTRAVENOUS ADMINISTRATION OF MEDICATION
Parenteral Administration
4. INTRAVENOUS ADMINISTRATION OF MEDICATION

31. Medications are Administered Intravenously by the following methods:
a.) Large volume infusion of intravenous fluid
Mixing a medication into a large-volume IV container.
Drugs are diluted in volumes of 1000 ml or 500 ml of compatible fluids. Fluids such as IV normal saline or Ringer’s lactate are frequently used.
Commonly added drugs are Potassium Chloride and Vitamins.
The medication can be added to the fluid container that is running or before it is hung and infusing.

32. Procedure:
Wash hands and observe other appropriate infection control procedure.
Prepare medication ampule or vial for drug withdrawal.
Add the medication.
To new IV container:
Locate the injection port and carefully remove its cover. Clean the port with antiseptic or alcohol swab.
Remove the needle cap from the syringe, insert the needle through the center of injection port, and inject the medication into the bag or bottle.
Mix the medication and solution by gently rotating the bag or bottle.

33. Adding medications to Intravenous Fluid Container
Parenteral Administration
Adding medications to Intravenous Fluid Container
Equipment:
MAR or computer form
Correct medication
Diluent for medication in powdered form
Correct solution container, if a new one is to be attached
Antiseptic or alcohol swabs
Sterile syringes of appropriate size
IV additive label

34. Complete the IV additive label with name and dose of medication, date, time, and nurse’s initials. Attached it upside down on the bag or bottle.
Clamp the IV tubing. Spike the bag or bottle with IV tubing and hang the IV.
Regulate infusion rate as ordered.
To an existing Infusion:
Determine that the IV solution in the container is sufficient for adding the medication.
Confirm the desired dilution of the medication, that is, the amount of medication per milliliter of solution

35. Closed the infusion clamp.
Parenteral Administration
Closed the infusion clamp.
Wipe the medication port with the alcohol swab.
Remove the needle cover from the medication syringe.
While supporting and stabilizing the bag, carefully insert the syringe needle thorough the port and inject the medication
Remove the bag or bottle from the pole and gently rotate the bottle or bag.
Re-hang the container and regulate IV flow.

36. Dispose of the equipment and supplies according to agency policies/practice.
Document the medication in the appropriate form in the client’s record.

37. b.) Intermittent intravenous infusion (piggyback or tandem setups)
Parenteral Administration
b.) Intermittent intravenous infusion (piggyback or tandem setups)
Methods of administering a medication mixed in a small amount of IV solution, such as 50 or 100 ml.
The drugs are administered at a regular intervals, such as every 4 hrs, with the drug being infused for a short period of time such as 30 to 60 minutes

38. Parenteral Administration
Two commonly used additive or secondary IV setups are the tandem and the piggy back.
Traditionally the tubing of the secondary set has been attached to the ports of the primary infusion by inserting needle through port and taping it in place.
Tandem setups – a second container is attached to the line of the first container at thelower, secondary port. It permits medications to be administered intermittently or simultaneously with the primary solution.

39. Piggyback – a second set connects the second container to the tubing of the primary container at the upper port. This setup is used solely for intermittent drug administration.

40. c.) Volume controlled infusion( often used for children)
Parenteral Administration
c.) Volume controlled infusion( often used for children)
Intermittent medications may also be administered by volume controlled infusion set such as Buretrol, Soluset, Volutrol, and Pediatrol. They are small fluid containers ( ml in size) attached below the primary infusion container so that the medication is administered through the clients IV line.
Volume control sets are frequently used to infuse solutions into children and older clients when the volume administered is critical and must be carefully monitored.

41. Adding Medication to a Volume-Control Infusion Set
Equipment:
Medication in a vial or ampule
Sterile syringe
Antiseptic or alcohol swab
Procedure:
Withdraw the required dose of the medication into a syringe.
Ensure that there is sufficient fluid in the volume-control fluid chamber to dilute the medication. Generally, at least 50 ml of fluid is used.

42. Close the inflow to the fluid chamber by adjusting the upper roller or slide clamp above the fluid chamber; also ensure that the clamp on the air vent of the chamber is open.
Clean the medication port on the volume-control fluid chamber with an alcohol swab.
Inject the medication into the port of the partially filled volume control set.
Gently rotate the fluid chamber until the fluid is well mixed.
Open the line’s upper clamp, and regulate the flow by adjusting the lower roller or slide clamp below the fluid chamber.
Attach a medication label to the volume-control fluid chamber.
Document relevant data, and monitor the client and the infusion.

44. It is used when a medication cannot be diluted or in an emergency.
Parenteral Administration
d.) IV push or bolus
IV push or bolus is the intravenous administration of an undiluted drug directly into the systemic circulation.
It is used when a medication cannot be diluted or in an emergency.
An IV bolus can be introduced directly into the vein by venipuncture or into an existing IV line through an injection port or through an IV lock.

