2. INTRATHECAL ROUTE
It is the route to administer medication
through a catheter placed in
subarachnoid space or one of the
ventricles of the brain.
Intrathecal :- administer directly in the
CSF.
Epidural :- administer in dura matter
thus have slower effect compared to
intrathecal.
3. Intrathecal administration is prescribed
for chemotherapy, pain management
or anesthesia administration, where
immediate effect is expected.
This route has high potential to
introduce infection, therefore aseptic
techniques should be maintained.
4. EPIDURAL ROUTE
It is used to administer the medication
into the epidural space around the
spinal cord.
Such as local anesthetic drugs,
analgesics and some radio contrast
agent for diagnostic purpose.
5.
6.
7. Articles
Disinfectants for cleaning
Spinal needle
10 mL syringe
Medicine card and prescribed
medicine
Sterile dressing
Adhesive tape
Tincture benzoin
Dressing set
8.
9. Procedure
Explain the procedure to the patient.
Gain consent from the patient.
Assess for any contraindication.
Provide privacy.
Assist the patient to attain the
procedure.
Drape the patient.
Assist the physician in cleaning the
area.
Give spinal needle and syringe to
physician.
10. Insert the spinal needle in the epidural
space and remove the stylet.
CSF will start dripping from the needle
(it indicates the entry in the
subarachnoid), then the needle is
withdrawn when the fluid stops
dripping, then connect the syringe and
administer the medicine is injected.
After administration, remove the
needle.
11. Seal the puncture with gauze piece
soaked in tincture benzoin.
Provide supine position for 6-8 hours
and head end should not be raised for
6-8 hours.
12. Post procedure care
Document the procedure and record
the observation made during the
procedure.
Replace articles.
Discard waste as per BMW policies.
Provide supine position for 6-8 hours
and head end should not be raised for
6-8 hours.
13. INTRAOSSEOUS
It is the administration of medication
into the bone marrow of long bone of
arms and legs.
This route is generally used when it is
difficult to access intravenous route.
The long bone contain network of
blood vessels which helps in
delivering the medication.
This method is commonly used in
infant and toddlers.
16. Articles
Dressing set and disinfectants
Peritoneal needle and catheter
Syringe for aspiration and
administration of local anaesthetic
agent
25 and 20 gauze needle
Anaesthetic agent
Connecting tubing
Scalpel and sterile gloves, sterile
drape
17. Dressing to seal the puncture site
Medication card and medicine to be
administered
Specimen bottle is to be collected of
peritoneal fluid
18. Preprocedure
Assist the patient to gain the position-
supine in bed head slightly elevated.
Expose the abdomen
Bladder should be emptied before the
procedure
Percuss the dullness on abdomen
Locate the site
Use ultrasound to confirm, if needed
19. Procedure
Wear sterile gloves
Clean the area to create sterile field
Drape the sterile sheet
With 25 gauge needle, infilterate skin
with anaesthetic agent
Insert the 20 gauge needle for
aspiration intermittently
Collect the specimen id needed
20. Once fluid is aspirated connect the
syringe loaded with medicine and
administer the medication
After administration seal the puncture
In case the fluid needs to be drained,
then connect the three way connector
to be needle inserted and connect the
tubing and collect the drained fluid in a
sterile container
21. Postprocedure
Abdominal binder should be applied if
the patient has coagulation risk or
bleeding tendency.
Patient shall lie in prone position and
avoid squatting position and weight
lifting for 6-8 hours.
22. INTRAPLEURAL
It is the route to administer the drug
through the chest wall into the pleural
space or through a chest tube placed
in the pleural cavity for any kind of
drainage.
Chemotherapeutic medications are
most commonly infused by this route.
23.
24. Articles
Dressing set and disinfectants
Syringe for aspiration and
administration of local anaesthetic
agent
25 and 22 gauge needles for
administering local anaesthesia and
aspirate the pleural fluid
Anaesthetic agent
Connecting tubing
25. Scalpel and sterile gloves, sterile
drape
Dressing to seal the puncture
Medication card and medicine to be
administered
Specimen bottle if specimen is to be
collected
26. Preprocedure
Explain the procedure and gain
consent
Collect all the articles
Place the patient in fowler’s position
with hands resting forward on the
cardiac table at the edge of the bed
Use ultrasound to confirm the pleural
space
Mark 5-10 cm lateral spine and 1-2
intercostal space below the effusion if
present
27. Procedure
Wear gloves and clean the area with
disinfectant and drape the area
Using 25G needle to infiltrate the local
anaesthetic agent
Connect syringe with 22G needle,
insert in the located site and aspirate
intermittently
When fluid is aspirated, stop the
insertion and attach the syringe
loaded with the medicine to administer
28. In case of drainage, 18G needle is
used, connect the three way
connector and tubing to drain the fluid
in the collection bottles
During procedure, ask the patient to
breathe normally and be steady
When done ask patient to hmmm and
withdraw the needle while patient is
humming, it prevents the air entry
Apply dressing and documentation
29. Postprocedure
Perform a chest X-ray
Position the patient to lie on the side
from where the procedure is
performed, it will help to seal the
puncture
30. INTRA-ARTERIAL
In this route, medications are
administered directly into the arteries
This procedure requires arterial line
access, it can be gained sonography
guided or blind procedure
The arterial line need to have
pressurized IV bag connected to it in
order to maintain the patency and
transducer may be connected to gain
the arterial blood pressure
31.
32. Articles
Dressing set
Arterial line set and transducer
Disinfectant for cleaning
Sterile gown gloves
Sterile sleeve for USG probe
Local anaesthetic agent
Syringe and needle and scalpel
Pressure bag, IV bottle and IV set
33. Preprocedure
Explain the procedure to patient and
gain consent
Collect all the articles
Position the patient
Hang the pressurized IV bottle ready
with connection
Use USG if needed
34. Procedure
Wear sterile gloves and gown
Clean the area and drape it
Cleaning is done from centre to
periphery in circular motion
Provide the arterial line to physician
Provide saline and syringe to flush the
line
Physician then insert the arterial line
sheath with stylet and observe gush of
blood coming through it
35. Stylet is removed and guide wire is
inserted
Then sheath is also removed
