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