Parenteral Medication
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Mr.Upendra Yadav (M.Sc.) Child Health Nursing College of Nursing, B.P.Koirala Institute of Health Sciences Dharan 1 Nepal.
Parenteral therapy includes: 2.
Intradermal
3.
Subcutaneous
4.
Intramuscular and
5.
IV injections.
2
Types of Injections • Intradermal Injection: Injected into the dermis, chiefly used for diagnostic purposes e.g. Skin test for sensitivity • Subcutaneous (hypodermic) injection: into fatty tissues. • Intramuscular Injection: Injected between the layers of muscles. This route is used when rapid action is required or when a drug would irritate upper layers of tissues. 3
4
Types of Injections (Conti..) •
Intravenous Injection: Injected into veins. When large quantity of fluid is given, it is called infusion or venoclysis.
•
Intra cardiac: into the heart.
•
Intra peritoneal: into the peritoneal cavity.
•
Intra spinal or intrathecal: into spinal canal.
•
Intra pleural: into the pleural cavity.
•
Intra articular: into a joint.
5
A syringe and needle is essential to give parenteral medication. Syringes • Are made up of glass and plastic (disposable). • Glass syringes need to be sterilized. Most commonly used syringes are hypodermic syringe, tuberculin and insulin syringes. • Followings are the parts of syringe: –
Barrel and piston (plunger)
6
Barrel: • It may be touched anywhere outside except the tip but one should not touch anywhere to the piston except the flat surface at the top called flange. • There is a marking over the outside of the barrel. The usual sizes of the syringes are 2cc, 2.5cc, 5cc, 10cc, 20cc, 50cc (rarely used), etc. 7
Syringes (Conti.) • Tuberculin syringes have a small slender holding 1 ml. • An insulin syringe has a same size and shape of a tuberculin syringe, but with marking in the units specially made for insulin.
8
Syringes (Conti.) Needle: • Are made up of steel or other metal and are reusable or disposable. • It has two parts: the hub and the shaft. • The hub (hilt) fits on the rip of the syringe. The hub of the needle can be touched when preparing to give an injection. • The shaft is long and slender. It has a flat surface diagonally across the end called the bevel, which is very sharp for piercing the skin. The opening inside the shaft is called lumen. 9
Syringes (Conti.) Sizes: • According to the diameter of the lumen. • The diameter sizes of the lumen are indicated by the number from 14 to 27. The increase in the gauge number, the smaller is the diameter of the needle. • The gauge of the needle is selected according to the viscosity of the medication to be given. Water preparations are given 10 with 22 – 25 gauge needles.
Syringes (Conti.) Length: • Vary from 0.6 - 5.0 cm. • The length of the needle is selected according to the site of the injection and the size of the patients.
11
Drugs may be dispensed in: 1. Ampule 2. Vial 3. Prefilled cartridges
12
Ampoule: •
An ampoule is a glass flask that contains a single dose of medication for parenteral administration.
•
If all medications are not used, the remainder must be discarded. Medication can be removed from an ampoule by breaking its thin neck
13
Vial: •
A glass bottle with a self-sealing stopper through which medication is removed.
•
The rubber stopper that exposed is the means of entrance into the vial, to facilitate the removal of medication, the nurse should inject air into the vial. The amount of the air is the same as desired quantity of solution. 14
Prefilled cartridges •
Provide a single dosage of medication.
•
The nurse inserts a cartridge into a reusable holder.
•
Before giving the injection, the nurse should check the dosage in the cartridge and clears the cartridge of excess air.
•
Most Prefilled cartridges are over filled and the nurse should eject any excess medications to give an exact dose and avoid medication errors. 15
16
Purposes (Conti..) •
To get the rapid and systemic effect of the drugs.
•
Some medications are not given by mouth. Some drugs are rendered ineffective in the GI tract by the action of gastric juice (insulin) .
