Parenteral Medications Unit XIII Keith Rischer, RN, MA, CEN, CCRN.

Parenteral MedicationsUnit XIII

Keith Rischer, RN, MA, CEN, CCRN

Definitions

ParenteralIntradermal (ID)SubcutaneousIntramuscular (IM)Intravenous (IV)

If not done correctly…

A drug response that is too rapid or too slow

Nerve injury with associated pain Localized bleeding Tissue necrosis Sterile abscess Decreased therapeutic effect

Syringes

Syringe PartsTipBarrelFlangePlungerSafety Shield

Syringes

RisksSyringe Sizes

HypodermicInsulinTB

Needles

Parts of the NeedleHubShaftBevelLumenSheath

Needles

Length 1/2” to 1 1/2”Intradermal

25 to 27g Three eighths to five eighths of an inch

Subcutaneous

25 to 27g

Three eighths to five eighths of an inch

Intramuscular

20 to 25g

One half to 1 1/2 inches

Safe Administration

HandwashingGlovingAsepsis6 RightsAllergiesSitesKnowledge of Meds

Check for Tissue Injury

Recapping NeedlesSharps ContainerNeedle Sticks

Selection of Injection Site

Amount and character of medicationWhat is the amount and condition of the

muscle mass?What is the frequency of the injection?

Preparing an Injection

AmpulesVials

Multi dose vials

Carpujects

Reconstituting Medications

Make sure correct solution Roll gently If viscous use 18g needle

Site Preparation

Hand hygiene Prevent contamination

Syringe Needle

Cleanse site Alcohol swab Chloroprep

Apply gloves

Intradermal Injection

Indications Needle Size Syringe Size Angle of insertion Amount Site

Inner Forearm Upper Back

Subcutaneous Injection

AdvantageDisadvantageNeedle SizeSyringe SizeAngleAmount

Sub-q Injection Sites

Upper ArmAnterior ThighUpper BackLower BackAbdomen

Sub-q Heparin

DO: Abd. only 3/8” 25/26 g.

90 degree angle

DO NOT: Inject into an area of

ecchymosis Aspirate prior to

injection Massage area

following injection

Intra-Muscular Injection: IM

Advantage Disadvantage Needle Size Syringe Size Angle Amount Z-Track

IM Sites: Ventrogluteal

SiteLocationRiskPositionUses

IM Sites: Vastus Lateralis

SiteLocationRiskPositionUses

SiteLocationRiskPositionUses

IM Sites: Deltoid

Determining Site & Needle Size

Amount & Characteristic of MedicationAmount & Condition of Muscle MassFrequency of InjectionType of MedicationAgeRecommended Route

Comfortable Injections

Appropriate Needle Position of Client

Relax muscle Proper Injection Site

Rotate sites Insert Needle Quickly

Hold syringe steady Diversion Z-Track

IM Injection: Z Track

Pull skin laterally 1-1.5” Hold taut w/nondominant hand

Release skin after needle removed Less pain and more effective delivery

Complications of IM Injections

InfectionLipodystrophyNerve DamageEcchymosis

Diabetes Mellitus: Patho Insulin is secreted by the Islets of Langerhans

(Beta Cells) Insulin lowers blood glucose levels after meals Insulin moves glucose from the blood into the

muscle, fat, liver, and cells Types

I-IDDM II-NIDDM

Diabetes Mellitus

Normal Blood Glucose99 mg/dl – upper level of normalHemoglobin A1c

Type II MedicationsStimulates the pancreas to release more insulin and to

increase sensitivity of body cells to insulinGiven twice daily, before meals

Glyburide (Diabeta) Glucophage (Metformin) Rosiglitazone (Avandia)

Insulin: Subcutaneous (35-10, p.743 P&P)

Rapid-acting (lispro, aspart-

Novolog) Short-acting

(Regular) (CLEAR) Intermediate-acting

(NPH) (CLOUDY) Long-acting

Glargine (Lantus)*

Insulin: Nursing Implications

Monitor & assess for hypoglycemia Anxiety/restlessness Tremors Diaphoretic Cool/pale Altered LOC

Confusion…lethargy…unconscious

Glucagon 1mg dose-may repeat in 15” Give subq or IM if unresponsive

Insulin: Subcutaneous Given 1-4 times daily Room Temperature for 30

Minutes Gently roll, look for

flocculation Must use syringe that

matches the insulin (U-100)

Verify dosages with another Nurse

If mixing do not keep in syringe longer than 15 minutes

Blood Glucose Monitoring

Done 2-4 times per day if on subq insulin

Done 3-4 times per week if on oral hypoglycemic (Oral Diabetic) therapy

Sliding Scale

Heparin

Mechanism of action Low dose

Prevents conversion of prothrombin to thrombin

High dose Prevents

conversion of fibrinogen to fibrin

Table Scenarios:1. Heparin 5000 units

subcut. For 65 yr old male who weighs 220 lbs

2. Morphine 4 mg IM for 88 yr female who weighs 92 lbs

3. Regular Insulin 10 units for 45 yr male who weighs 160 lbs

4. Ketorolac (Toradol) 60 mg IM for 60 yr male who weighs 310 lbs

5. Mantoux 0.1cc ID for 25 yr female nurse as part of yearly screening

6. Heparin 20,000 units/ml12,000 units bid…amount?

7. Dilaudid 10 mg/ml4 mg IM now…amount?

8.Ondansetron 4 mg/ml6 mg IM now

9. Glucose 354NPH 20 units with low dose scale…

10. Glucose 266 NPH 15 units with high dose