Administering Medications

Intradermal Administration

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Intradermal

Administration

• An intradermal (I0) injection is the

injection of a small amount of fluid into the dermal layer of the skin.

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• It is frequently done as a diagnostic

measure, such as for tuberculin testing (screening test for tuberculosis referred to as a tine test) and allergy testing (placing very small amounts of the suspected antigen or allergen in a solution under the skin). The intradermal injection is made in skin areas of the body that are soft and yielding.

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• Often the tuberculin syringe is the only syringe with fine enough calibrations to measure the minute dose that is used. A

26-gauge needle, which is one-fourth to one-half inch in length, is usually selected. The fluid is in a small welt or “wheal” (a small swelling of the skin due to the medication placed under the skin)

just under the surface of the skin and between its layers.

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dermis sebaceous gland

subntaneous

IasOii

follde

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PROCEDURE FOR

ADMINISTERING AN

INTRADERMAL INJECTION

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PROCEDURE FOR ADMINISTERING AN
INTRADERMAL INJECTION

• Use only acetone or alcohol to clean injection site and allow the area to dry before injection is administered.

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PROCEDURE FOR ADMINISTERING AN
INTRADERMAL INJECTION

• Select Injection Site and Prepare Patient.

– Selecting site. Usually palmer (inner) forearm or sub scapular region of the back is selected. The site selected should be an easily obtainable area and relatively free from being rubbed by clothing.
– Position patient. To position the patient, proceed as follows:

• Place arm in a relaxed position, elbow flexed.

• Place palm up, exposing palmer or inner arm area.

• Prepare Injection Site.

• Remove Needle Guard. Pull the guard straight off.

• Stabilize Injection Site.

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PROCEDURE FOR ADMINISTERING AN
INTRADERMAL INJECTION
– Using your non dominant thumb, apply downward pressure, directly below and outside the prepared injection site. (Do not draw the skin back or move the skin to the side because the skin will return to its normal position when pressure is released and will cause the needle bevel to either go deeper into the skin or to leave the skin, depending upon which direction the skin moves.)
– Hold the skin taut until the needle bevel has been inserted between the skin layers
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PROCEDURE FOR ADMINISTERING AN INTRADERMAL INJECTION
• Insert Needle.
• Using your dominant hand, hold syringe, bevel up, with fingers and thumb resting on the sides of the barrel. If you insert the needle at a 20 degree angle, lower it at once to
15 degrees. Do not place thumb or fingers under syringe because this will cause the angle of insertion to exceed 15 degrees causing the needle to insert beyond the dermis.
• Insert needle, bevel up, just under the skin at an angle of 15 to 20 degrees until the bevel is covered (see figure 2-11). Continue stabilizing thumb pressure. You should feel some resistance. If the needle tip moves freely, you have inserted slightly and check again for resistance.
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PROCEDURE FOR ADMINISTERING AN INTRADERMAL INJECTION

• Inject Medication. It is not necessary to aspirate the syringe since no large vessels are commonly found in the superficial layer of the skin. Inject the medication as follows:

• Continue holding syringe with same hand.

• Release skin tension with other hand.

• With free hand, push plunger slowly forward until the medication is injected and a wheal appears at the site of the injection. The appearance of a wheal indicates that the medication has entered the area between the intradermal tissues. If a wheal does not appear, withdraw the needle and repeat the procedure in another site.

• Withdraw Needle. To withdraw the needle, quickly withdraw it at the same angle that it was inserted.

• Cover Injection Site. Without applying pressure, quickly cover injection site with a dry sterile small gauze.

• Perform Post injection Patient Care.

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Intramuscular administration

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Intramuscular administration

• This route of administration is generally

considered less hazardous and easier to use than the intravenous route. The onset of action is typically longer than with intravenous administration, but shorter than with subcutaneous administration. Patients generally experience more pain via intramuscular administration compared to intravenous administration.

needle

Intramuscular administration

• Intramuscular (IM) injections are made into the

striated muscle fibers that are under the subcutaneous layer of the skin. Thus needles used for the injections are generally 1 inch to 1.5 inches long and are generally 19 to 22 gauge in size.

needle

Intramuscular administration

• The principal sites of injection are

the:

– gluteal (buttocks)

– deltoid (upper arm)

– vastus lateralis (thigh) muscles.

needle
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• When administering intramuscular injections into the gluteus maximus, the size of the needle must be chosen based on the patient’s deposits of fat. If a needle is used that is too short to pass all the way through the fat into the muscle, then the injection will be made into the fat. Women tend to have more fat in this region than men, so the possibility of a intralipomatous injection is significant. It is estimated that few women and about 15% of men actually receive the intended intramuscular injection because an improper needle length was used.