45. Administering Intravenous Medications Using IV Push
Parenteral Administration
Administering Intravenous Medications Using IV Push
Equipment: For IV push for an existing line:
Medication in a vial or ampule
Sterile syringe
Sterile needles
Antiseptic swab

46. For IV push for an IV lock Medication in a vial or ampule
Parenteral Administration
For IV push for an IV lock
Medication in a vial or ampule
Sterile syringe (3 or 5 ml, to prepare medication)
Sterile syringe (3 ml, for saline or heparin flush)
Vial of normal saline to flush the IV catheter or vial of heparin flush or both
Sterile needles
Antiseptic swab
Disposable gloves

47. Procedure:
Wash hands and observe other appropriate infection control procedures.
Prepare the medication.
Existing IV line:
Prepare the medication according to the manufacturer’s direction.
IV lock:
Flushing with saline – prepare two syringes, each with 1 ml of sterile normal saline.
Flushing with heparin and saline – prepare one syringe with 1 ml heparin flush solution, prepare two syringes with 1 ml each of sterile, normal saline, and draw up the medication into a syringe.

48. Put a small-gauge needle on the syringe if using a needle system.
Wash hand and put clean gloves.
Provide client privacy.
Prepare the client.
Explain the purpose of the medication and how it will help, using language that the client can understand. Include relevant information about the effects of the medication.
Administer the medication by IV push.
For existing IV line:
Identify the injection port closest to the client.
Clean the port with alcohol swab.
Stop the IV flow by closing clamp or pinching the tubing above the injection port.

49. Release the clamp or tubing.
Parenteral Administration
Insert the needle of the syringe that contains the medication through the center of the port.
Pull back plunger of the syringe in order to aspirate a small amount of blood.
After observing the blood, continue to keep the clamp closed and inject the medication at the ordered rate.
Release the clamp or tubing.
After injecting the medication withdraw the needle.

50. For IV lock:
Clean the diaphragm with antiseptic swab.
Insert the needle of the syringe containing normal saline through the center of the diaphragm and aspirate for blood.
Flush the lock by injecting 1 ml of saline slowly.
Remove the needle and syringe.
Clean the lock’s diaphragm with an anti septic swab.
Insert the needles of the syringe containing the prepared medication through the center of the diaphragm.
Inject the medication slowly at the recommended rate of infusion.
Withdraw the needle and syringe.
Clean the diaphragm of the lock.

51. Attach the second saline syringe and inject 1 ml of saline.
If heparin is used, inert the heparin syringe and inject the heparin slowly into the lock.
Dispose of equipment according to agency practice.
Remove and dispose of gloves. Wash hands.
Observe the client closely for adverse reactions.
Determine agency practice about recommended times for changing the IV lock.
Document.

52. Parenteral Administration

53. e.) Intermittent infusion ports
Maybe affixed to an intravenous catheter or needle to allow medications to be administered intravenously without requiring repeated needle sticks or a continuous intravenous infusion.
Intermittent injection ports have either a resealable latex injection site for needle access or a port that allows a syringe or a needle less adapter to be connected for administering medications.
Intermittent injection ports may be flushed with the sterile saline prior to medication administration, and with saline or heparinized saline afterward. (flushing the port maintains the patency of the intravenous catheter and port, and reduce the risks of mixing incompatible medications within the system)

54. Site for injection 5. Total Parenteral Nutrition Definition
Parenteral Administration
5. Total Parenteral Nutrition
Definition
TPN, total parenteral nutrition, or "hyperal" is the special IV solution of nutrients (calories, fat, and protein) into the blood stream through an IV
It is used in cases of long-term coma, severe burns or severe gastrointestinal syndromes
Purpose/Why it is necessary
is used for patients who cannot or should not get their nutrition through eating.
Site for injection
It is given through an IV placed in the arm, groin, neck, or chest and any central vein.

55. Equipment Needed IV Catheter or medical infusion pump Sterile bag of
Parenteral Administration
Equipment Needed
IV Catheter or
medical infusion
pump
Sterile bag of
nutrient solution

56. A local anaesthetic is used to numb the area.
Parenteral Administration
Technique
A local anaesthetic is used to numb the area.
A tube or "catheter" is normally inserted into a large vein, such as the one situated under the collarbone.
A nutritious solution is fed through the catheter into the veins. The feeding each day will take several hours. TPN provides:
Carbohydrates in the form of glucose.
Protein in the form of amino acids.
Lipids in the form of triglycerides.
Electrolytes.
Vitamins and trace minerals.

57. 4. Epidural Injection Definition Purpose
Parenteral Administration
4. Epidural Injection
Definition
An epidural injection places anti-inflammatory medicine into the epidural space.
Purpose
It is used to treat swelling, pain, and inflammation associated with neurological conditions that affect nerve roots.
Also used to administer anaesthesia for pain relief in labor.

58. Parenteral Administration
Site of injection
The membrane that covers the spinal cord and nerve roots in the spine is called the dura membrane. The space surrounding the dura is the epidural space.

59. Parenteral Administration
Site of injection

60. Equipment needed Epidural needle Syringes Aniseptic Epidural catheter
Parenteral Administration
Equipment needed
Epidural needle
18 gauge
Syringes
Aniseptic
Betadine
Epidural catheter
Fluoroscope
Fluoroscope- An X-ray machine that combines an X-ray source and a fluorescent screen to enable direct observation

61. Fluoroscope

62. Types of Epidural Injection
Needle through Needle
Epidural Catheter

63. Parenteral Administration
Technique
The patient is positioned, either lying down or sitting up, in a hunched posture to flex the spine. By palpating the bony protrusion area, the midpoint of the chosen interspace is found and marked.
Once the correct entry point has been marked and standard sterility and procedures has been completed, an epidural needle is advanced through the skin and tissues.
Hunch position maximizes the peripheral spacing of the vertebrae and allows easy feel of the bony protrusions