OTHER PARENTERAL ROUTE.pptx

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1. OTHER PARENTERAL ROUTE ARPIT PARTIL

2. INTRATHECAL ROUTE It is the route to administer medication through a catheter placed in subarachnoid space or one of the ventricles of the brain. Intrathecal :- administer directly in the CSF. Epidural :- administer in dura matter thus have slower effect compared to intrathecal .

3. Intrathecal administration is prescribed for chemotherapy, pain management or anesthesia administration, where immediate effect is expected. This route has high potential to introduce infection, therefore aseptic techniques should be maintained.

4. EPIDURAL ROUTE It is used to administer the medication into the epidural space around the spinal cord. Such as local anesthetic drugs, analgesics and some radio contrast agent for diagnostic purpose.

5. Articles Disinfectants for cleaning Spinal needle 10 mL syringe Medicine card and prescribed medicine Sterile dressing Adhesive tape Tincture benzoin Dressing set

6. Procedure Explain the procedure to the patient. Gain consent from the patient. Assess for any contraindication. Provide privacy. Assist the patient to attain the procedure. Drape the patient. Assist the physician in cleaning the area. Give spinal needle and syringe to physician.

7. Insert the spinal needle in the epidural space and remove the stylet . CSF will start dripping from the needle (it indicates the entry in the subarachnoid), then the needle is withdrawn when the fluid stops dripping, then connect the syringe and administer the medicine is injected. After administration, remove the needle.

8. Seal the puncture with gauze piece soaked in tincture benzoin. Provide supine position for 6-8 hours and head end should not be raised for 6-8 hours.

9. Post procedure care Document the procedure and record the observation made during the procedure. Replace articles. Discard waste as per BMW policies. Provide supine position for 6-8 hours and head end should not be raised for 6-8 hours.

10. INTRAOSSEOUS It is the administration of medication into the bone marrow of long bone of arms and legs. This route is generally used when it is difficult to access intravenous route. The long bone contain network of blood vessels which helps in delivering the medication. This method is commonly used in infant and toddlers.

11. INTRAPERITONEAL Administer substance in peritoneum cavity. Intraperitoneal procedure can be performed sonography guided.

12. Articles Dressing set and disinfectants Peritoneal needle and catheter Syringe for aspiration and administration of local anaesthetic agent 25 and 20 gauze needle Anaesthetic agent Connecting tubing Scalpel and sterile gloves, sterile drape

13. Dressing to seal the puncture site Medication card and medicine to be administered Specimen bottle is to be collected of peritoneal fluid

14. Preprocedure Assist the patient to gain the position- supine in bed head slightly elevated. Expose the abdomen Bladder should be emptied before the procedure Percuss the dullness on abdomen Locate the site Use ultrasound to confirm, if needed

15. Procedure Wear sterile gloves Clean the area to create sterile field Drape the sterile sheet With 25 gauge needle, infilterate skin with anaesthetic agent Insert the 20 gauge needle for aspiration intermittently Collect the specimen id needed

16. Once fluid is aspirated connect the syringe loaded with medicine and administer the medication After administration seal the puncture In case the fluid needs to be drained, then connect the three way connector to be needle inserted and connect the tubing and collect the drained fluid in a sterile container

17. Postprocedure Abdominal binder should be applied if the patient has coagulation risk or bleeding tendency. Patient shall lie in prone position and avoid squatting position and weight lifting for 6-8 hours.

18. INTRAPLEURAL It is the route to administer the drug through the chest wall into the pleural space or through a chest tube placed in the pleural cavity for any kind of drainage. Chemotherapeutic medications are most commonly infused by this route.

19. Articles Dressing set and disinfectants Syringe for aspiration and administration of local anaesthetic agent 25 and 22 gauge needles for administering local anaesthesia and aspirate the pleural fluid Anaesthetic agent Connecting tubing

20. Scalpel and sterile gloves, sterile drape Dressing to seal the puncture Medication card and medicine to be administered Specimen bottle if specimen is to be collected

21. Preprocedure Explain the procedure and gain consent Collect all the articles Place the patient in fowler’s position with hands resting forward on the cardiac table at the edge of the bed Use ultrasound to confirm the pleural space Mark 5-10 cm lateral spine and 1-2 intercostal space below the effusion if present

22. Procedure Wear gloves and clean the area with disinfectant and drape the area Using 25G needle to infiltrate the local anaesthetic agent Connect syringe with 22G needle, insert in the located site and aspirate intermittently When fluid is aspirated, stop the insertion and attach the syringe loaded with the medicine to administer

23. In case of drainage, 18G needle is used, connect the three way connector and tubing to drain the fluid in the collection bottles During procedure, ask the patient to breathe normally and be steady When done ask patient to hmmm and withdraw the needle while patient is humming, it prevents the air entry Apply dressing and documentation

24. Postprocedure Perform a chest X-ray Position the patient to lie on the side from where the procedure is performed, it will help to seal the puncture

25. INTRA-ARTERIAL In this route, medications are administered directly into the arteries This procedure requires arterial line access, it can be gained sonography guided or blind procedure The arterial line need to have pressurized IV bag connected to it in order to maintain the patency and transducer may be connected to gain the arterial blood pressure

26. Articles Dressing set Arterial line set and transducer Disinfectant for cleaning Sterile gown gloves Sterile sleeve for USG probe Local anaesthetic agent Syringe and needle and scalpel Pressure bag, IV bottle and IV set

27. Preprocedure Explain the procedure to patient and gain consent Collect all the articles Position the patient Hang the pressurized IV bottle ready with connection Use USG if needed

28. Procedure Wear sterile gloves and gown Clean the area and drape it Cleaning is done from centre to periphery in circular motion Provide the arterial line to physician Provide saline and syringe to flush the line Physician then insert the arterial line sheath with stylet and observe gush of blood coming through it

29. Stylet is removed and guide wire is inserted Then sheath is also removed