• The point of injection should be as far as possible from major nerves and blood vessels to avoid neural damage and accidental intravenous administration. To insure that a blood vessel has not been entered, the syringe should be slightly aspirated after insertion and before injection to see if blood enters the syringe. Other injuries that can occur following intramuscular injection are abscesses, cysts, embolism, hematoma, skin sloughing, and scar formation.

Complications and contraindications

• When the gluteal muscles are used, injections should be made on the upper, outer quadrant of the buttock to avoid damaging the sciatiC nerve. Injection fibrosis is a complication that may occur if the injections are delivered with great frequency or with improper technique.

 

Complications and contraindications

• Thrombocytopenia (low platelet counts)

and coagulopathy (bleeding tendency) are contraindications for intramuscular injections, as they may lead to hematomas.

 

• Examples of medications that are sometimes administered intramuscularly are:

codeine

morphine

methotrexate

metoclopramide

olanzapine

Streptomycin

diazepam

prednisone

penicillin

Interferon beta-1a

• sex hormones, such as testosterone, estradiol valerate,

• and Depo Provera

dimercaprol

ketamine

lupron

 

Advantages

• Simple and accessible

• No indwelling medical devices required, although devices exist for intra-muscular cannulation.

• Required for certain types of drugs, e.g. immunoglobulins, vaccines

 

Disadvantages

• Absorption dependent on blood flow. May be danger of sudden absorption of drugs, e.g. if large amounts of opioids administered to a ‘shut-down’ patient, sudden overdose may result when perfusion to muscle improves.
• Slower absorption than intravenous, i.e. not good for immediate analgesia. This may be an advantage, e.g. when adrenaline is used in anaphylaxis as administration of 0.5mg of adrenaline intravenously could be result in tachyarrhythmias.
• Painful.
• Limited volume.
• Nerve damage, if incorrectly performed (often confusion over meaning of upper, outer quadrant).
• Potential for subcutaneous injection, especially in

Disadvantages

• Sterile or infected abscesses reported.

May be related to inadvertent subcutaneous injection. Rare, but disastrous

 

subcutaneous injection

 

subcutaneous injection

•is administered as a bo us into the sub cutis the ayer of skin direct y be ow the dermis and epidermis, co ective y referred to as the cutis.

•Subcutaneous injections are high y effective in administering vaccines and such medications as insu in, morphine,

diacety morphine or gosere in.

•A subcutaneous injection is a method of drug administration. Up to 2 m of a drug so ution can be injected direct y beneath the skin. The drug becomes effective within 20 minutes.

 

PURPOSE

•Subcutaneous injection is the method used to administer drugs when a sma amount of f uid is to be injected, the patient is unab e to take the drug ora y, or the drug is destroyed by intestina secretions.

PRECAUTION

•If the drug to be administered is harmfu to superficia tissues, it shou d be administered intramuscu ar y or intravenous y. It is usefu to remember the fo owing when administering any medication:
•the right patient
•the right medicine
•the right route
•the right dose
•the right site

How to Give a Subcutaneous Injection

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where lbo was nl-rn

 

Intravenous therapy

 

Intravenous therapy

•Intravenous therapy or IV therapy is the giving of iquid substances direct y into a vein.

•The word intravenous simp y means “within a vein”.

•Therapies administered intravenous y are often ca ed specia ty pharmaceutica s.

•It is common y referred to as a drip because many systems of administration emp oy a drip chamber, which prevents air entering the b ood stream (air embo ism) and a ows an estimate of f ow rate.

•Compared with other routes of administration, the intravenous route is the fastest way to de iver f uids and medications throughout the body.

•Some medications, as we as b ood transfusions and etha injections, can on y be given intravenous y.

 

Intravenous access

devices

 

Intravenous access devices

•Hypodermic needle

•The most convenient site is often the arm, especia y the veins on the back of the hand, or the median cubita vein at the e bow, but any identifiab e vein can be used.

•Often it is necessary to use a tourniquet which restricts the venous drainage of the imb and makes the vein bu ge.

