EMT

1. Copyright © 2023 by Jones & Bartlett Learning, LLC, an Ascend Learning Company and the American Academy of Orthopaedic Surgeons.
Medication
Administration
CHAPTER 14

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Introduction
 Vascular access may be needed for patients in hemodynamically unstable
condition.
 Many techniques are used.
 Patient’s survival depends on your abilities.

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Medical Direction (1 of 2)
 Online (direct) medical control
 If you are not confident with medication administration:
 Use your protocols, a drug formulary, a flip guide, a smartphone app, or other
resource.
 Consider medical control.

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Medical Direction (2 of 2)
 Online medical control
 Approval of medications
 General consultation of treatment modalities
 When in doubt, contact medical control.

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Ensuring Safe Medication Administration (1 of 2)
 Use standing orders or online
medical direction.
 Avoid human factors.
 Use a tool to verify.
Reproduced from: Misasi P, Braithwaite S. The Medication Administration Cross-Check
(MACC) User’s Manual. Wichita-Sedgwick County EMS System; March 20
12.https://kansasemstransition.files.wordpress.com/2012/08/macc-user-manual-v2-
0.pdf. Accessed May 27, 2021.

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Surgeons.
Ensuring Safe Medication Administration (2 of 2)
 Document
 Dose administered
 Name of medication
 Route
 Rate
 Time of administration
 Who administered the drug
 Who helped perform the medication check
 Patient’s response

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Local Drug Distribution System
 Ensure functionality of all equipment at the beginning of your shift.
 Check that medications are:
 Not expired
 Not damaged
 Readily available in right quantity
 You are responsible for documentation and security of all controlled
substances.

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Medical Asepsis (1 of 4)
 Practice of preventing contamination of the patient using aseptic technique
 Accomplished through:
 Sterilization of equipment
 Antiseptics
 Disinfectants

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Medical Asepsis (2 of 4)
 Clean technique versus sterile technique
 Sterile technique
 Deconstruction of all living organisms using heat, gas, or chemicals
 Sterile field:
 Wear mask and sterile sleeves/gown
 Wear sterile gloves.
 Place sterile drapes around procedural area.

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Medical Asepsis (3 of 4)
 May not be possible to maintain a sterile environment in the field
 Practice medical asepsis to reduce risk of contamination and infection.
 Handwashing, wearing gloves, keeping equipment as clean as possible

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Medical Asepsis (4 of 4)
 Antiseptics are used before invasive procedure.
 Disinfectants are toxic to living tissue.

12. Copyright © 2023 by Jones & Bartlett Learning, LLC, an Ascend Learning Company and the American Academy of Orthopaedic Surgeons.
Standard Precautions and
Contaminated Equipment Disposal

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Standard Precautions
 Treat any bodily fluid as being potentially infectious.

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Disposal of Contaminated Equipment (1 of 2)
 After an IV catheter or needle has
penetrated a patient’s skin, it is
contaminated.
 Sharps:
 Needles/catheters
 Scalpels
 Broken ampules/vials
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Disposal of Contaminated Equipment (2 of 2)
 Immediately dispose of all sharps in
a sharps container.
 Two in back of ambulance
 Small one in jump kit
© MedstockPhotos/Shutterstock.

16. Copyright © 2023 by Jones & Bartlett Learning, LLC, an Ascend Learning Company and the American Academy of Orthopaedic Surgeons.
Cellular Fluid Composition and
Status

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Body Fluid Composition
 The human body is composed mostly of water.
 Provides environment needed for life
 Body maintains balance between intake and output of fluids and electrolytes.
 Injured or ill body may be unable to maintain homeostasis.
 Healthy person looses 2–2.5 of fluid daily
 Urine output, lungs (exhalation), and skin

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Dehydration (1 of 2)
 Inadequate total systemic fluid volume
 Signs and symptoms:
 Decreased level of consciousness
 Postural hypotension
 Tachypnea
 Dry mucous membranes
 Decreased urine output
 Tachycardia
 Poor skin turgor
 Flushed, dry skin

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Dehydration (2 of 2)
 Causes:
 Diarrhea
 Vomiting
 Gastrointestinal drainage
 Infections
 Metabolic disorders
 Hemorrhage
 Environmental emergencies
 High-caffeine diet
 Insufficient fluid intake

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Overhydration (1 of 2)
 Occurs when the body’s systemic
fluid volume increases.
 Signs and symptoms:
 Shortness of breath
 Puffy eyelids, edema
 Polyuria
 Moist crackles (rales)
 Acute weight gain
© Medical-on-Line/Alamy Stock Photo.

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Overhydration (2 of 2)
 Causes:
 Unmonitored IVs (pediatrics)
 Kidney failure
 Water intoxication in endurance sports
 Prolonged hypoventilation

22. Copyright © 2023 by Jones & Bartlett Learning, LLC, an Ascend Learning Company and the American Academy of Orthopaedic Surgeons.
IV Fluid Composition

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IV Fluid Composition (1 of 2)
 Each bag of IV solution is
individually sterilized.
 Altering IV concentration can move
water into or out of fluid
compartment.
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IV Fluid Composition (2 of 2)
 Electrolytes can become altered from:
 Excessive vomiting
 Diarrhea
 Dietary issues
 Medications
 Blood loss, or a variety of other injuries

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Types of IV Solutions (1 of 8)
 Crystalloid solutions
 Dissolved crystals in water
 Cross membranes and alter fluid levels
 Optimal replacement fluid is as near to whole as possible
 Cannot carry oxygen
 Boluses maintain perfusion

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Types of IV Solutions (2 of 8)
 Colloid solutions
 Molecules too large to pass out of capillary membranes
 Molecules remain in vascular system
 High osmolarity
 Reduce edema
 Dramatic fluid shifts
 Short duration of action
 Low cost-to-benefit ratio

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Types of IV Solutions (3 of 8)
 IV solutions are categorized by their tonicity.
 Isotonic
 Hypertonic
 Hypotonic
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Types of IV Solutions (4 of 8)
 Isotonic solutions
 Same concentration of sodium as cell
 Water does not shift
 No change in cell shape
 Examples:
 Lactated Ringer’s (LR) solution
 D5W, 5% dextrose in water

