Parenteral Medication

Parenteral Medication 

Injections are parenteral therapy. It means giving of therapeutic agents including food outside the alimentary tract.

Injection is the forcing of a fluid into a cavity, body tissue, blood vessels through a hallow tube or needle.

Purposes of Injection

• to experience the drug's quick and widespread effects.
• Some drugs must be administered parenterally because they cannot be given by mouth.
• The effect of gastric juice on some drugs, such as insulin, renders them ineffective in the gastro intestinal system.
• Due to vomiting, diarrhea, or gastric suction, some are not held in the colon for long enough to be absorbed.
• Some medications have low gastric absorption.
• when a medicine causes gastro intestinal mucosal irritation and toxicity.
• to have the desired impact when the patient is unable to cooperate, asleep, or unable to swallow owing to medical or surgical issues.
• To achieve a local effect at the injection location, for example

• For diagnostic purpose (tuberculin test)
• For local anesthesia (Injection xylocaine)
• To test the allergic condition of the drug e.g. penicillin.
• To treat local conditions e.g. hydrocortisone injection into joint cavity (for pain, swelling)
• To restore blood volume and electrolyte balance by replacing fluid e.g. in shock conditions.
• To give nourishment when it cannot be taken through the mouth.

Advantages

• Quick action
• Absorb completely
• Most effective in emergency case
• Useful for unconscious or vomiting patients
• Safe for those who cannot take from oral
• Can be given drugs which are inactive by gastrointestinal tract or medication that are poorly absorbed or irritating to the gastrointestinal tract.

Disadvantages

• Painful and causes infection at the site of injection.
• Aseptic technique must be maintained during the preparation and administration of the drug.
• It is possible for the needle to break off the tissue.
• An irritating or slowly absorbed drug may cause tissue necrosis, skin slough, abscess and persistent pain.
• Injury to the nerve or vital structure.
• It can easily cause anaphylactic shock and adverse reactions if care is not taken. (rapid onset of adverse reaction)
• Air embolism.
• Require trained manpower.
• Costly/expensive.

General Instruction

• Be sure to receive the doctor's written approval before administering an injection.
• Use only aseptic approach for sterilizing the tools, making the three drugs, and administering the injections.
• The needle should be sharp and patent, and the syringe should be airtight.
• Before injecting the medication into the patient, swap out the needle after removing it from the rubber-sealed container to prevent infection.
• Prior to administering injections, observe the rights of medicine administration.
• Ask the patient about his medical history and find out if he has ever received this kind of injection. Ascertain the patient's pharmacological allergies. In the case of penicillin and all types of sera, always provide a test dosage to check for allergic responses.
• Always keep the patient relaxed and comfortable while administering an injection. Give the injections while lying down or leaning to one side with your knee flexed. Ask the patient to stretch their arm at the elbow after the deltoid injection is administered to help the shoulder muscles relax.
• Choose the ideal location to administer the shots. The website will vary depending on the kind of drug, the quantity ordered, and the administration route.
• Avoid bony prominences, and look for any tissue induration there.
• To avoid lipodystrophy, switch up the injection site, especially for patients receiving insulin. (Waste of subcutaneous tissue) Use the proper injection technique. Quickly and carefully insert the needle, inject the medicine slowly, then quickly and gently remove the needle. This will lessen injection pain. planger
• In the case of intramuscular or subcutaneous injection, always remove the piston after insertion to ensure that it is not in blood vessels; if blood is present in the syringe, remove the needle and administer the injection at a different place.
• After administering the injection, watch the patient for a while.
• Clear, sterile, and nearly neutral in response should characterize the injection solution.

Factors that Favor Absorption

• Blood supply to the area: Fluids injected into the blood stream will act quicker than any other methods used.
• The composition of the fluid injected: Solubility and diffusibility of the fluid.
• Application of heat: Heat dilates the blood vessels and increases circulation; therefore, the heat applied over the site of injection increases the rate of absorption.
• Massage: It stimulates the local blood supply and increases the rate of absorption.
• Circulation time of the blood: Absorption of medicines and fluids injected to the body will diminish in a person who has venous congestion (edema)
• Physical condition: The local disease condition of the skin and underlying tissues such as 10 10 9312 skin lesions, inflammations etc. delays the absorption of the drug.