 

Intravenous access devices

•Hypodermic needle

•Once the need e is in p ace, it is common to draw back s ight y on the syringe to aspirate

b ood, thus verifying that the need e is rea y in a vein.

•The tourniquet shou d be removed before injecting to prevent extravasation of the medication.

 

Intravenous access devices

•Periphera Cannu a

•This is the most common intravenous access method in both hospitals and pre- hospital services.

• A peripheral IV line consists of a short catheter (a few centimeters long) inserted through the skin into a peripheral vein (any vein that is not inside the chest or abdomen).

 

Intravenous access devices

•Periphera Cannu a

•This is usua y in the form of a cannu a-over- need e device, in which a f exib e p astic cannu a comes mounted on a meta trocar.
•Once the tip of the need e and cannu a are ocated in the vein the trocar is withdrawn and discarded and the cannu a advanced inside the vein to the appropriate position and secured.
•8 ood may be drawn at the time of insertion.

Intravenous access devices

•Centra IV ines

•Centra IV ines f ow through a catheter with its tip within a arge vein, usua y the superior vena cava or inferior vena cava, or within the right atrium of the heart. This has severa advantages over a periphera IV:

•It can de iver f uids and medications that wou d be over y irritating to periphera veins because of their concentration or chemica composition. These inc ude some chemotherapy drugs and tota parentera nutrition.

Intravenous access devices

•Centra IV ines

•Medications reach the heart immediate y, and are quick y distributed to the rest of the body.
•There is room for mu tip e para e compartments ( umen) within the catheter, so that mu tip e medications can be de ivered at once even if they wou d not be chemica y compatib e within a sing e tube.
•Caregivers can measure centra venous pressure

Intravenous access devices

•Peripherally inserted central catheter

•PICC ines are used when intravenous access is required over a pro onged period of time or when the materia to be infused wou d cause quick damage and ear y fai ure of a periphera IV and when a conventiona centra ine may be too dangerous to attempt.

 

Intravenous access devices

•Peripherally inserted central catheter

•Typica uses for a PICC inc ude:

• ong chemotherapy regimens

•extended antibiotic therapy

•tota parentera nutrition.

 

Intravenous access devices

•Central venous lines

•There are severa types of catheters that take a more direct route into centra veins. These are

co ective y ca ed central venous lines.

•In the simp est type of centra venous access, a catheter is inserted into a subc avian, interna jugu ar, or ( ess common y) a femora vein and advanced toward the heart unti it reaches the superior vena cava or right atrium.

 

Intravenous access devices

•Central venous lines

•8ecause a of these veins are arger than periphera veins there is greater b ood f ow past the tip of the catheter meaning irritant drugs are more rapid y di uted with ess chance of extravasation.
•It is common y be ieved that f uid can be pushed faster through a centra venous catheter but as they are often divided into mu tip e umens then the interna diameter is ess than that of a arge-bore periphera cannu a.

Intravenous access devices

•Central venous lines

•They are a so onger, which as ref ected in Poiseui e’s aw, requires higher pressure to achieve the same f ow, a other variab es being equa .

 

Intravenous access devices

•Tunnelled Lines

•Another type of centra ine, ca ed a Hickman line or Broviac catheter, is inserted into the target vein and then “tunneled” under the skin to emerge a short distance away.

•This reduces the risk of infection, since bacteria from the skin surface are not ab e to trave

direct y into the vein; these catheters are a so

c otting.

 

Intravenous access devices

•Implantable ports

•A port (often referred to by brand names such as Port-a- Cath or MediPort) is a centra venous ine that does not have an externa connector; instead, it has a sma reservoir that is covered with si icone rubber and is
imp anted under the skin.
•Medication is administered intermittent y by p acing a sma need e through the skin, piercing the si icone, into the reservoir. When the need e is withdrawn the reservoir cover resea s itse f. The cover can accept hundreds of need e sticks during its ifetime.

Forms of intravenous

therapy

 

Forms of intravenous therapy

•Intravenous drip

•An intravenous drip is the continuous infusion of f uids, with or without medications, through an IV access device. This may be to correct dehydration or an e ectro yte imba ance, to

de iver medications, or for b ood transfusion.

 

Forms of intravenous therapy

•IV f uids

•There are two types of f uids that are used for intravenous drips; crysta oids and co oids.