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Types of IV Solutions (5 of 8)
 Hypotonic solutions
 Lower concentration of sodium than cell
 Hydrate the cells while depleting the vascular compartment
 Sudden fluid shift from intravascular space to the cells
 Example:
 0.45% sodium chloride

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Types of IV Solutions (6 of 8)
 Hypertonic solution
 Greater concentration of sodium than cell
 High osmolarity and ionic concentration
 Pulls fluid from intracellular and intestinal compartments to intravascular
compartment

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Surgeons.
Types of IV Solutions (7 of 8)
 Hypertonic solution (cont’d)
 Stabilize blood pressure, increases urine output, and reduces edema
 Careful monitoring to avoid fluid overloading
 Example:
 3% sodium chloride

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Surgeons.
Types of IV Solutions (8 of 8)
 Oxygen-carrying solutions
 Whole blood is the best replacement for lost blood.
 Synthetic blood substitutes

33. Copyright © 2023 by Jones & Bartlett Learning, LLC, an Ascend Learning Company and the American Academy of Orthopaedic Surgeons.
Techniques and Administration

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Techniques and Administration
 IV therapy involves cannulation of a vein with a catheter.
 Peripheral vein cannulation involves cannulating veins of the periphery.
 Keep IV equipment sterile!

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Assembling Equipment
 Gather and prepare in advance:
 Latex-free tourniquet
 Cleaning wipe or solution
 Gauze pads
 Tape or adhesive bandage
 Transparent polyurethane dressing
 Appropriate size IV catheter
 IV extension set
 Saline flush
 IV fluid and administration set
 Sharps container
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Choosing an IV Solution
 Usually limited to normal saline and
LR solution
 IV solution bags guaranteed sterile
 Must be used within 24 hours once
opened
 Two ports (injection and access)
 Removable pigtail
 Different fluid volumes
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Choosing an Administration Set
 Must be used once piercing spike is
exposed
 Two sizes
 Microdrip set: 60 gtt/mL
 Macrodrip set: 10 or 15 gtt/mL
© Amornrat Phuchom/iStock/Getty Images Plus/Getty Images © maradek/Shutterstock.

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Preparing an Administration Set
 Verify expiration date
 Check solution
 Spike the bag
© MedstockPhotos/Shutterstock.

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Spiking the Bag (1 of 2)
 Ensure:
 Solution is clear and not expired
 Correct administrative drip rating
 Tubing not tangled
 Protective covers are present
 Flow clamp is closed/up to drip chamber
 Remove protective covering
 Slide spike into IV bag port
 Squeeze drip chamber to fill line
 Run fluid into line to flush out air

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Spiking the Bag (2 of 2)
 Twist protective cover to remove air bubbles
 Either turn roller clamp wheel to stop flow or set drip rate per required dose
 Check drip chamber fluid level
 Half-filled
 Too low: squeeze chamber
 Too full: invert bag and chamber and squeeze chamber to empty fluid back into bag
 Hang bag in appropriate location

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Other Administration Sets
 Blood tubing
 Volutrol
 Buretrol or burette
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Choosing an IV Site (1 of 3)
 Avoid areas that contain valves and
bifurcations.
 Locate vein that looks straightest,
firm, round, and springs when
palpated.
 Limit IV access to distal areas of
extremities.
© Jones & Bartlett Learning. © Jones & Bartlett Learning.

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Choosing an IV Site (2 of 3)
 Bulging veins can roll.
 Pull skin over vein taut with thumb
of free hand.
 Flex patient’s hand.
 Stabilize wrist.
 Consider patient’s opinion
Courtesy of Rhonda Hunt.

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Choosing an IV Site (3 of 3)
 Avoid extremity if it shows signs of:
 Trauma
 Injury
 Infection
 IV cannulation of leg veins
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Choosing an IV Catheter (1 of 3)
 Over-the-needle
 Automatic needle retraction
 Smaller the gauge, the larger the
diameter
 Choose the largest-diameter
catheter for vein
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Choosing an IV Catheter (2 of 3)
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Choosing an IV Catheter (3 of 3)
 Butterfly catheter
 Intracatheter
 Rarely used in prehospital setting
© felipe caparros/Shutterstock.

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Inserting the IV Catheter (1 of 3)
 Keep the beveled side up.
 Maintain adequate traction.
 Use a constricting band above the
site.
 Remove the band while
assembling IV equipment.
 Latex-free IV tourniquet
 If visualizing or palpating IV site is
difficult, use a device that applies
more pressure.
Courtesy of Rhonda Hunt.

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Inserting the IV Catheter (2 of 3)
 Prep site.
 Inspect needle.
 Loosen catheter hub.
 Apply lateral traction over vein.
 Catheter in dominant hand
 Insert at a 35 to 45° angle.
 Push the catheter through skin until
the vein is pierced.
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Inserting the IV Catheter (3 of 3)
 Drop angle to 15° and advance the catheter a few centimeters
 Slide sheath off needle into vein
 Hub touching skin
 Apply pressure to the vein proximal to the end of the indwelling catheter
 Remove needle
 Activate shielding device
 Dispose of needle

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Vein Identification Assistive Devices
 Helps to visualize a patient’s vasculature in the event of a challenging IV start
 Portable vein transilluminators
 Most economically feasible in prehospital setting

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Securing the Line
 Tape the area to secure the
catheter and tubing.
 Cover the site with sterile gauze
and secure with tape.
 Refer to Skill Drill 14-1: Obtaining
Vascular Access
© GracePhotos/Shutterstock.

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Changing an IV Bag
 Stop the flow by closing the roller clamp.
 Prepare the new IV bag.
 Remove the piercing spike and insert it into the port on the new bag.
 Ensure the drip chamber is filled and open the roller clamp.

