Parentral medications Importants knowledge .ppt

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1. Parentral Medication Presented By Aamir Ali Bhatti Lecturer at SION khairpur mirs Year 1 semester II

2. Parentral Medication Para: outside enteron : intestine (i.e. beside the intestine) S ituated or occurring outside the intestine . These are the preparations which are given other than oral routes. Parenteral administration is injection or infusion by means of a needle or catheter inserted into the body. Parenterals are sterile solutions or suspension of drug in aqueous or oily vehicle. Parenteral drugs are administered directly in to the veins, muscles or under the skin , or more specialized tissues such as spinal cord.

3. Parenteral Routes Parenteral administration involves injecting a medication into body tissues. The following are the four major sites of injection: 1. Intradermal (ID): Injection into the dermis just under the epidermis. 2. Subcutaneous (SC): Injection into tissues just below the dermis of the skin. 3. Intramuscular (IM): Injection into a muscle. 4. Intravenous (IV): Injection into a vein.

4. Parenteral Routes Some medications are administered into body cavities.These additional routes include 5. Intra-arterial 6. Intracranial 7. Intrathecal 8. Intracisternal or Intraventricular 9. Epidural 10.Intraarticular 11.Intracerebral 12. Intrapleural 13. Intraosseous 14. Intraperitoneal

5. Intradermal Injections An intradermal (ID) injection is the administration of a drug into the dermal layer of the skin just beneath the epidermis. Usually only a small amount of liquid is used, for example 0.1ml. This method of administration is frequently used for allergy testing and tuberculosis(TB) screening. Use a tuberculin or small hypodermic syringe for skin testing. The angle of insertion for an intradermal injection is 5 to 15 degrees (Syringe is positioned at 5˚-15˚ angle. ) Needle used is a short (1/4 inch to ½ inches) length, gauge (25-27G). Create small bubble like.

6. Intradermal Injections It is an injection given into the dermal layer(the top few layers of the skin. ) of the skin for some purposes : – Local Anesthesia – Diagnostic Tests – Immunizations (BCG vaccine) After injecting the medication, a small bleb resembling a mosquito bite appears on the surface of the skin

7. Intradermal Injection Procedure Check the 5 Right then : 1.Wash hand and Take equipment to the patient's side. 2.Explain procedure to patient. 3.Locate the site of injection, and Cleanse the skin with a spirit swab, allow the area to dry. 4.Remove needle cap and holds syringe at 10˚-15˚ angle from skin with bevel up and Inject the solution. 5.Remove the needle quickly but gently at the same angle used for injection. 6.Wipe with dry cotton ball but do not press or massage the injection site. 7.Chart the data and time of the administration of the drug. 8.Take care of the equipment & return to their places.

8. Subcutaneous Injections The injection of the drug under the skin into the fatty layer, but not into the muscle. Absorption of the drug is rapid. Eg ; insulin The subcutaneous injection sites include The outer posterior aspect of the upper arms The abdomen The anterior aspects of the thighs The scapular areas of the upper back The upper ventral or dorsal gluteal areas.

9. Subcutaneous Injections Subcutaneous (SC; SQ ;Sub Q) : The injection is given under the skin Need to be isotonic Upto 2 ml is given Using ½ to 1 inch 23 to 25 gauge needle or smaller needle

10. Subcutaneous Injections Kinds of drugs commonly administered: 1. Vaccines 2. Preoperative medications ( scoplamine ) 3. Narcotics 4. Insulin 5. Heparin Only small volumes (0.5 to 1.5 mL) of medicationsare given subcutaneously. The angle of insertion for a subcutaneous injection is 90 or 45 degrees.

11. Subcutaneous Injection Procedure Check the 5 Right then : 1.Wash hand and Take equipment to the patient's side. 2.Explain procedure to patient. 3.Locate the site of injection, and Cleanse the skin with a spirit swab, allow the area to dry. 4.Remove needle cap and holds syringe at 45˚angle, then Inject the needle . 5.Draw back the plunger to check you are or aren't in the blood vessel (Blood return should not be seen) then inject the solution. 6.Remove the needle quickly but gently at the same angle used for injection and massage the area with alcohol swab . 7.Chart the data and time of the administration of the drug. 8.Take care of the equipment & return to their places.

12. Intramuscular Injection Intramuscular injection (IM) is  installing medications into the depth of specifically selected muscles . The bulky muscles have good vascularity, and therefore the injected drug quickly reaches the systemic circulation and thereafter into the specific region of action, bypassing the first-pass metabolism. Used to administer : Some antibiotics, Vitamins or iron and Some Vaccines (DTP) Needle used is (1-1.5 inch)length, gauge(22-25G ). Volume usually 2-5 ml are injected. Inject the needle at an angle of 90˚ .

13. Intramuscular Injection Preferably isotonic Principle sites: Gluteal (buttocks) ( Ventrogluteal , Dorsoglutea ) Deltoid (upper arms) Vastus lateralis (lateral thigh) Rectus Femoris

14. Intramuscular Injection Procedure Check the 5 Right then : 1.Wash hand and Take equipment to the patient's side. 2.Explain procedure to patient. 3.Locate the site of injection, and Cleanse the skin with a spirit swab, allow the area to dry. 4.Remove needle cap and holds syringe at 90˚ angle then Inject the needle . 5.Draw back the plunger to check you are or aren't in the blood vessel (Blood return should not be seen) then inject the solution.

15. Intramuscular Injection Procedure 6.Remove the needle quickly but gently at the same angle used for injection and massage the area with alcohol swab. 7.Chart the data and time of the administration of the drug. 8.Take care of the equipment & return to their places.