•Crysta oids are aqueous so utions of minera sa ts or other water-so ub e mo ecu es.

•Co oids contain arger inso ub e mo ecu es, such as ge atin; b ood itse f is a co oid.

 

Infection

Forms of intravenous therapy

•IV f uids

•The most common y used crysta oid f uid is normal saline, a so ution of sodium ch oride at 0.9% concentration, which is c ose to the concentration in the b ood (isotonic).
•Ringer’s lactate or Ringer’s acetate is another isotonic so ution often used for arge-vo ume f uid rep acement.
•A so ution of 5% dextrose in water, sometimes ca ed having ow b ood sugar or high sodium.

Forms of intravenous therapy

•IV f uids

•The choice of f uids may a so depend on the chemica properties of the medications being given.

•Intravenous f uids must a ways be steri e.

Forms of intravenous therapy

Composition of common crysta oid so utions

So ution Other Name [Na+](mmo /L) [C ](mmo /L) [G ucose](m mo /L)

[G ucose](mg

/d )

05W 5% 0extrose 0 0 278 5000

3.3%

2/30 & 1/3S

Ha f-norma sa ine

0extrose / 51 51 185 3333

0.3% sa ine

0.45% NaC 77 77 0 0

Norma sa ine 0.9% NaC 154 154 0 0

 

Ringer’s

actate

05NS

Lactated

Ringer

5% 0extrose,

Norma

Sa ine

130 109 0 0

154 154 278 5000

 

Forms of intravenous therapy

Ringer’s actate a so has 28 mmo /L actate, 4 mmo /L K+ and 1.5 mmo /L Ca2+. Ringer’s acetate a so has 28 mmo /L acetate, 4 mmo /L K+ and 1.5 mmo /L Ca2+.

Effect of adding one i

So ution

tre

Ch

ange

in

ECF

Ch

ange

in

ICF

05W

333

mL

667

mL

2/30 & 1/3S

556

mL

444

mL

Ha f-norma sa ine

667

mL

333

mL

Norma sa ine

1000 mL

0 mL

Ringer’s actate

900 mL

100 mL

 

Risks of intravenous

therapy

Risks of intravenous therapy

•Infection

•Any break in the skin carries a risk of infection. A though IV insertion is an aseptic procedure, skin-dwe ing organisms such as Coagulase-negative staphylococcus or Candida albicans may enter through the insertion site around the catheter, or bacteria may be accidenta y introduced inside the catheter from contaminated equipment. Moisture introduced to unprotected IV sites through washing or bathing substantia y increases the infection risks.

Infi tration

Risks of intravenous therapy

•Phlebitis

•Ph ebitis is inf ammation of a vein that may be caused by infection, the mere presence of a foreign body (the IV catheter) or the f uids or medication being given.

•Symptoms are warmth, swe ing, pain, and redness around the vein.

necessary re-inserted into another extremity.

 

Risks of intravenous therapy

•Infiltration

•Infi tration occurs when an IV f uid accidenta y enters the surrounding tissue rather than the vein.

•It is characterized by coo ness and pa or to the skin as we as oca ized swe ing or edema.

•It is usua y not painfu .

•It is treated by removing the intravenous access co ected f uids can drain away.

 

Risks of intravenous therapy

•Fluid overload

•This occurs when f uids are given at a higher rate or in a arger vo ume than the system can absorb or excrete.

•Possib e consequences inc ude hypertension, heart fai ure, and pu monary edema.

 

Risks of intravenous therapy

•Electrolyte imbalance

•Administering a too-di ute or too-concentrated so ution can disrupt the patient’s ba ance of sodium, potassium, magnesium, and other

e ectro ytes.

•Hospita patients usua y receive b ood tests to monitor these eve s.

 

Risks of intravenous therapy

•Embolism

•A b ood c ot or other so id mass, as we as an air
bubb e, can be de ivered into the circu ation through an
IV and end up b ocking a vesse ; this is ca ed embo ism.
• Periphera IVs have a ow risk of embo ism, since arge so id masses cannot trave through a narrow catheter, and it is near y impossib e to inject air through a periphera IV at a dangerous rate.
•The risk is greater with a centra IV.

Risks of intravenous therapy

•Extravasation

•Extravasation is the accidenta administration of IV infused medicina drugs into the surrounding tissue which are caustic to these tissues, either by eakage (e.g. because of britt e veins in very

e der y patients), or direct y (e.g. because the need e has punctured the vein and the infusion goes direct y into the arm tissue).