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Discontinuing the IV Line
 Shut off the flow.
 Peel tape back.
 Stabilize the catheter.
 Do not remove IV tubing from hub.
 Pull catheter and IV line from
patient’s vein.
 Apply pressure.
 Apply bandage. © Jones & Bartlett Learning.

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Surgeons.
Alternative IV Sites and Techniques (1 of 4)
 Saline locks
 Or intermittent sites (INT)
 Maintain active IV site without
running fluids through vein
 Male and female Luer-lock
connector
 Attached to end of IV catheter
 2 mL of saline
© SoraSky0303/Shutterstock.

56. Copyright
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Surgeons.
Alternative IV Sites and Techniques (2 of 4)
 EJ vein cannulation
 Vein runs behind jaw
 Large
 Exhaust all other means before
cannulation.
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Surgeons.
Alternative IV Sites and Techniques (3 of 4)
 EJ vein cannulation (cont’d)
 Place patient in supine, head-down
position.
 Turn head to opposite side of
intended venipuncture.
 Feel carefully for a pulse.
 Cleanse the site.
 Occlude with your finger.
Courtesy of Rhonda Hunt.

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Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Alternative IV Sites and Techniques (4 of 4)
 EJ vein cannulation (cont’d)
 Align catheter in the direction of the vein.
 Puncture midway between jaw and midclavicular line.
 Stabilize vein.
 Proceed cannulation as if for a peripheral vein.
 Tape line securely.

59. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Pediatric IV Therapy Considerations (1 of 2)
 Catheters
 Best gauges for over-the-needle catheters are:
 20, 22, 24, 26
 Butterfly catheters are ideal.

60. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Pediatric IV Therapy Considerations (2 of 2)
 IV locations
 Explain your actions to child and parent.
 Hand veins remain the location of choice.
 Technique for starting pediatric IV line:
 Use penlight to illuminate veins through back of hand.
 Scalp vein cannulation can be difficult.

61. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Older Adult IV Therapy Considerations
 Use smaller catheters.
 Puncturing the vein may cause
massive hematomas.
 Tape may damage skin.
 Be careful using macrodrips.
 Locations
 Consider poor vein elasticity
 Avoid spidery veins and varicose
veins
© Mark Boulton/Alamy Stock Photo.

62. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Factors Affecting IV Flow Rates
 Checks to perform after IV administration:
 Fluid
 Administration set
 Height of bag
 Catheter type
 Constricting band
 No clamping of line
 Positioning of line

63. Copyright © 2023 by Jones & Bartlett Learning, LLC, an Ascend Learning Company and the American Academy of Orthopaedic Surgeons.
Potential Complications of IV
Therapy

64. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Local Complications (1 of 15)
 Infiltration
 Localized area of edema
 Causes:
 Dislodgement of catheter
 Puncture of distal vein wall
 Solution leakages
 Poorly secured line
 Poor vein/site selection
 Irritating solution/medication
 Improver cannula size
 High delivery rate/pressure

65. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Local Complications (2 of 15)
 Infiltration (cont’d)
 If it occurs:
 Discontinue IV line.
 Reestablish line in another site with new equipment.
 Document and report condition.

66. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Local Complications (3 of 15)
 Catheter occlusion
 Physical blockage of vein or catheter
 First sign is a decreasing drip rate or blood in IV tubing.
 Causes:
 Position of catheter within the vein
 Blood pressure overcoming the flow

67. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Local Complications (4 of 15)
 Catheter occlusion (cont’d)
 Do not flush a catheter.
 If suspected:
 Remove the catheter.
 Assess catheter integrity.
 Apply dry, sterile dressing to the site.

68. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Local Complications (5 of 15)
 Vein spasm
 Patients report the solution is bothering them.
 Signs and symptoms:
 Sluggish/stopped infusion rate
 Severe pain radiating up extremity
 Blanching or redness over and around the site

69. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Local Complications (6 of 15)
 Vein spasm (cont’d)
 If it occurs:
 Slow the infusion rate until the spasm subsides.
 Remove the catheter if the spasm persists.

70. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Local Complications (7 of 15)
 Phlebitis
 Chemical
 Mechanical
 Bacterial

71. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Local Complications (8 of 15)
 Phlebitis (cont’d)
 If it develops:
 Discontinue IV line.
 Save equipment for analysis.
 Reestablish line in another site with new equipment.

72. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Local Complications (9 of 15)
 Thrombophlebitis
 May occur in:
 Association with venous cannulation
 Patients who misuse drugs
 Patients who receive long-term IV therapy
 Conjunction with vein-irritating solutions

73. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Local Complications (10 of 15)
 Thrombophlebitis (cont’d)
 If suspected:
 Stop the infusion.
 Discontinue the IV line.
 Warm compress

74. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Local Complications (11 of 15)
 Hematoma
 Accumulation of blood is
surrounding tissue near an IV site
 Causes:
 Vein perforation
 Improper catheter removal
 Signs and symptoms:
 Bruising
 Pain at the site
 Swelling and hardness
 Inability to flush IV line
 Inability to advance cannula
completely into vein
Courtesy of Rhonda Hunt.

75. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Local Complications (12 of 15)
 Hematoma (cont’d)
 Common in patients:
 With a history of vascular diseases
 Taking certain medications
 Drinking alcohol
 If it occurs:
 While inserting a catheter
 Stop and apply direct pressure
 After insertion
 Evaluate the IV flow
 Monitor leave the line in place
 After discontinuing
 Apply pressure

76. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Local Complications (13 of 15)
 Nerve, tendon, or ligament damage
 Causes:
 Improper venipuncture technique
 Improper identification of anatomic structures around IV site
 Improper securing/stabilization of cannula and line after insertion
 Extravasation of the solution

77. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Local Complications (14 of 15)
 Nerve, tendon, or ligament damage (cont’d)
 Injuring results in sudden and severe shooting pain
 Increased risk near joints
 If it occurs:
 Remove the catheter.
 Select another IV site.

78. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Local Complications (15 of 15)
 Arterial puncture
 High risk near an EJ vein
 Bright red blood spurts back through the catheter.
 If it occurs:
 Withdraw the catheter.
 Apply direct pressure for at least 5 minutes or until bleeding stops.

79. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Systemic Complications (1 of 8)
 Allergic reactions
 Response to IV solution, preservatives, or medication
 Wide range of signs and symptoms
 If it occurs:
 Stop the infusion.
 Discontinue the IV.
 Select a new IV site.

80. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Systemic Complications (2 of 8)
 Pyrogenic reactions
 Foreign proteins capable of producing fever
 Reaction begins within 30 seconds
 If it occurs:
 Stop the infusion.
 Start a new IV line in the other arm with fresh solution.
 Remove the first IV.
 Always inspect IV bags before use.

81. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Systemic Complications (3 of 8)
 Circulatory overload
 Excessive fluid administration can lead to pulmonary edema.
 Commonly caused by failure to readjust drip rate after flushing an IV line after
insertion.

82. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Systemic Complications (4 of 8)
 Circulatory overload (cont’d)
 If it occurs:
 Slow the IV rate to keep the vein open.
 Place patient in a semi-Fowler position.
 Administer high-flow oxygen.
 Monitor vital signs and breathing adequacy.
 Consider CPAP use.

83. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Systemic Complications (5 of 8)
 Speed shock
 Rapid introduction of medication or solution into the circulation
 If it occurs:
 Halt infusion or medication.
 Ensure IV line is patent and monitor.

84. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Systemic Complications (6 of 8)
 Air embolus
 Air enters the bloodstream
 Properly flush IV lines
 Replace empty IV bags
 If it occurs:
 Place patient on the left side with head down.
 Administer 100% oxygen.
 Transport to closest facility.
 Assist ventilations if needed.

85. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Systemic Complications (7 of 8)
 Vasovagal reactions
 Anxiety concerning needles or sight of blood
 Drop in blood pressure and collapse
 If it occurs:
 Place patient in supine position.
 Apply high-flow oxygen.
 Monitor vital signs.
 Establish an IV line.

86. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Systemic Complications (8 of 8)
 Catheter shear
 Needle slices through pinched catheter
 Free-floating fragment
 If suspected:
 Put patient in left lateral recumbent position.
 Obtain an IV site in the other extremity.
 Transport.

87. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Obtaining Blood Samples (1 of 4)
 Obtain at the same time as IV line.
 Equipment:
 15- or 20-mL syringe
 18- or 20-gauge needle
 Self-sealing blood tubes
 Red Blood Gives Life: red, blue,
green, lavender
© Manop Boonjumnian/Shutterstock.

88. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Obtaining Blood Samples (2 of 4)
 After catheter is in place, occlude and remove constricting band.
 Attach a 15- or 20-mL syringe to the hub of the IV and draw necessary blood.
 Remove constricting band while drawing blood.
 Remove syringe after blood has been obtained.
 Attach IV tubing and begin infusion.

89. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Obtaining Blood Samples (3 of 4)
 If IV therapy is not indicated but
blood samples are required, use a
Vacutainer.
 Apply a constricting band and
locate vein.
 Prep the vein and insert the
needle.
 Remove constricting band and
insert blood tubes.
 Remove the needle and apply
direct pressure.
 Dispose of the needle and label all
the tubes.
9 ~UserGI15632523/iStock/Getty Images Plus/Getty Images.

90. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Obtaining Blood Samples (4 of 4)
 Vacutainer
 Turn blood tubes back and forth to
mix.
 Do not shake the red tube!
 Blood tubes must be at least three-
fourths full to be viable for testing.
© Dmitry Naumov/Shutterstock.

91. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Blood Transfusions (1 of 3)
 Type and cross-match
 Bracelet identifies blood type
 Verification:
 Name
 Medical record number
 Transfused product
 Product unit number
 ABO and Rh type of the product
 Expiration date

92. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Blood Transfusions (2 of 3)
 Type O blood available for transfusion
 Accepted blood must be used within 4 hours or returned
 For transports:
 Verify ABO type and Rh factor before leaving.
 Ensure at least one available vascular site with no blood running

93. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Blood Transfusions (3 of 3)
 If transfusion reaction occurs, discontinue IV lines.
 Blood is administered through specific tubing.
 Assess vital signs every 5 minutes.
 Monitor for reactions.

94. Copyright © 2023 by Jones & Bartlett Learning, LLC, an Ascend Learning Company and the American Academy of Orthopaedic Surgeons.
Intraosseous Infusion

95. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Intraosseous Overview
 Within the bone
 IO infusion: Into proximal tibia,
humeral head, or sternum
 Spongy cancellous bone of the
epiphyses and medullary cavity of
the diaphysis
 IO space remains patent even with
difficult IV access.
 Quick absorption
© Jones & Bartlett Learning.

96. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
IO Sites (1 of 4)
 Sternum
 Humerus
 Proximal tibia
Courtesy of Stephen J. Rahm, NRP.

97. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
IO Sites (2 of 4)
© Jones & Bartlett Learning.

98. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
IO Sites (3 of 4)
 Humeral IO site
 Manipulate arm and palpate
humeral head.
 Proximal tibia IO site
 Flat bone is medial to tibial
tuberosity, the bony protuberance
just below the knee.
 Distal tibia IO site
 Palpate to identify medial
malleolus.
 Adults: 2 to 3 cm above that site
 Pediatric: 1 to 2 cm above
© Jones & Bartlett Learning.

99. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
IO Sites (4 of 4)
© Jones & Bartlett Learning

100. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Equipment for IO Infusion (1 of 5)
 Manually inserted IO needles
 Solid boring needle inserted
through hollow needle
 Pushed into bone via screwing and
twisting
© Jones & Bartlett Learning

101. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Equipment for IO Infusion (2 of 5)
 FAST
 Not for children
 Design elements allow for IO
placement in sternum.
 Can be used during cardiac arrest
 FATSR device expediates insertion
process
 Less required pressure
 Remain in place for up to 24 hours
© Pyng Medical Corporation.

102. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Equipment for IO Infusion (3 of 5)
 EZ-IO
 Battery-powered driver with an
attached IO needle
 Inserts IO needle into proximal or
distal tibia
Courtesy of VidaCare Corporation.

103. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Equipment for IO Infusion (4 of 5)
 Bone Injection Gun (BIG)
 Spring-loaded device
 Inserts IO needle into proximal
tibia (adults and children) and
humeral head (adults)
Courtesy of PerSys Medical.

104. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Equipment for IO Infusion (5 of 5)
 New Intraosseous (NIO) device
 Spring-loaded device that contains
neither drill nor battery
 Placed in proximal tibia of adult
 NIO Pediatric (NIO-P)
Courtesy of PerSys Medical.

105. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Performing IO Infusion
 Refer to Skill Drill 14-2: Gaining IO Access With an EZ-IO Device

106. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Potential Complications of IO Infusion (1 of 2)
 Infiltration
 Osteomyelitis
 Failure to identify the proper anatomic landmark can damage the growth plate.

107. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Potential Complications of IO Infusion (2 of 2)
 Improper technique can cause fracture.
 Through-and-through insertion
 Pulmonary embolism (PE)

108. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Contraindications to IO Infusion
 Functional IV line is available.
 Fracture of the bone intended for IO cannulation
 Osteoporosis
 Osteogenesis imperfecta
 Bilateral knee replacements
 Prosthetic limb

109. Copyright © 2023 by Jones & Bartlett Learning, LLC, an Ascend Learning Company and the American Academy of Orthopaedic Surgeons.
Medication Administration

110. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Medication Administration
 Understand how medications affect the human body before administering them.
 Become familiar with:
 Mechanism of action
 Indications
 Contraindications
 Adverse effects
 Routes of administration
 Pediatric and adult doses
 Antidotes

111. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Mathematical Principles Used in Pharmacology (1 of 7)
 Mathematics review
 Fractions represent a portion of a whole number.
 Decimals distinguish numbers that are greater and smaller than zero.
 Dividing or multiplying by 10:
 When dividing, move decimal point to the left.
 When multiplying, move decimal point to the right.
 Percentages are part of 100 and use the % symbol.

112. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Mathematical Principles Used in Pharmacology (2 of 7)
 The metric system
 Based on multiples of ten
 Measures length, volume, weight
 Meter (m): Length
 Liter (L): Volume
 Gram (g): Weight
 Prefixes demonstrate the fraction of the base being used.
© Jones & Bartlett Learning.

113. Copyright
©
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by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Mathematical Principles Used in Pharmacology (3 of 7)
 Drugs are supplied and packaged in a variety of weights and volumes.
 Weight and volume conversion

114. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Mathematical Principles Used in Pharmacology (4 of 7)
 Volume conversion
 Prehospital setting uses two measurements of volume: Milliliters and liters.
 mL to L: Divide smaller volume by 1,000
 L to mL: Multiply L by 1,000

115. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Mathematical Principles Used in Pharmacology (5 of 7)
 Weight conversion
 Large unit to small: Multiply large by 1,000
 Small unit to large: Divide large by 1,000

116. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Mathematical Principles Used in Pharmacology (6 of 7)
 Converting pounds to kilograms
 Two formulas:
 Divide the patient’s weight in pounds by 2.2.
 Divide the patient’s weight in pounds by 2 and subtract 10% of that number.

117. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Mathematical Principles Used in Pharmacology (7 of 7)
 Temperature conversion
 To convert Fahrenheit to Celsius:
 Subtract 32 then multiply by 0.555 (5/9).
 To convert Celsius to Fahrenheit:
 Multiply by 1.8 (9/5) then add 32.

118. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Calculating Medication Doses (1 of 3)
 Desired dose: Amount of drug ordered by the physician
 Standard dose
 Specific number of micrograms, milligrams, or grams

119. Copyright
©
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Bartlett
Learning,
LLC,
an
Ascend
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Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Calculating Medication Doses (2 of 3)
 Drug concentrations: Total weight of the drug contained in a specific amount of
volume
 Volume on hand: Volume of solution that the drug is contained in
 Weight of drug present in 1 mL = concentration

120. Copyright
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Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Calculating Medication Doses (3 of 3)
 Volume to be administered
 Desired dose (mg)/Concentration of drug on hand (mg/mL) = Volume to be
administered

121. Copyright
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by
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Learning,
LLC,
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Ascend
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Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Weight-Based Drugs
 Medication doses are based on patient’s weight in kilograms.
 Convert the weight

122. Copyright
©
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by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
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Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Calculating Fluid Infusion Rates
 Adjust flow rate based on patient’s condition
 To calculate the flow rate:

123. Copyright
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by
Jones
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Learning,
LLC,
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Ascend
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and
the
American
Academy
of
Orthopaedic
Surgeons.
Calculating the Dose and Rate for a Medication Infusion
(1 of 2)
 Non-weight-based medication infusion
 Use the same formula to calculate a drug dose.
 Then calculate the desired dose to be administered continuously:

124. Copyright
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Learning,
LLC,
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Ascend
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and
the
American
Academy
of
Orthopaedic
Surgeons.
Calculating the Dose and Rate for a Medication Infusion
(2 of 2)
 Weight-based medication infusions
 Use the previously discussed formula.
 Factor in the patient’s weight in kilograms

125. Copyright
©
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Learning,
LLC,
an
Ascend
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Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Pediatric Drug Doses
 Length-based resuscitation tape measures
 Pediatric wheel charts
 EMS field guide with tables or charts
 Most drugs are based on child’s weight in kg.

126. Copyright © 2023 by Jones & Bartlett Learning, LLC, an Ascend Learning Company and the American Academy of Orthopaedic Surgeons.
Enteral Medication Administration

127. Copyright
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Learning,
LLC,
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and
the
American
Academy
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Surgeons.
Overview
 Medications given through the digestive or intestinal tracts
 Forms include:
 Capsules, time-released capsules, lozenges, pills, tablets, elixirs, emulsions,
suspensions, syrups

128. Copyright
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Learning,
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American
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Surgeons.
Oral Medication Administration (1 of 2)
 Drugs are absorbed at a slow rate
(30 to 90 minutes).
 Check for:
 Indications
 Contraindications
 Precautions
 Review the 10 rights prior to
administration.
© SamJonah/Shutterstock.

