Parenteral Medication Administration Rights of med administration 1

Parenteral Medication Administration

Rights of med administration • • 1. right medication 2. right patient 3. right dosage 4. right route 5. right time 6. right reason 7. right documentation

Parenteral routes • • Subcutaneous Intramuscular Intradermal Intravenous

Equipment • • Syringe Needle Alcohol preps Medication

Parts of Syringe • Barrel –holds medication, scales on outside • Plunger – fits into the barrel – Shaft of plunger is sterile

Parts of Syringe • Tip – connects with needle – Sterile – Luer-lock or catheter tip

Parts of Needle • Hub – fits onto syringe • Cannula or shaft – attached to hub – 3/8 – 1 ½ inch • Bevel – slanted part of needle • Sharper needles cause less discomfort • Gauge- diameter – 28 – 16 – Larger the number, smaller the needle

Syringe/Needle Selection • • • Route Viscosity Amount of med Body size Type of med

Drawing up Medications • Ampules • Prefilled cartridges • Vials • Powders

Subcutaneous • • • Landmarks Equipment Med amount Medications Procedure Site rotation

Landmarks- Sub Q

Equipment • Needle size – length 3/8˝, 5/8˝, ½˝(short) – 25 -30 Gauge(small) • Syringe – Depends on med – Insulin only use insulin syringe • Volume – Less than 1 ml • Alcohol preps – Maintain asepsis

Equipment/Syringes • Insulin – Insulin syringe • Needle usually attached • • Heparin – Tb syringe

Equipment/Syringes Lovenox Misc.

Preparation • • Check orders with MAR Assessment Equipment Preparation – Maintain sterility draw up medications – 3 med checks – Label syringe • Administration

Administration • • • • Hand hygiene Identify client Assessment Gloves Site selection/positioning Cleanse Bunch or spread skin Insert at 45 -90 degrees Release bunch or spread Inject med Remove needle Dispose of needle correctly Page 792 -795 in Taylor

Special considerations • • Aspirate/massage Site rotation Multiple injections Scars

IM • • • Landmarks Equipment Med amount Medications Procedure Site rotation

IM landmarks Deltoid-1 ml Ventrogluteal 2 mls

IM landmarks Vastus Lateralis 2 ml Infants/Children

Site selection • Depends on – Med – Volume – Age – Muscle size

Equipment • Needle size – Length ⅝ -1 ½ inch – Gauge 18 -25(depends on thickness of med) • Syringe – Depends on med • Medication • Diluent if necessary • Alcohol preps – Maintain asepsis

Preparation • • Check orders with MAR Assessment Equipment Preparation – Maintain sterility draw up medications – 3 med checks – Label syringe • Administration

Administration • • • Hand Hygiene Identify Client Assessment Gloves Site selection/positioning Cleanse Insert between 72 - 90 degrees Aspirate Inject med Remove needle Dispose of needle correctly Page 796 in Taylor

Z Track • • Prevents backflow of med into tissues Used with irritating meds- decreases discomfort Displace skin Insert needle Administer injection Withdraw needle Release skin Med remains in muscle

Special considerations • Reconstitution • Mixing meds in same syringe(determine compatibility) • Multiple injections • Large volumes • Z Track • Change needle • Label syringe

Intradermal • • • Landmarks Equipment Med amount Medications Procedure

Equipment • Needle size – Length ¼"- ½" – Gauge 26 -27 • Syringe – Tb • Medication • Alcohol preps – Maintain asepsis

Preparation • • Check orders with MAR Assessment Equipment Preparation – Maintain sterility draw up medications – 3 med checks • Administration

Administration • • • Hand hygiene Identify client Assessment Gloves Site selection Cleanse Insert at 5 -15 degrees Inject med Remove needle Dispose of needle correctly Special considerations Page 788 -790 in Taylor

Nurses Call the Shots

Order: Rocephin 1 g IM

Equipment • 1 ml syringe, 20 g 1 ½ inch needle • 3 ml syringe, 22 g 1 inch needle • 3 ml syringe, 18 g 1 ½ inch needle • 1 ml syringe, 25 g 5/8 inch needle

Ordered: Flu Shot IM Available: 0. 5 mls

• 3 ml syringe, 18 g 1 ½ inch needle • TB syringe, 23 g 1 inch needle • Tb syringe, 22 g, 1 ½ inch needle • 3 ml syringe, 20 g 1 inch needle

Order: Penicillin 1, 000 units IM Available: 1, 000 units/2 mls Hint: med is thick

Equipment • Equipment choices: – 3 ml syringe, 22 g 1 ½ inch needle – 3 ml syringe, 20 g 1 ½ inch needle – 1 ml syringe, 25 g 5/8 inch needle – 3 ml syringe, 20 g 1 inch needle

Ordered: Insulin NPH 20 units SQ

High Alert Meds • Insulin • Heparin

Insulin • Hormone secreted by pancreas to regulate glucose levels • Diabetics have an insulin deficiency or an insulin resistance • Lowers blood sugar • Measured in units • Concentration is 100 u/ml • Only use insulin syringe • Reactions • Contingency • Procedure for mixing p. 777 Taylor

Heparin • • Anticoagulant Administered Subcutaneous or IV Administer in abdomen Do not aspirate Do no massage Contingency- PTT(30 -40 seconds) Enoxaparin (Lovenox) is a low-molecular weight heparin

Lovenox • • Anticoagulant Administered in abdomen Prefilled syringe Air bubble in top Do not aspirate Do not massage Protective covering that deploys after administering

The End