med admin sites and admin technique

Oral Med Admin

Raise HOB to High Fowlers position (90 degrees is ideal). Patients may wish to hold solid medications in their hand or cup before placing them in their mouth. Offer water or preferred liquid to help patients swallow medications. Some oral meds must be taken with food, some on an empty stomach.

Sublingual Med Admin

Have the patient place medication under their tongue and allow it to dissolve completely (approximately 15 minutes). Caution patient against chewing or swallowing tablet. They should have nothing to eat or drink until fully dissolved. This route enters the bloodstream after absorbing into tissues and bypasses the liver.

Buccal Med Admin

Place medication between cheek and gums and allow it to dissolve completely (approximately 15 minutes). Caution patient against chewing or swallowing tablet. They should have nothing to eat or drink until fully dissolved. This route enters the bloodstream after absorbing into tissues and bypasses the liver.

Topical-Eye/Optic/Ophthalmic Med Admin

If discharge is present, wipe from inner to outer canthus. Roll dropper bottle to evenly distribute medication. Use medical asepsis (make sure dropper end and inside cap aren’t contaminated). Hold dropper 1-2” above eye. Place drop(s) in lower conjunctival sac. Apply pressure to nasolacrimal duct to prevent systemic response (if drop is meant to dilate the pupil, having this type of medication drain into the sinuses can cause dilation throughout the body, such as vasodilation, which can cause orthostatic hypotension)

Topical-Ear/Otic Med Admin

For older children and adults- pull pinna up and back (straightens ear canal)

For children under age three- pull pinna down and back.

Roll dropper bottle to evenly distribute, and warm, medication (with going deeper into the body, cold solutions, even room temperature, may cause vertigo, tinnitus, or pain). Hold dropper 1-2” above ear. Drops should be placed on the wall of the ear canal, to roll in (this rolling in allows the medication to warm, as well as preventing eardrum injury by having the drop fall there directly). Massage the tragus (to allow medication to pass through inflammation and wax, to go deeper). Patient should remain in a side- lying position for several minutes.

SubQ needle size and syringe size

25g-27g needle OR 28g-31g insulin syringe. Up to 1.5mL volume

Intramuscular needle size and syringe size

18g-25g needle. 1-1.5 inch long. up to 5mL

SubQ Injection sites

1. Dorsolateral aspect of the upper arm, approximately 3 to 5 inches above the elbow.

2. Anterior thigh, approximately 3 to 5 inches above the knee and 3 to 5 inches below the groin.

3. Abdomen, below the costal margins of the ribs, above the iliac crests, and about 2 inches away from the umbilicus (avoiding the beltline

Intramuscular injection sites

1 Deltoid: Locate site by placing four fingers across the deltoid muscle, with the top finger along the acromion process. The injection site is three finger widths below the acromion process.

2 Vastus Lateralis: Anterolateral aspect of the thigh. In an adult, it extends from a handbreadth above the
knee to a handbreadth below the greater trochanter of the femur. The middle third of the muscle is the suggested site for injection.

3 Ventrogluteal: Place heel of the hand over the greater trochanter with the thumb pointed toward the groin. Point the index finger toward the anterior superior iliac spine and extend the middle finger back along the iliac crest toward the buttock. The index finger, middle finger, and iliac crest form a V-shaped triangle, and the injection site is the center of the triangle.