•
Some drugs are not retained in the intestines for sufficient periods for its absorption due to diarrhea, vomiting, or gastric suction. 17
Purposes (Conti..) • Some drugs are poorly absorbed from GI tract and some drugs are toxic and irritating to the gastric mucosa. • To give required effects when the patient is unconscious, unable to swallow due to surgical or neurological problems or when the patient is not cooperative.
18
Purposes (Conti..) •
To get local effects at the site of injection: –
For diagnostic purposes (tuberculin test)
–
For local anesthesia (xylocaine)
–
For allergy test (penicillin test) and
–
For treating local condition (hydrocortisone injection into joint cavity).
19
Purposes (Conti..) •
To restore blood volume and electrolyte balance by replacing fluids e.g. shock.
•
To give nourishment when it can not be taken by mouth.
20
Preparation of drug from Vial • Clean the rubber stopper of the vial with a spirit swab, rubbing it in a rotatory motion. Discard the swab. • Fix the needle on syringe using aseptic technique. Dissolve the drug if needed. • Put some amount of air into the syringe that is equal to the volume of the medication to be drawn by pushing the plunger. 21
Preparation of drug, Conti.. •
Inject the air through rubber stopper into the vial. This is done by grasping and inverting the vial in one hand.
•
Withdraw the required amount of medication by keeping the level of the needle immersed in the solution.
•
This is done by grasping and inverting the vial in one hand and pulling back on the plunger with the other hand. Hold the syringe straight and at eye level with the other hand. 22
Preparation of drug, Conti.. •
Remove the needle from the vial holding the barrel of the syringe securely.
•
Cover the needle immediately with its sterile cover. If the cover is not available, place the needle between sterile gauges.
•
Place the syringe on the tray.
•
Dispose of the vial or return to the storage place. 23
24
Preparation of drug, Conti.. •
Remove any medication that is lodged in the head of the ampoule by flicking the head with your index finger nail.
•
Open the ampoule by filling across the neck of the ampoule and then breaking off the top away from you.
•
Prepare the needle and the syringe.
•
Insert the needle into the ampoule touching the sides of the ampoule. Do not invert the ampoule. Once the ampoule is opened, it is not airtight. So one does not require injecting air into it 25 before withdrawal of medication.
Preparation of drug, Conti.. •
Withdraw medication into syringe.
•
Cover the needle immediately with its sterile cover or with sterile gauge.
•
Dispose off the ampoule and unused solution.
26
27
Equipment needed • Two vials of insulin • Cardex • Sterile syringe with 25 gauge or 27 gauge needle • Alcohol swab
28
Procedure • Gather equipment. • Wash your hands. • If necessary, remove the metal cap that protects the rubber stopper in the vial. • If insulin is a suspension, rotate the vial between your palms to mix before withdrawal. • Cleanse the rubber tops with alcohol swabs. 29
Procedure (Conti..) • Remove cap from needle. Inject air into the modified insulin preparation (e.g. NPH insulin). Use an amount of air equal to the amount of medication to be withdrawn in the vial. Remove the needle. • Inject air into the clear insulin without additional protein (regular insulin). Use an amount of air equal to the amount of medication to be withdrawn in the vial. Do not bubble the air through the medication. 30
Procedure (Conti..) • Invert the vial of clean insulin and aspirate the amount prescribed. Remove the needle from the vial. • Clear the rubber top of the modified insulin vial. Insert the needle into the vial, invert it and withdraw the medication. Cap the needle. • Store the vial according to the agency recommendation. • Wash your hands.
31
32
Reconstitution (Conti..) • Many drugs are supplied as powers in vials. • A liquid or diluents must be added to the powder before it is administered as a solution. • The technique of adding diluents to a powdered drug is called reconstitution. • The nurse must know the amount and types of diluents to be added to the powders. 33
Reconstitution (Conti..) • Common dilutes are water for injection and normal saline. • After the diluents are added to the solution, the nurse reads the label further to determine the concentration of the drug per millimeter of solution. This is essential to the dose computation. 34
Reconstitution (Conti..) • If all the medication is not given at the time of reconstitution, the nurse refers to the vial label for storage instruction. • Additional source of information about reconstitution of medication are package inserts and the pharmacists. 35
36
Parenteral therapy includes: 2.