129. Copyright
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Learning,
LLC,
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Ascend
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American
Academy
of
Orthopaedic
Surgeons.
Oral Medication Administration (2 of 2)
 To administer:
 Determine need for medication.
 Obtain history.
 Follow standing orders/contact
medical control.
 Check the medication and
determine dose.
 Instruct patient to swallow with
water.
 Monitor patient, and document
response.
© Jones & Bartlett Learning.
© Jones & Bartlett Learning.

130. Copyright
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Learning,
LLC,
an
Ascend
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and
the
American
Academy
of
Orthopaedic
Surgeons.
Orogastric and Nasogastric Tube Medication
Administration
 Gastric tubes are occasionally inserted to:
 Decompress stomach
 Perform gastric lavage
 Establish a route for administration
 Tube feeding

131. Copyright
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Learning,
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Surgeons.
Rectal Medication Administration (1 of 3)
 Rapid and predictable absorption
 Suppository form
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132. Copyright
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Learning,
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American
Academy
of
Orthopaedic
Surgeons.
Rectal Medication Administration (2 of 3)
 To administer:
 Determine the need for the
medication.
 Obtain a history.
 Follow standing orders/contact
medical control.
 Determine dose, and ensure it is
correct.
 Lubricate and insert into the
rectum 1 to 1.5 inches. © Jones & Bartlett Learning.

133. Copyright
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Learning,
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Ascend
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American
Academy
of
Orthopaedic
Surgeons.
Rectal Medication Administration (3 of 3)
 To administer (cont’d):
 Modifications may be needed for liquid form:
 Lubricate device and insert 1 to 1.5 inches into rectum.
 Tell patient not to bear down.
 Push medication through tube with needleless syringe.
 Remove and dispose of tube.
 Monitor patient, and document response.

134. Copyright © 2023 by Jones & Bartlett Learning, LLC, an Ascend Learning Company and the American Academy of Orthopaedic Surgeons.
Parenteral Medication
Administration

135. Copyright
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Learning,
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Surgeons.
Overview
 Any route other than the gastrointestinal tract
 Fast and predictable absorption into the central circulation

136. Copyright
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Jones
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Learning,
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Surgeons.
Syringes and Needles (1 of 2)
 Syringes consist of:
 Plunger
 Body or barrel
 Flange
 Tip
 Marked with 10 calibrations per
milliliter on one side
© N.Vinoth Narasingam/Shutterstock.

137. Copyright
©
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Learning,
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the
American
Academy
of
Orthopaedic
Surgeons.
Syringes and Needles (2 of 2)
 Hypodermic needles consist of:
 Hub
 Shaft
 Bevel
 Length varies from 3/8 to 2 inches
 Gauge refers to diameter
 Most commonly 18–26
© anmbph/Shutterstock.

138. Copyright
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Learning,
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and
the
American
Academy
of
Orthopaedic
Surgeons.
Packaging of Parenteral Medication (1 of 7)
 Ampules
 Breakable sterile glass containers
 Carry single dose of medication
 Refer to Skill Drill 14-3: Drawing
Medication From an Ampule
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139. Copyright
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Learning,
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the
American
Academy
of
Orthopaedic
Surgeons.
Packaging of Parenteral Medication (2 of 7)
 Vials
 Glass or plastic bottles with rubber
stopper top
 Contain single or multiple doses
 Removing the cover makes it no
longer sterile.
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140. Copyright
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Learning,
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and
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American
Academy
of
Orthopaedic
Surgeons.
Packaging of Parenteral Medication (3 of 7)
 Vials (cont’d)
 Medications may need to be
reconstituted.
 Mix-o-Vial: Two compartments
 Squeeze vials together and then
shake.
 Refer to Skill Drill 14-4: Drawing
Medication From a Vial
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141. Copyright
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Surgeons.
Packaging of Parenteral Medication (4 of 7)
 Prefilled syringes
 Packaged in tamper-proof boxes
 Two types:
 Separated into a glass cartridge
and syringe
 Preassembled prefilled syringes
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142. Copyright
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Learning,
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American
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Orthopaedic
Surgeons.
Packaging of Parenteral Medication (5 of 7)
© American Academy of Orthopaedic Surgeons.

143. Copyright
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Learning,
LLC,
an
Ascend
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Company
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the
American
Academy
of
Orthopaedic
Surgeons.
Packaging of Parenteral Medication (6 of 7)
 Single-dose medication cartridges
inserted into a reusable syringe are
available.
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144. Copyright
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Learning,
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Surgeons.
Packaging of Parenteral Medication (7 of 7)
 Push-dose pressors
 Vasopressors
 Small bolus format
 Push-dose epinephrine
 Mix appropriate concentration

145. Copyright
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Learning,
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Orthopaedic
Surgeons.
Intradermal Medication Administration (1 of 3)
 Medication administered into the dermal layer
 Avoid superficial blood vessels
 Slow absorption rate

146. Copyright
©
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Learning,
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American
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Orthopaedic
Surgeons.
Intradermal Medication Administration (2 of 3)
 To administer:
 Determine need for medication.
 Obtain history.
 Follow standing orders/contact
medical control.
 Check the medication.
 Explain procedure to patient.
 Assemble and check equipment
needed.
© Jones & Bartlett Learning.

147. Copyright
©
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Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Intradermal Medication Administration (3 of 3)
 To administer (cont’d):
 Cleanse the area for injection.
 Pull skin taut.
 Insert the needle and slowly inject medication.
 Remove the needle and dispose of it.
 Monitor the patient and document response.

148. Copyright
©
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Learning,
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Ascend
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American
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Orthopaedic
Surgeons.
Subcutaneous Medication Administration (1 of 2)
 Given into connective tissue
between dermis and muscle
 Common sites include:
 Upper arms
 Anterior thighs
 Abdomen
 Refer to Skill Drill 14-5:
Administering Medication via the
Subcutaneous Route
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149. Copyright
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American
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Surgeons.
Subcutaneous Medication Administration (2 of 2)
© Jones & Bartlett Learning.

