DRUG ADMINISTRATION
USING MANNEQUINS
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PARENTERAL ROUTES
ROUTE OTHER THAN “ENTERAL”
ADVANTAGES OF PARENTERAL ROUTE OVER ORAL ROUTE
1. Bioavailability is faster and more predictable
2. Gastric irritation and vomiting are not provoked
3. Used in unconscious, uncooperative and those having vomiting,
diarrhoea patients
4. No chances of interference by food or digestive enzymes
5. Bypass First pass metabolism
6. Drugs with poor oral bioavailability
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INJECTIONS
Injection is an infusion method of putting liquid into the body, usually with a
hollow needle and syringe which is pierced through skin to a sufficient depth
for the material to be forced into the body.
1. Intravenous
2. Intramuscular
3. Subcutaneous
4. Intra dermal
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DOSAGE FORM FOR PARENTERAL ADMINISTRATION
1. Solutions for IV administration supplied in
ampoules or vials.
2. Liquids for IM,SC,ID administration- Can
be solutions or suspensions of the drug.
Some available as solid powder forms
(mixed with water ) or some are oily base
given IM and called Depot Preparations
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VIAL OR AMPOULE ?
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1. Wash hands.
2. Prepare the materials needed (check the label, expiration date, integrity).
3. Check if the stem of the ampoule is cleared of any trapped medication (If ever gently
tapping the top with the finger or swinging it fast in a downward spiralling movement).
4. Place or wrap the ampoule on small sterile gauze square.
(A medicine file is drawn across the constricted portion to make a cut).
5. Hold the lower portion of the ampoule with gauze, while the stem is snapped away with
the other hand and carefully break off the top of the ampoule.
(The gauze protects the finger from injury, for a plastic ampoule twist the top).
6. Check the syringe for air before aspirating the solution from the ampoule.
7. Carefully insert the needle into the opening without touching the outside of the ampoule
8. Aspirate the desired amount of solution (make sure the tip of the needle kept submerged
in the solution to avoid drawing air into the syringe).
9. Once the syringe filled with the desired amount of medication pull the needle out of the
ampoule.
10. Hold the syringe with the needle directed upward -to check accuracy of measurement.
11. Remove possible air from the syringe.
12. Change the aspirating needle with a new one (G21-G23).
13. Dispose of sharps and waste material according to infection control standards.
14. Wash hands.
ASPIRATION FROM AMPOULE & VIAL
• Aspirating from ampoules (glass, plastic)
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STEP/TASK D PD ND
Preparation
1. Wash hands.
2. Prepare the materials needed (check the label, expiration date, integrity)
3. Remove the plastic cover (or the center of the metal cover) of the vial.
4. Disinfect the rubber top of the vial with alcohol swab.
5. Fill the syringe with an equal amount of air to the amount of solution to be withdrawn.
6. Hold the vial and insert the needle into (top of) vial and turn upside –down.
7. Pump air into vial (creating pressure).
8. Aspirate the desired amount of solution (make sure the tip of the needle kept submerged
in the solution to avoid drawing air into the syringe).
9. Pull the needle out of the vial.
10. Hold the syringe with the needle directed upward -to check accuracy of measurement.
11. Remove possible air from the syringe.
12. Change the aspirating needle with a new one (G21-G23).
13. Dispose of sharps and waste material according to infection control standards.
14. Wash hands.
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PARENTERAL ROUTES OF DRUG
ADMINISTRATION
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INTRAMUSCULAR INJECTION
SITE- Deltoid muscle or Gluteal mass of left or right buttock. Vastus muscle
alternative area.
ADVANTAGES DISADVANTAGES
[Link] aseptic conditions
1. Absorption more needed EXAMPLES
predictable, less variable 2. Chances of abscess at site Various antibiotics,
2. Rapid compare to oral and of injection antiemetics, depot injection
SC route 3. Chances of nerve damage neuroleptics, testosterone.
3. Depot injections can also be leading to paresis
given [Link] volume cannot be
administered
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Deltoid site Vastus lateralis and rectus femoris sites
Locate the lower edge of the acromial process.
Find the lateral quadriceps muscle for the
Insert the needle 1" to 2" below the acromial
vastus lateralis, or the anterior thigh for the
process at a 90-degree angle.
rectus femoris.
Insert the needle at a 90-degree angle into the
middle third of the muscle, parallel to the skin
surface.
Dorsogluteal site Ventrogluteal site
Draw an imaginary line from the posterior With the palm of your hand, locate the greater
superior iliac spine to the greater trochanter. trochanter of the femur.
Insert the needle at a 90-degree angle above Spread your index and middle fingers
and outside the drawn line. posteriorly from the anterior superior iliac
spine to the furthest area possible. This is the
correct injection site.
Remove your fingers and insert the needle at a 90-
degree angle.
You can administer a Z-track injection through this
site. After drawing up the drug, change theneedle,
displace the skin lateral to the injection site,
withdraw the needle, and then release the skin.