16. Intravenous Injections Fast-acting route because the drug goes directly into the bloodstream Often used in the emergency department and in critical care areas and admitted patient. Commonly used For fluid and electrolyte replacement To provide necessary nutrition to the patient who is critically ill. Needle used is (1-1.5 inch)length, gauge(16-24 G). Intravenous (IV) injections are administered at an angle of 15˚-25˚

17. Intravenous Injections W hen a person needs a potentially life saving medication very quickly W hen a person needs a very accurate dose of a medication W hen a person needs a large dose of a medication over an extended period of time W hen taking a medication by mouth would be impractical or ineffective W hen a person would otherwise require multiple injections, such as when receiving treatments for some chronic conditions W hen a person cannot eat or drink and requires fluids through an IV line

18. Intravenous Injections For adults, the veins on the arm are: Basilic vein Median cubital vein Dorsal veins Median vein Radial vein Cephalic vein On the foot, the veins are; Great saphenous vein Dorsal plexus

19. Intravenous Injection Procedure Check the 5 Right then : 1.Wash hand and Take equipment to the patient's side. 2.Explain procedure to patient. Expose the arm and apply tourniquet 3.Ask pt. To open and close his fist. 4.Palpate the vein and clean with alcohol swab the site of the injection 5.Remove needle cap and holds syringe at 15˚-25˚ angle. 6.Puncture the vein and draw back (Blood return should be seen(.

20. Intravenous Injection Procedure 7.Once you know that you are in the vein, release the tourniquet and gently lower the angle of the needle then inject the solution very slowly. 8.Remove the needle quickly but gently at the same angle used for injection and apply pressure over the area to prevent bleeding.. 9.Chart the data and time of the administration of the drug. 10.Take care of the equipment & return to their places

21. Complications During IV Therapy Infiltration escape of fluid into subcutaneous tissue due to dislodgement of the needle causing swelling and pain. Phlebitis is the inflammation of the vein. This may result from mechanical trauma due to the insertion too big a needle (for small vein) or leaving a device in place for a long time.

22. Complications During IV Therapy Circulatory Overload; the intravascular fluid compartment contains more fluid than normal. This occurs when infusion is too rapid or excess volume is infused. This manifests as dyspnoea , cough, frothy sputum and gurgling sounds on aspiration. Embolism; obstruction of the blood vessels by travelling air emboli or clot of the blood. It is fata

23. General requirements of parenteral preparations Stability Sterility Free from Pyrogens Free from foreign particles Isotonicity Specific gravity Chemical purity

24. Equipment To administer parenteral medications, nurses use syringes and needles to withdraw medication from ampules and vials.

25. Equipment Needles Available in different gauges – the smaller the number, the larger the gauge (inside diameter) Length – long enough to penetrate the appropriate layers of tissue Syringes Barrel Plunger With or without needle Calibrated in milliliters or units

26. Needle A needle has three parts,the hub , the shaft & the bevel.

27. Needle Size-is Designated By Length And Gauge

28. Preventing needle stick injuries One of the most potentially hazardous procedures that health care personnel face is using and disposing of needles and sharps. Needlestickinjuries present a major risk for infection with hepatitis B virus, human immunodeficiency virus (HIV), and many other pathogens. Use appropriate puncture-proof disposal containers to dispose of uncapped needles and sharps. Never throw sharps in wastebaskets. Never recap used needles When recapping a needle, Use a one-handed “scoop” method.

29. Preventing needle stick injuries This is performed by a) Placing the needle cap and syringe with needle horizontally on a flat surface. b) Inserting the needle into the cap, using one hand. c) Then using your other hand to pick up the cap and tighten it to the needle hub.

30. Syringes Syringes have three parts: The tip, which connects with the needle The barrel, or outside part, on which the scales are printed The plunger, which fits inside the barrel

31. Types Of Syringes Several kinds of syringes are available in differing sizes, shapes, and materials. Syringes range in sizes from 1 to 60 mL. A nurse typically uses a syringe ranging from 1 to 3 mL in size for injections (e.g. subcutaneous or intramuscular).

32. Types Of Syringes Standard- comes in 3ml ( guage of needle is 22) ,5ml ( guage of needle 21) and 10ml ( guage of needle 16) Insulin -designed specially for use with the ordered dose of insulin ( guage of needle is 30) Tuberculin-narrow syringe, use to administer small or precise doses such as pediatric dosages. Should be used for doses of 0.5ml or less (gauge of needle 27) Pre-filled Single dose Syringe Autoinjectors

33. Cannula A cannula is a flexible tube that can be inserted into the body. A venous cannula is inserted into a vein, for the administration of intravenous fluids, for obtaining blood samples and for administering medicines.

34. Types Of Cannula Types of cannula are IV cannula pen-like model. IV cannula with wings model. IV cannula with injection part model. IV cannula y-type model. Butterfly Canula

35. Pen like Model Canula

36. Parenteral Drug Packaging 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

37. Advantages of the Parenteral Route The IV route 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 GI tract. It provides higher concentration of drug to bloodstream or tissues

38. Advantages of the Parenteral Route Advantageous in serious bacterial infection. IV infusion provides a continuous amount of needed medication Infusion rate can be adjusted. To provide more or less medication as the situation dictates Drug action can be prolonged by modifying the formulation

39. Disadvantages of the Parenteral Route 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 Correct syringe, needle, and technique must be used e.g needle size, canulla . Rotation of injection sites with long-term use cause tissue & muscles damage.

40. Disadvantages of the Parenteral Route More expensive and costly to produce Trained person is required. Require specialized equipment, devices, and techniques to prepare and administer drugs Risk of infection. Hypersensitivity reaction.

41. References Fundamental of nursing by Erab & Koizer (6th edition)

42. Thank you