 

ADMINISTERING

MEDICATION THROUGH IV

 

ADMINISTERING MEDICATION THROUGH IV

•Administering medication by intravenous piggyback

•This method of administration is known as partia -fi , a piggyback, a mini-bott e or a sma vo ume parentera .

 

ADMINISTERING MEDICATION THROUGH IV

•Administering medication by intravenous piggyback

•STEPS:

1. Gather a equipment and bring to the patient’s bedside. Check the medication order against the physician’s order.

2. Exp ain the procedure to the patient.

3. Wash your hands and assess the site for the presence of inf ammation IV and infi tration.

 

ADMINISTERING MEDICATION THROUGH IV

•Administering medication by intravenous piggyback

•STEPS:

4. Attach the infusion tubing to the piggyback set containing di uted medication. Open the c amp and prime the tubing. C ose the c amp. Connect the capped steri e need e to the steri e end of the tubing.
5. Hang the piggyback container on the IV po e, positioning it higher than the primary IV according to the manufacturer’s recommendation.
6. Identify the patient by checking the identification band name.

ADMINISTERING MEDICATION THROUGH IV

•Administering medication by intravenous piggyback

•STEPS:

7. Use the a coho swab to c ean secondary port.
8. Remove the cap and insert the need e into the secondary port. Use set of tape to secure the secondary set tubing to the primary infusion tubing. Stop backf ow va ve in primary ine whi e
piggyback so ution in infusing once comp eted. Open backf ow va ve and f ow of primary so ution
resumes.

ADMINISTERING MEDICATION THROUGH IV

•Administering medication by intravenous piggyback

•STEPS:

9. Open the c amp on the piggyback set and
regu ates the f ow at the prescribed de ivery rate.
Monitor the medication infusion at periodic interva .
10.C amp the tubing on the piggyback set when the so ution is infused. Fo ow agency po icy regarding the disposa of equipment.
11. Re-adjust the f ow rate of the primary IV.
medication after it has been infused.

ADMINISTERING MEDICATION THROUGH IV

•Administration IV medication by volume- control administration set

•Contro ed-vo ume administration sets have different names, depending on the manufacturer. They are sma f uid containers (100 – 500 mL in size) attached be ow the primary infusion container. Vo ume-contro sets are equipped with either a stationary membrane fi ter or a f oating va ve fi ter at the base of the container and are designed to a oe precise contro of the amount of infusing f uid.

ADMINISTERING MEDICATION THROUGH IV

•Administration IV medication by volume- control administration set

• STEPS:

1. Gather the equipment and bring to the patient’s bedside. Check the medication order against the origina physician’s order according to agency po icy.
2. Exp ain the procedure to the patient and wash hands.
3. Assess the IV site for the presence of inf ammation.
4. Withdraw medication from via or ampu e into the

ADMINISTERING MEDICATION THROUGH IV

•Administration IV medication by volume- control administration set

• STEPS:

5. Identify the patient by checking the identification band on the c ient’s wrist and asking his or her name.
6. Open the c amp between IV so utions and the
vo ume-contro administration set or secondary fi up. Fi it up with desired amount of IV so ution. C ose the c amp.
7. Use an a coho swab to c ean the injection port on the secondary set-up.

ADMINISTERING MEDICATION THROUGH IV

•Administration IV medication by volume- control administration set

• STEPS:

8. Remove the cap and insert the need e into the port whi e ho ding the syringe steady. Inject the medication. Mix gent y with IV so ution.
9. Open the c amp be ow the secondary set-up and regu ate at the prescribed de ivery rate.
10. Monitor the medication infusion at periodic interva s.
11. Attach the abe to the vo ume-contro device.

ADMINISTERING MEDICATION THROUGH IV

•Administration IV medication by volume- control administration set

• STEPS:

12. P ace the syringe with the uncapped need e in the designated container.

13. Wash hands and chart the administration of the medication after it has been infused.

 

ADMINISTERING MEDICATION THROUGH IV

•Adding medication to an intravenous solution container

• Medications, vitamins and e ectro ytes may be added to the main IV f uid container to be administered over many hours.