Syringes

A syringe and a needle are essential to give parenteral medications. Syringes are made of glass and plastic. Glass syringes need to be sterilized.

Types of Syringe:

• Tuberculin
• Insulin
• Standard syringes

Tuberculin Syringes: It is 1 ml syringes that are calibrated with 0.1 ml marking and supplied with a small gauge (26 to 28 gauge) and short (about 0.5 inch) needle. It is used to administer tuberculin or sensitivity tests.

Insulin Syringes: It is a special syringe, which is graduated to 40, 80 or 100 units. Hence it is useful to give insulin in required units. It is made in 0.5 or ml sizes with very small gauge needles attached.

Standard Syringes are supplied in 3, 5, 10, 20, 50 ml sizes. Standard syringes may be supplied without needles or with 18,21,22,23 or 25 gauge needles that are 0.5 to 3 inches long.

Parts: Syringes have two parts, a barrel and a piston or plunger that fits inside the barrel.

Needles: A needle has three discernible parts: the hub which fits on to the syringe; the cannula or shaft which is attached to the hub; and the bevel which is the slanted part at the tip of the needle. A disposable needle has a plastic hub.

Ampule: The ampule is a glass container usually designed to hold a single dose of a drug. It is made of clear glass and has distinctive shape with a constrictive neck. Ampules vary in size ranging from 1 to 10 M1 or more. Most ampule neck has colored marks around it, indicating where they are pre-scared for easy opening.

Vial: A vial is a small glass bottle with a sealed rubber cap. Vials come in different sizes from single to multi dose vials. They usually have a metal or plastic cap that protects the rubber seal.

Criteria for Selection of Syringe and Needle

Intradermal: Tuberculin syringe or / 1ml calibrated in 0.01 units. 26 to 27 gauge diameter and 3/8 to 5/8 length size of needle used.

Sub-cutaneous: Insulin syringe or / 1ml calibrated in 40 to 80 units syringe. 25 gauge and ½ to 5/8 inches syringe is used.

Intra muscular: 2.5 ml syringe is commonly used. It is calibrated in 0.2 ml, 21, 22, 23 gauge, 1 to 2 inches in length needles are used.

Intravenous: The size depends upon the amount of fluids to be injected 18 to 20 gauges 1 to 2 inches needles used.

Preparation of Drugs for Injection

• Check the patient's name and medication order including medication name, dose and the route of administration.
• Perform hand washing and assemble equipment.
• Check medication order and check the label for the name of medication, dose and date of expiry.
• Prepare medication.

Ampule Preparation

• Pick up the ampule and tap the top of the ampule lightly and quickly with a finger until fluid moves from the neck of the ampule.
• Place small gauge pieces or cotton swab around the neck of the ampule.
• Partially file the neck of the ampule if necessary for a clean break.
• Snap the neck of the ampule quickly and firmly away from hands.
• Discard the broken neck appropriately; place the ampule on a flat surface. Insert a needle into the center of the ampule opening and withdraw the correct amount of medication by pulling up on the plunger. Do not allow the needle tip or shaft to touch the rim of the ampule.
• Keep the needle tip under surface of liquid. Tilt the ampule to bring all fluid within reach of the needle. If air bubbles are aspirated, do not expel air into the ampule. Air pressure may force fluid out of ampule and medication will be lost.
• Expel excess air bubbles; remove the needle from the ampule. Hold the syringe with the needle pointing up. Tap the side of syringe to cause bubbles to rise toward the needle. Draw back slightly on plunger and then push the plunger upward to eject air. Make sure that the syringe contains the right amount of medicine.
• If a syringe contains excess fluid, use a kidney tray for disposal. Hold the syringe vertically with the needle tip up and slanted slightly toward the kidney tray. Slowly eject excess fluid into the kidney tray. Recheck the fluid level in the syringe by holding it vertically at the eye level.
• Cover the needle with its safety sheath or cap. Replace the needle with another needle for injection. The outer surface of the needle may be coated with medication, which may cause tissue irritation. Discard the ampule in a container.

