This document discusses parenteral administration, which is any route of medication administration other than through the digestive tract. It describes the equipment used including needles of varying lengths and gauges, syringes, and drug packaging like ampules and vials. The different types of parenteral injections are covered - intradermal, subcutaneous, intramuscular, and intravenous. Proper administration techniques, injection sites, and special considerations for different drugs are explained. The advantages and disadvantages of the parenteral route are also summarized.

1. PARENTERAL
ADMINISTRATION

2. I
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5. Assessment
Injection site
Drug allergies
Patient condition –be
alert to changes that
can affect drug
therapy
Consent forms

6.  Parenteral Medications are given through a route
other than the alimentary canal; these routes are:
 Intradermal (ID)
 Subcutaneous (SC orSQ)
 Intramuscular (IM)
 Intravenous (IV)
Parenteral Administration

7.  Needles
Available in different gauges – the
smaller the number, the larger the
gauge (insidediameter)
Length – long enough to penetrate the
appropriate layers of tissue
 Syringes
Barrel
Plunger
With or withoutneedle
Calibrated in milliliters or units
EQUIPMENT

8. Needles
A needle has three parts, the hub, the shaft, and the bevel.

9. The hub is at one end of the needle and is the
part that attaches to thesyringe.
The shaft is the long slender stem of the needle
that is beveled at one end to form a point.
bevel- is the slanted part at the tip of the shaft
The hollow bore of the needle shaft is known as
the lumen.

10. The length of a needle is measured in inches from
the juncture of the hub and the shaft to the tip of
the point. Needle lengths range from 3/8 inch to 3
1/2 inches; some special use needles are even
longer.
The gauge of a needle, used to designate the size
of the lumen, ranges from 27 (the finest) to 13
(the largest).
Needle Size-isdesignated by
LENGTHAND GAUGE

11. Thesmaller the number, the larger the
gauge (insidediameter).

15.  Tip-which connects the needle
 Barrel-outside part, which containsmeasurement
calibrations
 Plunger-which fits the inside the barrel and has a
rubber tip
THE NURSE MUST ENSURE THATTHE SYRINGE TIP,
INSIDE OF THE BARREL, SHAFT & RUBBER
PLUNGERTIP& SHAFT OFTHE NEEDLEARE KEPT
STERILE.
SYRINGES

16. Parts of aSyringe

17.  Standard- comes in 3ml,5 and10ml
 Insulin-designed specially for use withthe
ordered dose of insulin
 Tuberculin-narrow syringe, use to administer
small or precise doses such aspediatric
dosages.
 Should be used for doses of 0.5ml or less
TYPESOFSYRINGES

20. PRE-FILLEDSINGLE-DOSE
SYRINGES

21.  Ampule – glass or plastic container
that is sealed and sterile (open with
care)
 Vial – small bottle with rubber
diaphragm that can be punctured by
needle
Parenteral DrugPackaging

26. Rules for administration
Giveonly drugs the doctor orders – use drug reference, if
necessary
Washyour hands
 Prepare in awell-lit area
Focus on task; avoiddistractions
Calculate the dosecarefully
Do not leave aprepared drug unattended – never give a
drug thatsomeone else has prepared
Preparing to Administer a Drug (cont.)

27. Rules for administration
 Identify patientproperly
 Physician should be in the office
 Observe patient following administration
 Discard any ungiven medicationsproperly
 Report error to physician immediately
 Document properly
Preparing to Administer a Drug (cont.)

28.  Parenteral preparations must besterile
free of microorganisms
 To ensure sterility, parenterals are prepared using
aseptic techniques
special clothing (gowns, masks, hair net, gloves)
laminar flow hoods placed in special rooms
Parenteral DoseForms

29. Seven Rights of DrugAdministration
1. Right patient
2. Right drug
3. Right dose
4. Right time
5. Right route
6. Right technique
7. Right documentation
Preparing to Administer a Drug (cont.)

31. Apply YourKnowledge
How do you properly identify the patient before
administering a drug?
ANSWER: To ensure that you have the right patient, you
should check the name and date of birth on the patient record
and ask the patient to state his/her name and date of birth.

32. Techniques for
Administering Drugs(cont.)
 Methods of injection
 Intradermal
 Into upper layer of skin
 Used for skintests
 Subcutaneous
 Provides slow,sustained
release and longer
duration of action
 Rotate sites
 Intramuscular
 More rapidabsorption
 Lessirritation of tissue
 Larger amount ofdrug
 Z-track method
 Intravenous
 Not usually givenby
medical assistants

33.  -to diagnose TB,identifyallergens,
administer localanesthetics
 -drugs are absorb slowly from this site
 -commonly used for ID injection are the
INNERASPECTOFTHEFOREARM(upper
chest andupper backbeneath the scapula)
 -drug’s dosage contained inasmall quantity
of solution (0.01 to0.1ml)
Intradermal or Intracutaneous

35.  Given into capillary-rich layer just below epidermis
for
 local anesthesia
 diagnostic tests
 immunizations
Intradermal Injections

36.  Examples of ID injectionsinclude
skin test for tuberculosis (TB) or fungal infections
typical site is the upper forearm, below the area where IV
injections aregiven
allergy skintesting
small amounts of various allergens are administered to
detect allergies
usually on theback
Intradermal Injections

