Parenteral Medication Administration

Overview of Parenteral Medication Administration

Involves injecting a medication into body tissues.
Types of parenteral administration:
  - Intradermal (ID): Injection into the dermis just under the epidermis.
  - Subcutaneous (SC): Injection into the tissues just below the dermis.
  - Intramuscular (IM): Injection into a muscle.
  - Intravenous (IV): Injection into a vein.
Absorption rates:
  - IM and SC medications are absorbed more quickly than oral medications.
  - IM injections enter the bloodstream quicker than SC injections.
  - IV injection produces the most rapid absorption as medications are immediately available in systemic circulation.

Patient Assessment Factors

Medical History: Comprehensive review of the patient's health background.
Plan of Care: Evaluate if the medication aligns with the overall patient care strategy.
Vital Signs: Assess parameters to ensure the medication's safety for administration, particularly for medications that have specific prerequisites (e.g., BP medications, narcotics, digoxin).
Allergies: Verify any known allergic reactions the patient may have.
Current Medications: Review all prescriptions and over-the-counter medications.
Lab Values: Analyze relevant lab results that may affect medication administration (e.g., INR for warfarin, platelet levels for enoxaparin).

Infection Prevention Techniques

Recognize parenteral administration as an invasive procedure necessitating aseptic technique to reduce infection risks.
Guidelines for preventing infection:
  - Draw up medication promptly and avoid exposing ampules unnecessarily.
  - Prevent contamination of needles and syringes by ensuring surfaces remain untainted.
  - Cleanse the injection site with soap and water if soiled; if using an antiseptic swab, apply in a circular motion from the center outwards.

The Seven Rights of Medication Administration

The right medication: Ensure the correct drug is administered.
The right dose: Confirm that the dosage is appropriate.
The right patient: Verify the identity of the patient receiving the medication.
The right route: Consider the correct route of administration for the medication.
The right time: Administer medications at the scheduled time.
The right documentation: Accurately record medication administration.
The right indication: Ensure that the rationale for medication administration is strong.

Strategies for Preventing Medication Errors

Preparation Process:
- Prepare medications for one patient at a time.
Labeling:
- Label all medications and containers clearly in both operative and other procedural settings.
Medication Label Checks:
  - Read labels at least three times:
    1. When removing from storage.
    2. Before taking to the patient.
    3. Just prior to administration.
Patient Identifiers:
- Use at least two identifiers (e.g., name, date of birth).
Distractions:
- Minimize interruptions during medication administration to avoid errors.
Double-Check Calculations:
- Always verify dosage calculations and high-risk medication processes with another nurse.
Clarification of Orders:
- Do not attempt to interpret illegible handwriting; always confirm with the prescriber.
Documentation:
- Document medication administration immediately after giving the medication.
Error Handling:
- Reflect on errors and complete an occurrence report according to agency policy.
- Seek in-service education regarding commonly administered medications.

Role of Fatigue in Nursing Errors

Recognize that tired nurses are more prone to making errors.
Maintain personal well-being to ensure high levels of care.
Involve patients in their medication administration and actively address their concerns regarding medications.
Utilize technology for medication administration, avoiding overrides of alerts or mechanisms thoughtlessly.

Chemotherapy Medications

Definition: Chemotherapy refers to antineoplastic drugs that kill rapidly dividing cells.
Administration Forms: Can be administered either IV or orally.
Certification Requirement: Nurses must receive specialized certification for administering IV chemotherapy, while oral forms can be given by RNs without additional certification.
Contact Precautions: Chemotherapy is highly toxic and can be harmful to those who come into contact with it, as patients excrete these chemicals through various means (urine, stool, vomit, sweat, saliva).

Types of Syringes

Single Use: Syringes are disposable.
Types:
- Luer-Lok: Needle twists onto the tip and locks.
- Non-Luer-Lok: Does not use locking mechanism.
Sizes: Ranges from 0.5 to 60 mL.
  - Use 1-3 mL syringes for SC or IM injections.
  - Larger syringes are needed for IV medications or wound irrigation.
  - Tuberculin Syringe: 1 mL capacity, calibrated in sixteenths of a minim and hundredths of a mL.
  - Insulin Syringes: 0.3 to 1 mL; available in low-dose variations (30 or 50 units per 0.3 or 0.5 mL).

Needles Specifics

Characteristics: All needles are disposable and consist of three parts:
  - Hub: Attaches to the syringes.
  - Shaft: The lengthy middle section.
  - Bevel: The slanted tip of the needle that creates a narrow slit in the tissue.
Length Variations: Ranges from ¼ to 3 inches; selected based on the patient's size/weight and tissue type.
Gauge Selection: The gauge number indicates the diameter—smaller gauge number corresponds to a larger diameter. Selection depends on fluid viscosity being injected or infused.

Injection Techniques

Preparing an Injection

Ampules: Contain single doses; require snapping the neck to open. Use a filter needle to aspirate into a syringe.
Vials: Either single-dose or multi-dose; contain liquid or dry medication forms. Follow specifications regarding diluents and reconstitution.

Mixing Medications

Medications can be mixed only when compatible and within acceptable limits; always consult reference materials like Micromedex.
General guidelines:
- Vials/Ampules: Prepare from vial first, then withdraw from the ampule.
- Two Vials: Ensure non-contamination and accuracy of final dose while maintaining aseptic technique.

Insulin Administration

Uses: Treatment of diabetes with concentrations such as U-100 (100 units/mL) and U-500.
Insulin types include rapid, short, intermediate, and long-acting, possibly needing combination administration.
Administration Sites and Methods: Preferred site for rapid-acting insulin is the abdominal wall; should rotate injection sites. Insulin may be mixed in syringes if compatible, with the regular insulin drawn first. Note: Roll cloudy insulin (do not shake) to mix thoroughly.

Injection Guidelines

For IM:
- Typical volumes: 3 mL for adults, 1-2 mL for children, up to 0.5 mL for infants.
- Sites include ventrogluteal, vastus lateralis, and deltoid. Use anatomical landmarks for accuracy.
For SC:
- Recommended needle size: 25-gauge, ½ to 5/8 inches.
- Common sites: outer posterior aspect of upper arms, abdomen, and anterior thigh.
Intradermal injections are utilized for skin testing at a site free of lesions and hair. Bleb formation indicates successful administration.

Needlesticks & Safety Procedures

Use needleless systems when possible and avoid recapping used needles.
Plan for safe disposal of sharps prior to use and engage safety mechanisms.

Evaluation of Outcomes

Assess safety of medication administration and patient response post-medication (e.g., pain level).
Patient education should address what medications they are taking and details about side effects; verify affordability for prescriptions.
Effectiveness of education can be evaluated through teach-back methods and return demonstrations, assessing understanding of medication use.

Conclusion

Parenteral medication administration requires a comprehensive understanding of procedures, patient assessment, and safety practices to minimize risks associated with medication errors and ensure effective patient outcomes.