pediatric Drug administration


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Different medications must be absorbed to be effective. For absorption, the drug must be administered in proper manner. To choose a route of administration we need to relate the dosage form, the advantages and disadvantages etc.

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pediatric Drug administration

  2. 2. INTRODUCTION Different medications must be absorbed to be effective. For absorption, the drug must be administered in proper manner. To choose a route of administration we need to relate the dosage form, the advantages and disadvantages etc.
  3. 3. ROUTES OF ADMINISTRATION Definition It is the way of getting a drug onto or into the body. It is chosen based on the effect upon the speed and efficiency with the drug action.
  4. 4. CLASSIFICATION 1. Enteral  Oral  Rectal 2. Topical  Otic  Nasal  Ophthalmic 3. Parenteral  Intravascular  Intramuscular  Subcutaneous  Inhalation
  5. 5. ENTERAL Desired effect is nonlocal, it is systemic Substance is given via digestive tract
  6. 6. It is supplied in many forms as :  Liquids  Powders  Tablets  Capsules The equipments used are:  Medicine cup  Spoon  Plastic oral syringe  Dropper  Nipple without bottle
  7. 7. TABLETS & CAPSULES PROCEDURE • Crush the tablet (for children under 5-6 years) • Mix with pleasant tasting liquid • Never mix tablet with food FOR AN OLDER CHILD • Place tablet at the back of tongue • Tell child if there is medicine in food
  8. 8. LIQUIDS It should be given with proper equipment as mentioned in packet. Drop size may vary from one to another. Do not use syringe for parental administration. PROCEDURE • Shake well before use • While using dropper direct liquid directly to posterior side of mouth • Slowly in small amounts • Allow child to swallow
  9. 9. In case of nipple without bottle: • Fill nipple by keeping medication directly • Place infant in upright position In case of tube feeding: • Medicine should be in liquid form • Check tube placement before and after administration • Flush tube before and after to maintain patency
  10. 10. ADVANTAGES • Most convenient and commonly used route • Ease and safety of administration • Active ingredient is in powder or granule form which dissolve in GI tract • Sub linguinal administration has rapid onset (< 5 minutes)
  11. 11. DISADVANTAGES • Delayed onset • Destruction of drug by GI fluids, food or drink in stomach • Not indicated in patients with nausea, sedated or unable to swallow
  12. 12. RECTAL ADMINISTRATION It is not a preferred route for administration in children as it may be irritating and unpredictable. Method is invasive and upsetting. It is used when child is vomiting or receiving nothing by mouth. Suppositories and enemas are two types of rectal administration of medication
  13. 13. SUPPOSITORY This drug delivery system is inserted into rectum, vagina or urethra where it dissolves or melts. Suppositories are inserted as solids it dissolves to deliver medicine which is received later by blood vessels. Example : glycerin paracetamol diclofenac
  14. 14. PROCEDURES  Ensure the child in side lying position  Insert suppository into the rectum quickly but gently  Insert suppository above anal sphincter  Use index finger for insertion FOR AN INFANT OR CHILD UNDER 3 YEAR OF AGE  Use fifth finger for insertion  To prevent expulsion of suppository, hold buttocks together for several minutes
  15. 15. ENEMAS Usually used for cleaning the bowel, it has laxative action. In the case of diseases, drug is administered as enema.
  16. 16. ADVANTAGES Could be administered in unconscious patients and children. Useful for nauseous patient and children Easy to terminate exposure Relieve constipation or hemorrhoids
  17. 17. DISADVANTAGES Absorption is slow and unpredictable in effectiveness Irregular drug absorption Inconvenience.