 

ADMINISTERING MEDICATION THROUGH IV

•Adding medication to an intravenous solution container

• STEPS:

1. Gather a equipment and bring to the patient’s bedside.
2. Check the medication order against the physician’s order.
3. Exp ain the procedure to the c ient and wash hands.
4. Identify the Patient by checking the identification band on the c ient’s wrist and asking his or her name.

ADMINISTERING MEDICATION THROUGH IV

•Adding medication to an intravenous solution container

• STEPS:

5. Add the medication to the IV so ution that is infusing:

•Check the vo ume in the bag or if the bott e is adequate.

•C ose the IV c amp.

•C ean the medication port with an a coho swab.

•Steady the container, uncap the need e, and insert the need e into the port. Inject the medication.

•Remove the container from the IV po e and gent y rotate the so ution.

•Re-hang the container, open the c amp and re-adjust the f ow rate.

•Attach the abe to the container so that the dose of the medication that has been added is apparent.

 

ADMINISTERING MEDICATION THROUGH IV

•Adding medication to an intravenous solution container

• STEPS:

6. Add the medication to the infusion:
•Carefu y remove any protective cover and ocate the injection port. C ean with an a coho swab.
•Uncap the need e and insert into the port. Inject the medication.
•Withdraw the need e spike into the proper entry site on the bag or bott e.
•With tubing c amp, gent y rotate the IV so ution in the bag or bott e. Hang the IV.

ADMINISTERING MEDICATION THROUGH IV

•Adding medication to an intravenous solution container

• STEPS:

7. 0ispose the equipment according to agency po icy.

8. Wash hands and chart the administration of medication.

 

ADMINISTERING MEDICATION THROUGH IV

•Adding a bolus intravenous medication to an existing intravenous line

•Administering concentrated medications

direct y into a vein by the bo us technique is the most dangerous method of drug administration. These drugs act rapid y because they enter the c ient’s circu ations direct y. Serious side effects can occur within seconds. Therefore it is imperative that the nurse time the administrations carefu y to prevent too rapid

through an IV ock or an existing IV infusion ine.

 

ADMINISTERING MEDICATION THROUGH IV

•Adding a bolus intravenous medication to an existing intravenous line

•STEPS:

1. Gather the equipment and bring to the patient’s bedside. Check the medication order against the origina physician’s order.

2. Exp ain the procedure to the patient and wash your hands.

3. Assess the IV site for the presence of inf ammation or infi tration.

 

ADMINISTERING MEDICATION THROUGH IV

•Adding a bolus intravenous medication to an existing intravenous line

•STEPS:

4. Se ect the injection port on the tubing that is
c osest to the venipuncture site. C ean the port with an a coho swab.
5. Uncap the syringe. Steady the port with your non- dominant hand whi e inserting the need e in the center of the port.
6. Move your non-dominant hand to the section of IV tubing just beyond the injection port. Fo d the tubing between your fingers to temporari y stop the f ow of the IV

ADMINISTERING MEDICATION THROUGH IV

•Adding a bolus intravenous medication to an existing intravenous line

•STEPS:

7. Pu back s ight y the p unger just unti b ood appears in the tubing.

8. Inject the medication at the prescribed rate.

9.Remove the need e. 0o not cap it.

Re ease the tubing and a ow the IV to f ow at proper rate.

 

ADMINISTERING MEDICATION THROUGH IV

•Adding a bolus intravenous medication to an existing intravenous line

•STEPS:

10. 0ispose the need e and syringe in the proper receptac e.

11. Wash your hands and chart the administration of the medication after it has been infused.

GUIDELINES FOR CORRECT

ADMINISTRATION OF MEDICATIONS

 

GUIDELINES FOR CORRECT ADMINISTRATION OF MEDICATIONS

•ADMINISTERING INTRADERMAL INJECTIONS
•Stabilize Injection Site.
1. Using your nondominant thumb, app y downward pressure, direct y be ow and outside the prepared injection site. 0o not draw the skin back or move the skin to the side because the skin wi return to its norma position when pressure is re eased and wi cause the need e beve to either go deeper into the skin or to eave the skin, depending upon which direction the skin moves.

GUIDELINES FOR CORRECT ADMINISTRATION OF MEDICATIONS

•ADMINISTERING INTRADERMAL INJECTIONS

2. Ho d the skin taut unti the need e beve has been inserted between the skin ayers

•Insert Needle.