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PRECAUTIONS TO BE TAKEN BEFORE INJECTION
• ASEPSIS- To prevent contamination
1. Use sterilized needle and syringe
2. Use distilled and sterile water for injection
3. Handle the drug and equipment with aseptic technique
4. Clean the injection site with the spirit
5. During transportation of injection, use the needle guard or protector .
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HAND WASHING STEPS
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INTRAMUSCULAR INJECTION TECHNIQUE
1. Use an alcohol swab to clean the skin where you will give injection
2. Hold the muscle firmly and insert the needle into the muscle at 90 degree angle with a quick
firm motion
3. After you insert the needle completely release your grasp on the skin
4. Gently pull back on the plunger of the syringe to check for blood
5. If no blood appears, inject all of the solution by gently and steadily pushing down the plunger
6. Withdraw he needle and syringe and press an alcohol swab gently on the spot where the
injection was given.
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IM INJECTION
CHECKLIST
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Preparation
Introduce yourself to the patient.
Confirm patient’s ID.
Explain the procedure and reassure the patient.
Get patient’s consent.
Wash hands.
Prepare the necessary materials.
(Medication should be drawn up into the syringe beforehand and expiration dates checked.)
Check the doctor’s order with the drug to be administrated to ensure correct drug and
Dosage
Put on a pair of clean gloves.
Position the patient in a lying or sitting position and uncover the arm completely.
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The procedure
Identify the injection site* (Select a site free of skin lesions, swelling, tenderness and one
that has not been used frequently).
Clean the site with an alcohol swab using an expanding circular motion or a single wiping
from distal to proximal. Do this 3 times with separate swabs. Let it air dry.
Take the syringe and open its cap.
Hold the syringe (from its barrel) like a pencil or dart with your dominant hand
With your non-dominant hand, taut the gluteal muscle at the site of injection.
Insert the needle at a 90 degree angle to the patient’s skin in a quick, firm motion.
With your non-dominant hand, pull on the syringe's plunger to ensure that you have not entered a blood vessel. (If you
aspirate blood, withdraw the needle and repeat the
procedure at another site with a new needle.)
Inject the drug very slowly.
With your non-dominant hand, take the cotton wool and quickly remove the needle while
applying pressure with the sterile gauze, maintain gentle pressure for a minute.
Observe your patient at least 15 min. for any possible adverse effects of the injected drug.
After the procedure
Dispose of sharps and waste material according to infection control standards.
Ensure that the patient is comfortable. 26
SUBCUTANEOUS INJECTION
SITE- Injection into subcutaneous tissue under the skin
ADVANTAGES DISADVANTAGES
1. Suitable for only small
EXAMPLES
1. Smooth but slower volumes of drugs (max 1ml)
Local anaesthetics (for local
absorption for a longer 2. Irritant drugs cannot be
effect) and insulin (systemic
period administered
effect), Vaccines
2. Depot injections or 3. Not suitable in case of
implants can also be given shock
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Preparation
Introduce yourself to the patient.
Confirm patient’s ID.
Explain the procedure and reassure the patient.
Get patient’s consent.
Wash hands.
Prepare the necessary materials.
(Medication should be drawn up into the syringe beforehand and expiration dates checked).
Check the doctor’s order with the drug to be administrated to ensure correct drug and dosage.
Put on a pair of clean gloves.
Position the patient in a sitting position and expose her/his upper arm.
(Maintain the patient’s privacy and dignity).
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The procedure
Identify the injection site* (Select a site free of skin lesions, swelling, tenderness and one
that has not been used frequently).
Clean the site with an alcohol swab using an expanding circular motion or a single wiping
from distal to proximal. Do this 3 times with separate swabs. Let it air dry.
Take the syringe and open its cap.
Hold the syringe (from its barrel) like a pencil or dart with your dominant hand and place a
sterile gauze between 4th and 5th finger.
Grasp the skin between the thumb and index finger with your non-dominant hand and
pinch up*.
Insert the needle at a 45-90 degree angle to the patient’s skin in a quick, firm motion.
(for thin or muscular people insert the needle at a 45 degree angle to avoid injecting into muscle).
Release the skin that you are grasping.
With your non-dominant hand, pull on the syringe's plunger to ensure that you have not entered a blood vessel.(If
you aspirate blood,withdraw the needle and repeat the procedure at another site with a new needle.)
Inject the drug very slowly.
With your non-dominant hand, take the cotton wool and quickly remove the needle while
applying pressure with the sterile gauze, maintain gentle pressure for a minute.
Observe your patient at least 15 min. for any possible adverse effects of the injected drug.
After the procedure
Dispose of sharps and waste material according to infection control standards.
