Parenteral Medication Administration

Fundamentals of Nursing (NUR 112) Unit 2 Pharmacology content on Parenteral Medication Administration including SC, IM, ID injection content and insulin and heparin content.

Parenteral Medications

Medications that are injected or infused into body tissues or into the bloodstream.

Rapid action

When medications need to take effect quickly, parenteral medications are used as they are absorbed faster.

Luer Lock

A type of syringe tip that twists on securely.

Non-Luer Lock

A type of syringe tip that slips on.

Tuberculin syringe

A 1 mL syringe calibrated in 0.01 mL increments, used for small volumes of medication.

Hypodermic syringe

A 3 mL syringe calibrated in 0.1 mL increments, typically used for volumes greater than 1 mL.

Insulin syringe

A syringe calibrated for insulin administration, used for insulin only.

Gauge

The diameter of the lumen of a needle, with smaller gauge numbers indicating larger diameters.

Length

The distance from the hub to the tip of a needle.

Bevel

The slanted tip of a needle that creates an opening for medication administration or blood withdrawal.

Sharps Containers

Containers used for the safe disposal of used needles and other sharp medical instruments.

Intramuscular Administration

Administration of medication into the muscle tissue.

Subcutaneous Administration

Administration of medication into the subcutaneous tissue, between the skin and muscle.

Angle of Insertion

The angle at which a needle is inserted during administration, varies depending on the route of administration.

Z-track technique

A technique used during intramuscular injections to minimize pain and tissue irritation.

Which has a slower absorption rate: subcutaneous administration or intramuscular administration?

Subcutaneous administration

Why is it important to rotate sites?

To minimize scarring and hardening of fatty tissues.

Insulin

Hormone secreted by the islets of Langerhans in the pancreas that regulates blood sugar levels.

Categories of Insulin

Basal insulin, prandial (mealtime) and preprandial (a.c. and/or p.c.) insulins, and combination/mixed insulin

Sliding Scale Insulin (SSI)

A method of administering insulin based on the client's blood glucose level.

Never mix other insulins with _________________.

Lantus or Levemir

What is heparin?

A natural substance in the liver that prevents clot formation and is used as an anticoagulant.

When is heparin given?

When rapid anticoagulation is needed due to blood clot formation (deep vein thrombosis-DVT), pulmonary embolism (PE), or stroke (CVA)

Low Molecular Weight Heparin (LMWH)

A derivative of standard heparin with decreased risk of bleeding and more stable responses.

Why does intramuscular administration provide a more rapid effect than subcutaneous admistration?

Due to rich blood supply

Why is the Z-Track method used?

To minimize irritation and staining of medications during injections.

Ampules

Glass containers used for storing medications, which need to be handled with caution.

Vials

Glass or plastic containers with rubber stoppers used for storing medications.

Cartridges

Prefilled containers used for administering medications.

True or false: heparin sodium for injection and heparin lock solution can be used interchangeably.

FALSE-read labels carefully!

Too large a dose of heparin can cause what?

Hemorrhage

Too low a dose of heparin can cause what?

Thrombosis or emboli

What lab values are used to monitor heparin?

Partial thromboplastin time (PTT) and activated thromboplastin time (aPTT)

Dosage of heparin is based on a client’s __________.

Weight

Heparin is given IV as ___________?

Bolus or infusion (in units per hour)

Heparin is given subcutaneously in what site?

The abdomen

What increases the absorption of insulin?

Heat

What factors can increase the need for insulin?

Illness and stress

What is the correct order for mixing insulin? (4 steps)

1. Air into cloudy

2. Air into clear

3. Draw up clear

4. Draw up cloudy

What types of insulin are clear?

Regular, rapid acting, and long acting insulin

What types of insulins are cloudy?

Intermediate acting insulin, and USUALLY premixed insulin

What TYPE of insulin cannot be mixed?

Long-acting insulin

eg. Glargine (Lantus) and Determir (Levimir)

Regular insulin

Humulin R

NPH insulin

Humulin N

List 3 methods of delivering insulin.

Syringes, pen injectors, and pumps

What should you check before administration of insulin?

Glucose levels/blood sugar

What should you assess for after giving insulin?

Hypoglycemia (cool, clammy skin), confusion, agitation, decrease level of consciousness, thick slurred speech

Short acting insulin onset, peak, and duration times

Onset 30 min, peak 2-3h, duration 3-6h

Rapid acting insulin onset, peak, and duration times

Onset 15 min, peak 1h, duration 2-4h

Intermediate acting insulin onset, peak, and duration times

Onset 2-4h, peak 4-12h, duration 12-18h

Long acting insulin onset, peak, and duration times

Onset 2h, NO PEAK TIME, duration up to 24h

Premixed insulin onset, peak, and duration times

Onset 5-60 min, PEAK VARIES, duration 10-16 hours

Nonfunctioning GI system

When a client is unable to take medications orally due to their gastrointestinal system not functioning properly.

What gauge and needle length is needed for an intradermal injection?

#25-#27 gauge; 1/4"-1/2" length

At what angle do you give an intradermal injection?

5-15 degrees

Name the locations of intradermal injections.

Inner mid-forearm, clavicular area of chest, scapular area of back

How much of the needle inserts under the skin in an intradermal injection?

about 1/8th of the needle tip

What volume of medication can you inject in intradermal injection?

0.01-0.1mL

What are the subcutaneous injection sites?

Abdomen, upper outer thighs, upper buttocks, upper back, upper outer arms

What needle gauge and needle length do you need for a subcutaneous injection?

#25-#30 gauge; 3/8"-1”

How much skin do you pinch for an adult subcutaneous injection?

1"; 2" for obese clients

What are some examples of subcutaneous injections?

Vaccines, Insulin, Heparin, Enoxaparin (Lovenox)

What are some examples of intradermal injections?

TB and PPD

What size syringe would you pick for a subcutaneous injection?

1-3mL hypodermic or U-100 insulin syringe (FOR INSULIN ONLY)

What volume of medication can you inject in a subcutaneous injection?

0.5-1 mL

What are the intramuscular injection sites?

Deltoid, Vastus Lateralis, Ventrogluteal, and (AS A LAST RESORT ONLY) Dorsogluteal

What amount of medicine can be injected IM in the ventrogluteal muscle?

1-4 mL

What amount of medicine can be injected IM in the vastus lateralis muscle?

0.5-2 mL (1 mL for infant/child)

How much medicine can be injected IM into the deltoid muscle?

0.5-2 mL

What syringe size do you use for an IM injection?

3-5mL hypodermic syringe

What needle gauge and length do you need to administer and IM injection in an adult?

#18 gauge (viscous meds) -#25 (#22 gauge for most meds); 5/8” to 1 ½”

Name some examples of an IM injection.

Flu, HalDol, tetanus

Why use the "Z-Track" technique ofr IM injections?

Reduces medication leakage into subcutaneous tissue and reduces pain.

How fast do you push and injection?

1mL every 10 seconds

What needle gauge and length do you need to administer and IM injection in a child?

#25-#27; 5/8”-1 1/2”

What needle gauge and length do you need to administer and IM injection in an infant/small child?

#25-#27; 5/8”

What amount of medicine can be injected IM in the dorsogluteal muscle?

1-4 mL

When giving an IM injection, always _________.

Aspirate before injection

Deltoid landmarks

Acromion process and axilla

Vastus lateralis landmarks

Greater trochanter, lateral femoral condyle, anteriolateral aspect of leg

Ventrogluteal landmarks

Greater trochanter, anterior superior iliac spine, posterior iliac crest

Dorsogluteal landmarks

Posterior iliac crest, gluteal fold