  18. 18. TOPICAL It is the application of the drug directly to the surface of skin. it includes administration of drugs to any mucous membrane. In this type of administration, the desired effect is local.  Eye  Nose  Ear  Lungs  Urethra  Colon
  19. 19. The dosage forms include:  Creams  Solutions  Ointments  Lotions  Gels  Tran dermal patches  Sprays  powders
  20. 20. OPHTHALMIC MEDICATION  They are supplied in the forms of drops or ointments  Ensure medication is at room temperature  administer when child is not crying.. PROCEDURE  place child in supine position  Slightly hyperextend neck with head lower than body  Rest the heel of your hand to stabilize on child’s forehead  Retract the lower eyelid & place medication in conjunctival sac.
  21. 21.  For ointment, apply medication on a thin ribbon from inner canthus outward without touching eye or eyelash  For an older child, we should instruct child to gently close the eyes to allow medication to be dispersed.
  22. 22. OTIC MEDICATIONS Typically they are in the form of drops. This root is upsetting because child cannot see the procedure.. • Ensure that medication is at room temperature. • Cold ear drops cause pain & vertigo PROCEDURE • Place child in supine or side lying position with affected ear exposed. • Pull pinna downward & back in children under 3 years. • Pull pinna upward and back in children over 3 years.
  23. 23. •Instill medication using dropper •Have the child remain in the same position for several minutes. •Massage the area anterior to promote passage of medication
  24. 24. NASAL ADMINISTRATION These medications are typically drops & sprays Additional help may be needed to keep child’s position. PROCEDURE • Position child in supine position with hyper extended head to ensure that the drops will flow back to nares. • A pillow or folded towel can be used to facilitate the hyper extension. • Place thee tip of the dropper just at or inside nasal opening
  25. 25. • Bottle should not touch the nares • After installations, maintain child’s head in hyperextension for 1 minute. FOR NASAL SPRAYS • Position the child upright • Place tip of spray bottle just inside nasal opening and tilted to back. • Squeeze the container for instillation
  26. 26. ADVANTAGES • Local therapeutic effects • Lower risk of side effects • It offer steady level of drug in the system DISAVANTAGES • Messiness • Irregular drug absorption • Improper technique leads to risk of side effects • Alter drug efficacy
  27. 27. It is an infusion by means of needle or catheter inserted into the body. Any method of administration that does not involve passage through the digestive tract is called parenteral . Intra muscular Intra venous Intra-arterial Intra-cardiac
  28. 28.  Intra-thecal  Intraosseous- into bone marrow  Intrapleural  Intraperitoneal  Intra-articular  Intradermal (Intracutaneous)  Subcutaneous route (Hypodermic)
  29. 29. It is placing the drug directly into blood stream. It would be intravenous or intra arterial. It is used when we need a rapid response. For administration in pediatrics an IV device should be inserted peripherally or centrally. Insertion is traumatic but it is less compared to the pain of multiple injections.
  30. 30.  Peripheral Sites: -vein in hand or forearm -scalp vein or foot vein in infant (possible but central IV site preferred in neonates)  Central IV Sites: subclavian vein into superior vena cava -central line inserted peripherally -umbilical vein in neonates
  31. 31. Different methods could be taken for administration including :  large volume infusion pumps  syringe pumps are accurate for small volume delivery  volumetric infusion devices (Buretrol) used for small total fluid requirements and slow rates of administration
  32. 32.  Place the child in supine position  Seek the help of other nurses to hold the child  Check the patency of IV line  Choose the area for IV administration (Scalp vein is best for infant & toddler. Others sites are hand, foot antecubital fossa)  Meditation should be diluted appropriately  It should be given at the rate of over 2 – 3 minutes  Watch for irritation to small veins or any adverse reactions.