Ensure that the patient is comfortable. 30
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INTRAVENOUS ADMINISTRATION
SITE- Through lumen of the veins, mainly median cubital vein
ADVANTAGES DISADVANTAGES
1. 100 % Bioavailability 1. Strict aseptic conditions are
2. Quick onset of action needed
Examples
3. Lesser dose is required to 2. Dependency
Glucose, Glucose normal
achieve plasma 3. Painful and Risky
saline, dopamine and NE drips
concentration(emergency) 4. May produce embolism for IV infusion.
4. GIT irritant can be given 5. Drugs in suspension or oily Drugs like antibiotics,
5. Large volume can be infused drugs cannot be administered diazepam.
at a uniform rate [Link] thrombosis and
6. Amount of drug can be thrombophlebitis of vein and
controlled with accuracy necrosis around injection site
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TYPES OF IV DRUG ADMINISTRATION
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IV BOLUS VS IV PUSH
• IV push delivers medication
within seconds in emergencies and
IV bolus takes minutes.
• Both IV treatments deliver
instantaneous results because they
hit the bloodstream faster.
• A qualified medical professional
will determine which type of
treatment to use
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STEP/TASK
Preparation
Introduce yourself to the patient.
Confirm patient’s ID.
Explain the procedure and reassure the patient.
Get patient’s consent.
Wash hands.
Prepare the necessary materials.
(Medication should be drawn up into the syringe beforehand and expiration dates checked.)
Check the doctor’s order with the drug to be administrated to ensure correct drug and
Dosage
Put on a pair of clean gloves.
Position the patient in a lying or sitting position and uncover the arm completely.
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The procedure
Select the site and appropriate vein for injection.
Apply tourniquet 10 cm above injection site.
(Make sure it is not too loose or too tight. When necessary, check if pulse is still present.)
Visualize and palpate the vein using the pads of the fingertips.
(If veins are not visible ask patient i) to close and open the hand ii) apply gentle taps
iii) apply warm/hot pad to selected site to help dilate the veins.)
Clean the site with an alcohol swab using an expanding circular motion or a single wiping
from distal to proximal. Do this 3 times with separate swabs. Let it air dry.
Take the syringe and open its cap.
Stabilize the vein and apply counter tension to the skin.
Insert the needle through the skin at an angle of 30-45 degrees and ensure the bevel is up.
Reduce the angle of the needle and advance approximately 3-5 mm further into the vein.
Aspirate and make sure venous blood appears in the syringe.
(If not, re-adjust position of the needle and aspirate again.)
Release the tourniquet.
Inject the drug very slowly. (Check for pain, swelling, hematoma. If present; withdraw the
needle and repeat the procedure at another site with a new needle.)
Withdraw the needle swiftly. Apply pressure with sterile gauze on the opening, secure it
with an adhesive tape and have patient maintain the pressure.
After the procedure
Dispose of sharps and waste material according to infection control standards.
Ensure that the patient is comfortable. 37
Intravenous (IV) Cannulation
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STEP/TASK
Preparation
Introduce yourself to the patient.
Confirm patient’s ID.
Explain the procedure and reassure the patient.
Get patient’s consent.
Wash hands.
Prepare the necessary materials.
(Medication should be drawn up into the syringe beforehand and expiration dates
checked.)
Check the doctor’s order with the drug to be administrated to ensure correct drug and
Dosage
Put on a pair of clean gloves.
Position the patient in a lying or sitting position and uncover the arm completely.
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The procedure
• Apply tourniquet 10 cm above injection site.
• (Make sure it is not too loose or too tight. When necessary, check if pulse is still present.)
• Select the site and appropriate vein for injection.
• Visualize and palpate the vein using the pads of the fingertips.
(If veins are not visible ask patient i) to close and open the hand ii) apply gentle taps
iii) apply warm/hot pad to selected site to help dilate the veins.)
• Clean the site with an alcohol swab using an expanding circular motion or a single wiping
from distal to proximal. Do it for 3 times with different swabs. Let it air dry.
• Prepare and inspect the catheter.
• Slightly pull the needle from the cannula, turn, and inspect for any defects.
• Stabilize the vein and apply counter tension to the skin.
• Insert the stylet through the skin at an angle of 30-45 degrees and make sure the bevel is up.
• Observe for "flash back" of blood in the chamber of the stylet to confirm a successful entry.
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• Reduce the angle of the needle and advance approximately 1 cm further into the vein.
• Slowly advance the catheter over the needle and into the vein while keeping tension on the
vein and skin.
• Release the tourniquet and quickly remove the needle over the catheter while pressing at
least 0.5 cm above the insertion site to prevent backflow of blood.
• Connect the intravenous tubing immediately and open the regulator.
After the procedure
• Anchor the catheter firmly in place by the use of transparent dressing or tape.
• DO NOT interrupt the flow rate.
• Regulate the rate of flow according to the doctor’s order.
• Ensure that the patient is comfortable.
• Dispose of sharps and waste material according to infection control standards.
• Remove the gloves and wash hands.
• Document the procedure.
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• Thank You
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