39.  Given at a45-degree
angle
25-or 26-gauge needle,3/8
to 5/8 inchlength
 No more then 1.5mL
should be injectedinto
the site
to avoid pressure on
sensory nerves causingpain
and discomfort
Subcutaneous Injections

40. 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
Often have alonger onset of action and a longer
duration of action
compared with IM or IV injection
Subcutaneous Injections

41.  Insulin is given using 28- to 30-gauge short needles
 in special syringe that measures in units
 Insulin is administered following a plan for site
rotation
 to avoid or minimize local skin reactions
 Absorption may vary dependingon
 site of administration
 activity level of the patient
Subcutaneous Injections

42.  Keep insulin refrigerated
 Check expiration datesfrequently
 opened vials should be discarded after one month
 Avial of insulin is agitated and warmed by rolling
between the hands and should never be shaken
 The rubber stopper should be wiped with an
alcohol wipe
Subcutaneous Injections

43. Subcutaneous Injections
Do not shake insulin.

44.  Medications administered by this route include:
 epinephrine (or adrenaline)
 for emergency asthmatic attacks or allergic reactions
 heparin or low molecular–weight heparins
 toprevent blood clots
 sumatriptan or Imitrex
 for migraines
 many vaccines
Subcutaneous Injections

45.  Normally given with the syringe held at a 45-degree
angle
 in lean older patients with less tissue and obese patients
with more tissue, the syringe should be held at more of a
90-degree angle
 Correct length of needle is determined by a skin
pinch in the injection area
 proper length is one half the thickness of the pinch
Subcutaneous Injections

46.  When administering insulin, air is injected into vial
 equal to the amount of insulin to be withdrawn
 Air is gently pushed from syringe with the plunger
 Patient should plan meals, exercise, and insulin
administration
 to gain the best advantage of the medication
 avoid chances ofcreating hypoglycemia
Subcutaneous Injections

47.  Typical needle is 22-to 25-
gauge ½-to 1-inchneedle
 Intramuscular (IM)
injections areadministered
at a90-degreeangle
 volume limited to less than 3
mL
Intramuscular Injections

48.  Care must be taken with deep IM injections to avoid
hitting avein, artery, or nerve
 In adults, IM injections are given into upper, outer
portion of the gluteus maximus
large muscle on either side of the buttocks
 For children and some adults, IM injections are given
into the deltoid muscles of the shoulders
Intramuscular Injections

49.  Used to administer
 antibiotics
 vitamins
 iron
 vaccines
 Absorption of drug by IM route is unpredictable
 not recommended for patients who are unconscious or in a
shocklike state
Intramuscular Injections

50.  Intramuscular Injection
 Promote rapid drugabsorption.
 Provide an alternate route when drug is irritating to
subcutaneous tissue.
 Sites
 Gauge and needle length
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 30-52
Parenteral Administration

53.  Intravenous (IV) injections are administered at a
15-to 20-degreeangle
Intravenous Injections orInfusions

54.  Intramuscular (IM) injections
into amuscle
 Subcutaneous injections
under the skin
 Intradermal (ID) injections
into the skin
Parenteral DoseForms

55.  The IVroute is the fastest method for delivering
systemic drugs
 preferred administration in an emergency situation
 It can provide fluids, electrolytes, and nutrition
 patients who cannot take food or have serious problems
with the GItract
 It provides higher concentration of drug to
bloodstream or tissues
 advantageous in serious bacterialinfection
Advantages and Disadvantages of the
Parenteral Route

56.  Traumatic injury from the insertion of needle
 Potential for introducing:
 toxic agents
 microbes
 pyrogens
 Impossible to retrieve if adverse reaction occurs
 injected directly into the body
Advantages and Disadvantages of the
Parenteral Route

57.  Intramuscular (IM) and subcutaneous routes of
administration are convenient ways to deliver
medications
 Compared with theIV 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
Advantages and Disadvantages of the
Parenteral Route

58.  For intramuscular (IM) and subcutaneous routes
of administration, the injection site needs to be
“prepped”
 using alcoholwipe
 Correct syringe, needle, and technique must be
used
 Rotation of injection sites with long-term use
 prevents scarring and otherskin changes
 can influence drugabsorption
Advantages and Disadvantages of the
Parenteral Route

59.  The intradermal (ID) route of administration is
used for diagnostic and allergy skin testing
 patient may experience asevere local reaction if
allergic or has prior exposure to atesting antigen
Advantages and Disadvantages of the
Parenteral Route

60.  Most parenteral preparations are made up of
ingredients in asterile-watermedium
 the body is primarily an aqueous (water-containing)
vehicle
 Parenteral preparations areusually:
 solutions
 suspensions
Dispensing andAdministering
Parenteral Medications

61.  IV injections and infusions are introduced directly
into the bloodstream
 must be free of air bubbles and particulate matter
 introduction of air or particles might cause embolism,
blockage in a vessel, or severe painful reaction at the
injection site
Dispensing andAdministering
Parenteral Medications

62.  Fast-acting route because the drug goes directly
into the bloodstream
 often used in the emergency department and in
critical careareas
 Commonly used
 for fluid and electrolyte replacement
 to provide necessary nutrition to the patient who is
critically ill
Intravenous Injections orInfusions

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