Preparation from Vial

• Grab the vial. If the medication has been reconstituted or is suspended, rotate the vial between your palms rather than shaking it to mix the solution. Aqueous suspension is present in certain vials, which settles when they are upright. Bubbles produced by shaking can obstruct precise measurement. aolddud
• To reveal the sterile rubber seal, remove the cap covering the top of the empty vial. The cap is already off of a multi-dose vial that has been used before. list listings sd fodel)
• With an alcohol swab, quickly and firmly wipe the rubber seal's surface in a circular motion, then let it air dry.
• To remove the needle cap, prick up the syringe. To get the right amount of air into the syringe to aspirate the drug from the vial, pull back on the plunger. To avoid a buildup of negative pressure in the vial when aspirating medication, air must be introduced into it.
• Insert the needle tip into the vial, beveled end first, through the middle of the rubber seal, with the vial on a flat surface. While inserting, apply pressure on the needle's tip.
• Keep the needle's bevel above the medication's surface as you inject air into the vial. Bubbles are produced when air is injected into the solution, which could prevent the correct dosage of medication from being withdrawn.
• Holding the syringe and plunger back will cause the vial to invert. Hold the vial in your non-dominant hand between your thumb and middle fingers. To counteract pressure in the vial, grasp the end of the syringe barrel and the plunger with your dominant hand's thumb and fourth finger.
• Keep the needle's tip below the fluid line.
• Allow the vial's air pressure to gently dispense medication into the syringe. If necessary, slightly retract the plunger to get the right volume of solution.
• Once the necessary volume has been produced, insert the needle into the vial's air gap and gently tap the barrel of the syringe to remove any air bubbles.
• By drawing back on the syringe's barrel while being careful not to pull the plunger, remove the needle from the vial.
• In order to assure the proper volume and absence of air bubbles, hold the syringe at eye level at a 90 degree angle. If there are any air bubbles, remove them. To evacuate air, slightly pull back on the plunger before pushing it up. Don't spit out liquids. Verify the dosage once more.
• Depending on the pharmaceutical route, adjust the needle's gauge and length.
• Make a label for the multi-dose vial that specifies the date of mixing, the medication's concentration per ml, and the nurse's initials.
• If you want to mix medication from two vials in one syringe, inject the proper amount of air into each vial first, then take the prescribed amount from each vial.
• If utilizing both multiple dosage and single dose vials, take the dose first from the multiple dose vial to avoid any single dose contamination.
• Some medications come in powder form, so you must dilute them before using. It is possible to put vials of the appropriate diluent alongside vials of the powdered medicine. The quantity and kind of diluent to add should be specified in the manufacturer's directions written on the drug box or vial.
  •  To reconstitute the medicine, remove the cap covering the vial of powdered medication and cap covering vial/ampule of proper diluents. Firmly swab both seals with alcohol swab and allow it to dry.
  •  Draw up diluents into a syringe from the vial or ampule.
  •  Insert the tip of needle through center the of rubber seal of the vial containing powdered medication. Inject diluents into vial. Remove needle.
  •  Mix medication thoroughly by rolling in the palms. Do not shake. Shaking produces bubbles.
  •  Reconstituted medication in the vial is ready to be drawn into the new syringe. Read the label carefully to determine the dose after reconstitution.ed sit Haw Clean work area and perform handwashing
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Articles Required

• Syringe with needle,
• Alcohol swab,
• Medicine in vital or ampule,
• Gauge piece or cotton,
• Saw or file to cut or open the ampule,
• Kidney tray,
• Distilled water,
• Trolley,
• Tray,
• Gloves if needed,
• Cardex.