150. Copyright
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Learning,
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Surgeons.
IM Medication Administration (1 of 2)
 Needle penetrates through the
dermis and subcutaneous tissue
and into the muscle layer.
 Larger volume of medication
 Potential nerve damage
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151. Copyright
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Learning,
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Surgeons.
IM Medication Administration (2 of 2)
 Common sites:
 Vastus lateralis muscle
 Rectus femoris muscle
 Gluteal area
 Deltoid muscle
 Refer to Skill Drill 14-6:
Administering Medication via the
IM Route
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152. Copyright
©
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by
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Learning,
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American
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Surgeons.
IV Bolus Medication Administration (1 of 4)
 Drugs go directly into the circulatory system.
 Direct injection of drugs with a needle and syringe into IV line
 Needleless systems now available
 A bolus is a single dose given by the IV route.
 Small or large quantity of a drug
 Delivered rapidly or slowly
 Refer to Skill Drill 14-7: Administering Medication via the IV Bolus Route

153. Copyright
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Learning,
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Surgeons.
IV Bolus Medication Administration (2 of 4)
 Saline lock:
 Determine the need for the medication.
 Obtain a history.
 Follow standing orders/contact medical control.
 Check the medication.
 Explain the procedure to the patient.

154. Copyright
©
2023
by
Jones
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Learning,
LLC,
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Ascend
Learning
Company
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the
American
Academy
of
Orthopaedic
Surgeons.
IV Bolus Medication Administration (3 of 4)
 Saline lock (cont’d):
 Assemble equipment and draw up medication.
 Cleanse the injection port or remove the cap.
 Insert the needle into the port or screw the syringe onto the port.
 Pull back on the plunger and observe for blood.
 Place needle and syringe into a sharps container.

155. Copyright
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Learning,
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the
American
Academy
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Orthopaedic
Surgeons.
IV Bolus Medication Administration (4 of 4)
 To administer medication through a saline lock (cont’d):
 Clean the port; insert the needle with the flush.
 Flush and place needle in sharps container.
 Store any unused medication properly.
 Monitor the patient and document findings.

156. Copyright
©
2023
by
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Learning,
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Academy
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Orthopaedic
Surgeons.
Adding Medication to an IV Bag (1 of 5)
 Check fluid in the IV bag.
 Check name and concentration.
 Compute volume to be added and
draw up in syringe.
 Cleanse the injection port.
 Inject medication.
 Withdraw and dispose
of needle
© American Academy of Orthopaedic Surgeons.

157. Copyright
©
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by
Jones
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Learning,
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Ascend
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the
American
Academy
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Orthopaedic
Surgeons.
Adding Medication to an IV Bag (2 of 5)
 Agitate bag.
 Label the IV bag with the:
 Name
 Amount added
 Concentration
 Date and time
 Your name
 Attach IV administration set and prepare bag.

158. Copyright
©
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by
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Learning,
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Ascend
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American
Academy
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Orthopaedic
Surgeons.
Adding Medication to an IV Bag (3 of 5)
 IV piggyback
 Administration set directly connected to hub of IV catheter is primary line
 Distal end of drip set is connected to primary line.
 Multiple lines
 Refer to Skill Drill 14-8: Administering Medication via IV Piggyback Infusion

159. Copyright
©
2023
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Learning,
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the
American
Academy
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Orthopaedic
Surgeons.
Adding Medication to an IV Bag (4 of 5)
 IV infusion pumps
 Benefits include:
 Deliver the rates set by the pump
without deviating
 Calculate amount of fluid infused
and remaining
 Problems include:
 Lack of uniformity among
manufacturers
 Air trapping
© Alexander Oganezov/Shutterstock.

160. Copyright
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by
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Learning,
LLC,
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the
American
Academy
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Orthopaedic
Surgeons.
Adding Medication to an IV Bag (5 of 5)
 IV infusion pumps (cont’d)
 Deliver fluids via positive pressure.
 May be designed to accommodate:
 IV tubing to regulate the flow of fluids
 Needleless syringe
 Multiple chambers for multiple medications
 Databases calculate rate by desired dose and patient’s weight
 Wide variety

161. Copyright
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Learning,
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Orthopaedic
Surgeons.
IO Medication Administration
 Fluid does not flow well into the bone.
 Use a large syringe.
 A pressure infuser device forces fluid from the IV bag.
 Potential for compartment syndrome
 Refer to Skill Drill 14-9: Administering Medication via the IO Route

162. Copyright
©
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by
Jones
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Learning,
LLC,
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Ascend
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the
American
Academy
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Orthopaedic
Surgeons.
Percutaneous Medication Administration (1 of 8)
 Medications are applied to and absorbed through the skin and mucous
membranes.
 Transdermal medication administration
 Applied topically
 Useful for sustained release of medication

163. Copyright
©
2023
by
Jones
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Learning,
LLC,
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Ascend
Learning
Company
and
the
American
Academy
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Orthopaedic
Surgeons.
Percutaneous Medication Administration (2 of 8)
 Transdermal medication administration (cont’d)
 To apply:
 Determine need for medication; obtain history.
 Follow standing orders/contact medical control.
 Check the medication.
 Explain the procedure to patient.
 Clean area and apply the medication.
 Monitor patient and document response.

164. Copyright
©
2023
by
Jones
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Learning,
LLC,
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Ascend
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American
Academy
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Orthopaedic
Surgeons.
Percutaneous Medication Administration (3 of 8)
 Sublingual medication
administration
 Highly vascular
 Rapid absorption
 Injected under the tongue.
 Refer to Skill Drill 14-10:
Administering Medication via the
Sublingual Route
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165. Copyright
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by
Jones
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Learning,
LLC,
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Ascend
Learning
Company
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the
American
Academy
of
Orthopaedic
Surgeons.
Percutaneous Medication Administration (4 of 8)
 Buccal medication administration
 Between the cheek and gums
 Tablets or gel
 To administer medication:
 Determine the need and obtain history.
 Follow standing orders/contact medical control.
 Check medication and explain procedure to patient.
 Place medication between cheek and gum.
 Advise patient to allow the tablet to dissolve slowly.
 Monitor patient and document response.