Intradermal
3.
Subcutaneous
4.
Intramuscular and
5.
IV injections.
2
Types of Injections • Intradermal Injection: Injected into the dermis, chiefly used for diagnostic purposes e.g. Skin test for sensitivity • Subcutaneous (hypodermic) injection: into fatty tissues. • Intramuscular Injection: Injected between the layers of muscles. This route is used when rapid action is required or when a drug would irritate upper layers of tissues. 3
4
Types of Injections (Conti..) •
Intravenous Injection: Injected into veins. When large quantity of fluid is given, it is called infusion or venoclysis.
•
Intra cardiac: into the heart.
•
Intra peritoneal: into the peritoneal cavity.
•
Intra spinal or intrathecal: into spinal canal.
•
Intra pleural: into the pleural cavity.
•
Intra articular: into a joint.
5
A syringe and needle is essential to give parenteral medication. Syringes • Are made up of glass and plastic (disposable). • Glass syringes need to be sterilized. Most commonly used syringes are hypodermic syringe, tuberculin and insulin syringes. • Followings are the parts of syringe: –
Barrel and piston (plunger)
6
Barrel: • It may be touched anywhere outside except the tip but one should not touch anywhere to the piston except the flat surface at the top called flange. • There is a marking over the outside of the barrel. The usual sizes of the syringes are 2cc, 2.5cc, 5cc, 10cc, 20cc, 50cc (rarely used), etc. 7
Syringes (Conti.) • Tuberculin syringes have a small slender holding 1 ml. • An insulin syringe has a same size and shape of a tuberculin syringe, but with marking in the units specially made for insulin.
8
Syringes (Conti.) Needle: • Are made up of steel or other metal and are reusable or disposable. • It has two parts: the hub and the shaft. • The hub (hilt) fits on the rip of the syringe. The hub of the needle can be touched when preparing to give an injection. • The shaft is long and slender. It has a flat surface diagonally across the end called the bevel, which is very sharp for piercing the skin. The opening inside the shaft is called lumen. 9
Syringes (Conti.) Sizes: • According to the diameter of the lumen. • The diameter sizes of the lumen are indicated by the number from 14 to 27. The increase in the gauge number, the smaller is the diameter of the needle. • The gauge of the needle is selected according to the viscosity of the medication to be given. Water preparations are given 10 with 22 – 25 gauge needles.
Syringes (Conti.) Length: • Vary from 0.6 - 5.0 cm. • The length of the needle is selected according to the site of the injection and the size of the patients.
11
Drugs may be dispensed in: 1. Ampule 2. Vial 3. Prefilled cartridges
12
Ampoule: •
An ampoule is a glass flask that contains a single dose of medication for parenteral administration.
•
If all medications are not used, the remainder must be discarded. Medication can be removed from an ampoule by breaking its thin neck
13
Vial: •
A glass bottle with a self-sealing stopper through which medication is removed.
•
The rubber stopper that exposed is the means of entrance into the vial, to facilitate the removal of medication, the nurse should inject air into the vial. The amount of the air is the same as desired quantity of solution. 14
Prefilled cartridges •
Provide a single dosage of medication.
•
The nurse inserts a cartridge into a reusable holder.
•
Before giving the injection, the nurse should check the dosage in the cartridge and clears the cartridge of excess air.
•
Most Prefilled cartridges are over filled and the nurse should eject any excess medications to give an exact dose and avoid medication errors. 15
16
Purposes (Conti..) •
To get the rapid and systemic effect of the drugs.
•
Some medications are not given by mouth. Some drugs are rendered ineffective in the GI tract by the action of gastric juice (insulin) .
•
Some drugs are not retained in the intestines for sufficient periods for its absorption due to diarrhea, vomiting, or gastric suction. 17
Purposes (Conti..) • Some drugs are poorly absorbed from GI tract and some drugs are toxic and irritating to the gastric mucosa. • To give required effects when the patient is unconscious, unable to swallow due to surgical or neurological problems or when the patient is not cooperative.