1. Using your dominant hand, ho d syringe, beve up, with fingers and thumb resting on the sides of the barre . If you insert the need e at a 20 degree ang e, ower it at once to 15 degrees. 0o not p ace thumb or fingers under syringe because this wi cause

the ang e of insertion to exceed 15 degrees causing the need e to insert beyond the dermis.

 

GUIDELINES FOR CORRECT ADMINISTRATION OF MEDICATIONS

•ADMINISTERING INTRADERMAL INJECTIONS
2. Insert need e, beve up, just under the skin at an ang e of 15 to 20 degrees unti the beve is covered. Continue stabi izing thumb pressure. You shou d fee some resistance. If the need e tip moves free y, you have inserted the need e too deep y. At this point, withdraw need e s ight y and check again for resistance.
•Inject Medication. It is not necessary to aspirate the syringe since no arge vesse s are common y found in the superficia ayer of the skin. Inject the medication as fo ows:

GUIDELINES FOR CORRECT ADMINISTRATION OF MEDICATIONS

•ADMINISTERING INTRADERMAL INJECTIONS
1. Continue ho ding syringe with same hand.
2. Re ease skin tension with other hand.
3. With free hand, push p unger s ow y forward unti the medication is injected and a whea appears at the site of the injection. The appearance of a whea indicates that the medication has entered the area between the intraderma tissues. If a whea does not appear, withdraw the need e and repeat the procedure in another site.

GUIDELINES FOR CORRECT ADMINISTRATION OF MEDICATIONS

•ADMINISTERING INTRADERMAL INJECTIONS
•Withdraw Needle. To withdraw the need e, quick y withdraw it at the same ang e that it was inserted.
•Cover Injection Site. Without app ying pressure, quick y cover injection site with dry steri e sma gauze.

GUIDELINES FOR CORRECT ADMINISTRATION OF MEDICATIONS

•ADMINISTERING INTRAMUSCULAR INJECTIONS
•Wash your hands carefu y with soap and dry them comp ete y. Put on g oves if necessary. Open the foi covering the first a coho wipe.
•Take the cover off the need e by ho ding the syringe with your writing hand and pu ing on the cover with your other hand. It is ike taking a cap off a pen.

GUIDELINES FOR CORRECT ADMINISTRATION OF MEDICATIONS

•ADMINISTERING INTRAMUSCULAR INJECTIONS

•Ho d the syringe in the hand you use to write. P ace the syringe under your thumb and first finger. Let the barre of the syringe rest on your second finger. Many peop e ho d a pen this way when they write.

•Wipe the area where the need e wi go with the a coho wipe. Let the area dry.

•0epress and pu the skin a itt e with your free hand. Keep

ho ding the skin a itt e to the side of where you p an to put the need e.

needle

GUIDELINES FOR CORRECT ADMINISTRATION OF MEDICATIONS

•ADMINISTERING INTRAMUSCULAR INJECTIONS
•Use your wrist to inject the need e at a 90 degree need e (straight in). The action is ike shooting a dart. 0o not push the need e in. 0o not throw the need e in, either. Throwing the need e wi make a bruise. The need e is sharp and it wi go through the skin easi y when your
wrist action is correct.
•Let go of the skin. The need e wi want to jerk sideways. As you et go of the skin, ho d the syringe so it stays pointed straight in.
needle

GUIDELINES FOR CORRECT ADMINISTRATION OF MEDICATIONS

•ADMINISTERING INTRAMUSCULAR INJECTIONS
•Pu back on the p unger just a itt e to make sure you aren’t in a b ood vesse . (If b ood comes back, remove the need e immediate y. 0o not inject the medicine. If this happens, dispose of both the syringe and the medicine. Get more medicine in a new syringe. When you give the second shot give it on the other side.)
Pu ing back on the p unger is easier said than done. Use your other hand to pu back on the p unger whi e keeping the syringe in the straight up position. It wi
fee c umsy at first.

GUIDELINES FOR CORRECT ADMINISTRATION OF MEDICATIONS

•ADMINISTERING INTRAMUSCULAR INJECTIONS

Push down on the p unger and inject the medicine.

0o not force the medicine by pushing hard on the
p unger. Some medicines hurt. They wi hurt more if the medicine goes in quick y.
•After a the medicine is injected, pu the need e out quick y at the same ang e it went in.
•Use the dry steri e gauze 2×2 to press gent y on the p ace where the need e went in.