166. Copyright
©
2023
by
Jones
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Learning,
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the
American
Academy
of
Orthopaedic
Surgeons.
Percutaneous Medication Administration (5 of 8)
 Ocular medication administration
 Drops or ointment
 For pain relief, allergies, and
infections
 Rarely administered in prehospital
setting
© Adam Bronkhorst/Alamy Stock Photo.

167. Copyright
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by
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Learning,
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the
American
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Orthopaedic
Surgeons.
Percutaneous Medication Administration (6 of 8)
 Ocular medication administration (cont’d)
 To assist a patient:
 Confirm prescription.
 Have patient tilt head and look up.
 Expose conjunctiva and administer medication.
 Advise patient to close eye for 1 to 2 minutes.
 Document medication name, dose, and time.

168. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Percutaneous Medication Administration (7 of 8)
 Aural medication administration
 Via ear canal
 To assist a patient:
 Confirm prescription.
 Place patient on side with affected ear facing up.
 Expose the ear canal.
 Administer medication with a medicine dropper.
 Document medication name, dose, and time.

169. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Percutaneous Medication Administration (8 of 8)
 Intranasal medication
administration
 Nasal spray or solutions
 Rapidly absorbed
 Performed with a mucosal
atomizer device (MAD)
 Requires 2 to 2.5 times the dose of
IV medications
 Refer to Skill Drill 14-11:
Administering Medication via the
Intranasal Route
Courtesy of LMA North America.

170. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Medications Administered by the Inhalation Route (1 of 5)
 Metered-dose inhaler
 For patients with a history of
respiratory problems
 Delivered through mouthpiece or
mask
© Jones & Bartlett Learning.

171. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Medications Administered by the Inhalation Route (2 of 5)
 Refer to Skill Drill 14-12: Assisting a
Patient With a Metered-Dose
Inhaler
© Jones & Bartlett Learning. © Jones & Bartlett Learning.

172. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Medications Administered by the Inhalation Route (3 of 5)
 Liquid bronchodilators
 May be aerosolized for inhalation
 Blow-by administration or a
nebulized mask
© Jones & Bartlett Learning.

173. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Medications Administered by the Inhalation Route (4 of 5)
 Refer to Skill Drill 14-13:
Administering a Medication via a
Small-Volume Nebulizer
© Jones & Bartlett Learning.

174. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Medications Administered by the Inhalation Route (5 of 5)
 If patients are breathing
inadequately:
 Assist with bag-mask ventilation.
 Attach a small-volume nebulizer to
device.
 Place a short piece of corrugated
tubing between the bag and mask
or endotracheal tube.
 Most CPAP manufacturers have a
nebulizer designed for their device.
© Pulmodyne, Inc.

175. Copyright © 2023 by Jones & Bartlett Learning, LLC, an Ascend Learning Company and the American Academy of Orthopaedic Surgeons.
Long-Term Vascular Access
Devices

176. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Long-Term Vascular Access Devices
 For patients receiving:
 Antibiotic regimen
 Chemotherapy
 Blood draws for chronic disorders
 Hemodialysis
 Treatment for acute/chronic illnesses
 Two types:
 Non-tunneling
 Implanted
 Preserved with heparin

177. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Non-Tunneling VAD (1 of 4)
 Inserted by direct venipuncture
 Peripheral inserted central
catheters (PICC)
 Midlines at the antecubital vein
© Jones & Bartlett Learning.

178. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Non-Tunneling VAD (2 of 4)
 To access:
 Use aseptic technique.
 Prepare the equipment:
 Empty 10- to 20-mL syringe
 10-mL normal saline flush
 Sterile gloves
 Alcohol prep
 10-gttt administration set
 500 mL normal saline
 Ensure all lumens are clamped
and cleansed.
© Jones & Bartlett Learning.

179. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Non-Tunneling VAD (3 of 4)
 To access (cont’d):
 Attach the empty syringe and
withdraw blood from lumen.
 Minimum of 10 mL
 Discard syringe.
 Administer the 10mL syringe of
normal saline.
 Attach the IV drip set.
 Rate of at least 10 mL/h
 Monitor the patient’s position and
document response.
© Jones & Bartlett Learning.

180. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Non-Tunneling VAD (4 of 4)
© Jones & Bartlett Learning.

181. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Implanted VADs (1 of 4)
 Implanted surgically, sutured under
the skin
 Access with Huber needle
 Common uses:
 Long-term medication
administration
 Total parenteral nutrition
 Chemotherapy
 Blood products
 Venous blood sampling © Jones & Bartlett Learning. Courtesy of James Upchurch.

182. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Implanted VADs (2 of 4)
 Arteriovenous (AV) fistulas
 Connect vein and artery
 Used for hemodialysis and
plasmapheresis
 Require unique skill set to access
© Jones & Bartlett Learning. Courtesy of James Upchurch.

183. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Implanted VADs (3 of 4)
 To access:
 Special training and medical
authorization
 Use aseptic technique and prepare
all necessary equipment.
 Stabilize the upper part of the
chest.
 Clean the site.
 Apply pressure around the port
edges and stretch the skin.
 Insert the Huber needle.
© Jones & Bartlett Learning. Courtesy of James Upchurch.

184. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Implanted VADs (4 of 4)
 To access (cont’d):
 Withdraw the blood from the
needleless extension set.
 At least 10 mL
 Flush with 10-mL of normal saline
flush.
 Attach the 10-gtt IV administration
set.
 Administer medication.
 Monitor the patient’s condition and
document medication, route,
administration time, and response.
© Jones & Bartlett Learning. Courtesy of James Upchurch.

185. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Rates of Medication Absorption
 Drugs are absorbed at a speed directly related to the route of delivery.
 Injections into the bloodstream are fastest.
 Oral medications take longer.