  33. 33. ADVANTAGES  Complete and rapid drug absorption with rapid onset of action  Immediate access to cardiovascular system  Useful in neonates with little muscle mass  Less painful route for frequent injections  Administer drugs which cannot be given by another route
  34. 34. DISADVANTAGES  Rapid drug/fluid delivery means immediate onset of adverse reactions  inability to withdraw infused solutions  Risk infusion of air, microorganisms, pyrogens and particulate matter  Risk sepsis (infection), phlebitis (venous irritation), extravasations/infiltration (leaking outside of the vein)
  35. 35. INTRAMUSCULAR INJECTIONS Here the drug is administered directly into skeletal muscle. For children it is given into deltoid muscles of shoulders.  Typical needle is 22- to 25-gauge ½- to 1-inch needle  Intramuscular (IM) injections are administered at a 90-degree angle.  volume limited to less than 3 mL
  36. 36.  Fewer medications are given by this route due to potential for pain.  Medications typically given IM Newborn—Vitamin K Immunizations At times antibiotics  Vastus Lateralis muscle for newborns, infants and young children (Rectus femoris muscle is an alternative)  Dorso gluteal site is not used until the child has been walking ( atleast 1 year)
  37. 37. SITES
  38. 38. PROCEDURE  Select the needle size and gauge based on size of child’s muscle.  Position the child with proper assistance  Deltiod – 1 finger below acromion process  Vastus lateralis – lateral aspect of thigh (one handbreadth from greater trochanter and one handbreadth above femoral condyle in the lateral aspect)
  39. 39.  Rectus femoris – lies over the femur (one handbreadth from greater trochanter and one handbreadth above femoral condyle in the anterior aspect)  Spread the skin apart  Insert needle at a 90 degree angle.  Aspirate for blood and administer.  If it is an infant or a child with small muscle mass, 45 degree angle is preferred
  40. 40. ADVANTAGES  convenient ways to deliver medications  Compared with the IV route:  onset of response of the medication is slower  duration of action is much longer  Practical for use outside the hospital  Used for drugs which are not active orally  Absorption is rapid than subcutaneous route.  Oily preparations can be used.  Irritative substances might be given
  41. 41. DISADVANTAGES Neurovascular damage Bleeding (eg anticoagulant therapy) Pain Infection Delayed absorption in shock
  42. 42. SUBCUTANEOUS Here we administer medications below the skin into the subcutaneous fat outside of the upper arm top of the thigh lower portion of each side of the abdomen not into grossly adipose, hardened, inflamed, or swollen tissue
  43. 43. SITE Given at a 45- degree angle 25- or 26-gauge needle, 3/8 to 5/8 inch length
  44. 44. SITES Abdominal wall Thigh Deltoid area
  45. 45. PROCEDURE Position the baby with proper assistance Select the site and clean the area Pinch skin together and insert needle in 45 degree angle Aspirate for blood and administer
  46. 46. ADVANTAGES  slow and constant absorption  Often have a longer onset of action and a longer duration of action  compared with IM or IV injection DISADVANTAGES  absorption is limited by blood flow , affected if circulatory problems exist  concurrent administration of vasoconstrictor will slow absorption
  47. 47. Inhalation may be the route of choice to avoid the systemic effects. In this way drugs can pass directly to the lungs. Drugs used involve volatile drugs and gases. Examples include aerosols like salbutamol; steam inhalations include tincture and Benzoin. solids and liquids are excluded if larger than 20 micron. the particles impact in the mouth and throat. Smaller than 0.5 micron , they aren't retained.
  48. 48. Medications can be administered directly into the respiratory tree in cases of respiratory distress resulting from reversible airway disease including asthma and certain types of chronic obstructive pulmonary disease.These medications are usually nebulized into a water vapor and breathed with normal respiration.
  49. 49.  Shake canister well  “Prime” by pressing down and activating a practice dose.  Insert canister into a mouthpiece or spacer to reduce the amount of drug deposited on the back of the throat.  Breathe out and hold spacer between lips making a seal  Activate & take a deep slow inhalation.  Hold breath briefly &slowly exhale through nose
  50. 50.  Rapid absorption takes place.  Rapid onset of action takes place.  This route has minimum side effects.  No first pass effect takes place  This method is easy.  Fewer doses is required
  51. 51.  Special apparatus is required.  Irritation of the respiratory tract may take place.  Cooperation of the patient is required.  Airway must be patent.