18
Purposes (Conti..) •
To get local effects at the site of injection: –
For diagnostic purposes (tuberculin test)
–
For local anesthesia (xylocaine)
–
For allergy test (penicillin test) and
–
For treating local condition (hydrocortisone injection into joint cavity).
19
Purposes (Conti..) •
To restore blood volume and electrolyte balance by replacing fluids e.g. shock.
•
To give nourishment when it can not be taken by mouth.
20
Preparation of drug from Vial • Clean the rubber stopper of the vial with a spirit swab, rubbing it in a rotatory motion. Discard the swab. • Fix the needle on syringe using aseptic technique. Dissolve the drug if needed. • Put some amount of air into the syringe that is equal to the volume of the medication to be drawn by pushing the plunger. 21
Preparation of drug, Conti.. •
Inject the air through rubber stopper into the vial. This is done by grasping and inverting the vial in one hand.
•
Withdraw the required amount of medication by keeping the level of the needle immersed in the solution.
•
This is done by grasping and inverting the vial in one hand and pulling back on the plunger with the other hand. Hold the syringe straight and at eye level with the other hand. 22
Preparation of drug, Conti.. •
Remove the needle from the vial holding the barrel of the syringe securely.
•
Cover the needle immediately with its sterile cover. If the cover is not available, place the needle between sterile gauges.
•
Place the syringe on the tray.
•
Dispose of the vial or return to the storage place. 23
24
Preparation of drug, Conti.. •
Remove any medication that is lodged in the head of the ampoule by flicking the head with your index finger nail.
•
Open the ampoule by filling across the neck of the ampoule and then breaking off the top away from you.
•
Prepare the needle and the syringe.
•
Insert the needle into the ampoule touching the sides of the ampoule. Do not invert the ampoule. Once the ampoule is opened, it is not airtight. So one does not require injecting air into it 25 before withdrawal of medication.
Preparation of drug, Conti.. •
Withdraw medication into syringe.
•
Cover the needle immediately with its sterile cover or with sterile gauge.
•
Dispose off the ampoule and unused solution.
26
27
Equipment needed • Two vials of insulin • Cardex • Sterile syringe with 25 gauge or 27 gauge needle • Alcohol swab
28
Procedure • Gather equipment. • Wash your hands. • If necessary, remove the metal cap that protects the rubber stopper in the vial. • If insulin is a suspension, rotate the vial between your palms to mix before withdrawal. • Cleanse the rubber tops with alcohol swabs. 29
Procedure (Conti..) • Remove cap from needle. Inject air into the modified insulin preparation (e.g. NPH insulin). Use an amount of air equal to the amount of medication to be withdrawn in the vial. Remove the needle. • Inject air into the clear insulin without additional protein (regular insulin). Use an amount of air equal to the amount of medication to be withdrawn in the vial. Do not bubble the air through the medication. 30
Procedure (Conti..) • Invert the vial of clean insulin and aspirate the amount prescribed. Remove the needle from the vial. • Clear the rubber top of the modified insulin vial. Insert the needle into the vial, invert it and withdraw the medication. Cap the needle. • Store the vial according to the agency recommendation. • Wash your hands.
31
32
Reconstitution (Conti..) • Many drugs are supplied as powers in vials. • A liquid or diluents must be added to the powder before it is administered as a solution. • The technique of adding diluents to a powdered drug is called reconstitution. • The nurse must know the amount and types of diluents to be added to the powders. 33
Reconstitution (Conti..) • Common dilutes are water for injection and normal saline. • After the diluents are added to the solution, the nurse reads the label further to determine the concentration of the drug per millimeter of solution. This is essential to the dose computation. 34
Reconstitution (Conti..) • If all the medication is not given at the time of reconstitution, the nurse refers to the vial label for storage instruction. • Additional source of information about reconstitution of medication are package inserts and the pharmacists. 35
36
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