Medication Administration Routes

Routes of Medication Administration

Non-Parenteral Routes

  • Buccal Route: Medication is placed between the cheek and gums where it directly enters the bloodstream.
  • Enteral Route (NG, GIT, PEG): Delivered via a tube directly into the gastrointestinal (GI) tract. Tube placement must always be verified prior to administration.
  • Skin / Transdermal Patches: Applied to clean, hairless skin for local or systemic effects (e.g., Nicotine, Fentanyl). Transdermal patches have a slower onset of action and require site rotation with each application.
  • Ophthalmic Route (Eye Drops): Instilled into the lower conjunctival sac while the patient looks upward.
  • Otic Route (Ear Drops): When administering to adults, pull the auricle up and back.
  • Nasal Spray: The patient sits in a supine position and inhales during administration.
  • Rectal Route: Patient is placed in the Sims position, and the medication is inserted 2−3 inches2-3\,\text{inches}.

Parenteral Injections

  • Intradermal (ID):
    • Injection Location: Injected into the dermis directly under the epidermis.
    • Angle of Insertion: 5∘−15∘5^\circ - 15^\circ with the bevel facing up.
    • Syringe and Needle Equipment: Tuberculin syringe with a 26−27 gauge26-27\,\text{gauge} needle.
    • Anatomical Sites: Inner forearm, upper back under the scapula.
    • Expected Response: Creates a small "bleb" or "wheal".
  • Subcutaneous (SQ / SC):
    • Injection Location: Injected into adipose (fat) tissue.
    • Angle of Insertion: 45∘−90∘45^\circ - 90^\circ (pinch an inch of tissue; use a 90∘90^\circ angle for obese patients).
    • Syringe and Needle Equipment: 25−27 gauge25-27\,\text{gauge} needle, or 28−31 gauge28-31\,\text{gauge} insulin needle.
    • Anatomical Sites: Abdomen, upper outer arm, anterior thigh.
  • Intramuscular (IM):
    • Injection Location: Injected directly into muscle tissue.
    • Angle of Insertion: 90∘90^\circ.
    • Syringe and Needle Equipment: 18−27 gauge18-27\,\text{gauge} needle.
    • Anatomical Sites: Ventrogluteal, vastus lateralis, deltoid.
  • Intravenous (IV):
    • Injection Location: Delivered directly into the bloodstream for immediate effect.
    • Administration Safety Principle: Never give too much medication too quickly.
    • Administration Methods:
      • IV push
      • IV bolus (rapid administration)
      • Continuous infusion
      • Intermittent infusion

Medication Verification, Orders, and Safety

Three Medication Checks

Medications must be checked exactly three times prior to administration:

  1. Before retrieving medications.
  2. After retrieving medications.
  3. After prepping medications.

Components of a Complete Medication Order

A complete medication order must contain the following components:

  1. Patient's full name and Date of Birth (DOB).
  2. Date and time the order was written.
  3. Drug name (generic name preferred).
  4. Dosage and administration details.

Medication Error Management Procedure

When a medication error occurs, execute the following step-by-step management protocol:

  1. Assess the patient immediately.
  2. Notify the provider using SBAR (Situation, Background, Assessment, Recommendation).
  3. Inform the patient.
  4. Document the event.
  5. Complete an internal safety report.

Pharmacokinetics and Blood Concentration Concepts

  • Therapeutic Range: The blood concentration required to produce the desired effect without causing toxicity.
  • Peak Level: The highest concentration of a drug in the blood, indicating the rate of absorption.
  • Trough Level: The lowest concentration of a drug in the blood, indicating the rate of elimination.
  • Half-Life: The time required for 50%50\% of the drug concentration to be eliminated from the body.

Pharmacological Terminology and Adverse Effects

  • Side Effect: A predictable, mild, and often tolerable secondary effect of a medication.
  • Adverse Effect: An undesired and harmful effect.
  • Allergic Reaction: An immune response where the body forms antibodies against the drug.
  • Toxicity: A harmful accumulation of a drug in the body due to impaired metabolism, impaired excretion, or overdose.
  • Tolerance: A reduced response to a drug requiring larger doses to achieve a therapeutic effect.
  • Contraindications: Specific conditions under which a drug should not be given due to potential serious harm.

Intravenous Therapy Complications and Central Line Maintenance

Needleless Connection Maintenance

  • Scrub the Hub: Always friction-scrub needleless connections with alcohol for 15+ seconds15+\text{ seconds} to prevent Central Line-Associated Bloodstream Infection (CLABSI).

Intravenous Therapy Complications

  • Infiltration: Unintended leakage of a non-vesicant solution into the surrounding tissue.
  • Phlebitis: Inflammation of veins.
  • Extravasation: Leakage of a vesicant medication into surrounding tissue, causing severe tissue integrity impairment, blistering, or necrosis.