Chapter 7. Parenteral Medication Administration Show
Parenteral refers to the path by which medication comes in contact with the body. Parenteral medications enter the body by injection through the tissue and circulatory system. Injection medications are absorbed more quickly and are used with patients who are nauseated, vomiting, restricted from taking oral fluids, or unable to swallow. Parenteral medications can be effective and safe when prepared and administered correctly. However, because they are invasive and absorbed readily and quickly into the body, there are numerous risks associated with administering them (Perry et al., 2014). There are four routes for parenteral medications (also see Figure 7.1). Each type of injection requires a specific skill set to ensure the medication is prepared properly and administered into the correct location (Perry et al., 2014). The four types of injections are:
To administer parenteral medications safely, it is imperative to understand how to prevent an infection, prevent medication errors, prevent a needle-stick injury, and prevent discomfort to the patient. Tables 7.1 to 7.4 address specific practices to eliminate safety hazards to patients and health care workers. Preventing Infection During an InjectionAccording to Seigel et al, (2007), research has shown that unsafe injection practices have resulted in patient exposure to infections leading to outbreaks of infectious diseases. These unnecessary exposures were the result of deficient health care practices. Injectable medications must be given in a safe manner to maintain sterility of equipment and prevent the transmission of infectious diseases between patients and health care workers. Table 7.1 summarizes how to prevent an infection during an injection. Table 7.1 Preventing Infection During an Injection
Safe Medication AdministrationMedication errors have a substantial impact on health care in Canada (Butt, 2010). When preparing and administering medication, and assessing patients after receiving medication, always follow agency policy to ensure safe practice. Review Table 7.2 for guidelines for safe medication administration.
Promoting Safety and Comfort of a Patient During an InjectionInjections can be given safely and effectively, and harm can be prevented if proper injection technique is used. Most complications related to injections are associated with intramuscular injections, but may occur with any route. Complications can occur when an incorrect site is used, or with an inappropriate depth or rate of injection (Malkin, 2008). To promote patient safety and comfort during an injection, review the guidelines in Table 7.3. Table 7.3 Promoting Patient Safety and Comfort During an Injection
Preventing Needle-Stick InjuriesHealth care providers can be at risk for needle-stick injuries in any health care setting. The most common places for needle-stick injuries to occur are in the operating room and patient rooms. Tasks that place the health care provider at risk include recapping needles and mishandling IV lines. Table 7.4 provides guidelines to prevent needle-stick injuries.
Preparing Medications from Ampules and VialsSpecific equipment, such as syringes and needles, is required to prepare and administer parenteral medications. The selection of the syringe and needle is based on the type and location of injection; amount, quality, and type of medication; and the body size of the patient. Many syringes come with needleless systems or needles with safety shields to prevent injuries (Perry et al., 2014). Aseptic technique is paramount to the preparation and administration of these medications. Parenteral medications are supplied in sterile vials, ampules, and prefilled syringes. Ampules are glass containers in 1 ml to 10 ml sizes that hold a single dose of medication in liquid form. They are made of glass and have a scored neck to indicate where to break the ampule (see Figure 7.2). Medication is withdrawn using a syringe and a filter needle. A blunt fill needle with filter (see Figure 7.3) must be used when withdrawing medication to prevent glass particles from being drawn up into the syringe (see Figure 7.4). Never use a filter needle to inject medication (Perry et al., 2014). Read this information about ampules to review how to prepare medication from an ampule. Video 7.1A vial is a single- or multi-dose plastic container with a rubber seal top, covered by a metal or plastic cap (see Figure 7.5). A single-use vial must be discarded after one use; a multi-dose vial must be labelled with the date it was opened. Check hospital policy to see how long an open vial may be used. The vial is a closed system, and air must be injected into the vial to permit the removal of the solution (Perry et al., 2014) (see Figure 7.6). Figure 7.5 Preparing medications from a vialFigure 7.6 Vial with safety needle insertedRead this information about vials to review how to prepare medication from a vial and reconstitute medication. Video 7.2A syringe (see Figure 7.7)is a sterile, single-use device that has a Luer lock (see Figure 7.8) or non-Luer lock tip, which influences the name of the syringe. Syringes come in various sizes from 0.5 ml to 60 ml. Syringes may come with or without a sterile needle and will have a safety shield on the needle. Insulin is only given using an insulin syringe (see Figure 7.9). Insulin is ordered in units. It is important to use the correct syringe and needle for the specific injection. Always examine the measurement scale on the syringe to determine that you have the correct syringe (Lynn, 2011). Figure 7.9 Insulin syringe with safety shieldRead this information about syringes to review the different types of syringes. Needles are made of stainless steel, are sterile and disposable, and come in various lengths and sizes. The needle is made up of the hub, shaft, and bevel. The bevel is the tip of the needle that is slanted to create a slit into the skin. The hub fits onto the tip of the syringe. All three parts must remain sterile at all times. The length of the needle will vary from 1/8 in. to 3 in., depending on the injection. The gauge of a needle is the diameter of the needle. Gauges can vary from very small diameter (25 to 29 gauge) to large diameter (18 to 22 gauge). A needle will have its gauge and length marked on the outer packaging; choose the correct gauge and length for the injection ordered (Lynn, 2011) (see Figures 7.10, 7.11, and 7.12). Read this information about needles to review needles and how to “scoop cap”. Figure 7.10 Variety of needles with different gauges and lengthsFigure 7.11 Types of needles with safety shieldsFigure 7.12 Needle with safety cap
Which action would the nurse perform first when mixing medications from a vial and an ampule?When mixing medications from a vial and an ampule, the nurse should prepare medications from the vial first and then withdraw medication from the ampule using the same syringe and a filter needle.
When using an ampule The nurse must remember to use what type of needle?Blunt filter needles or filter straws with a 5 micron filter should be available and used each and every time a medication is aspirated from a glass ampoule to reduce glass particle contamination Such action will promote patient safety and reduce the risk of patient harm.
Which intervention should the nurse implement when withdrawing medication from an ampule?Take the gauze and wrap it around the head and neck of the ampule. Sit the ampule on a flat sturdy surface and pull on the head of the ampule in a snapping motion to break off the head of the ampule at it's neck… most ampules have a scored neck so they are easy to break off.
Which procedural step would the nurse perform first when preparing an injection using a safety syringe with a full protective sheath?Which procedural step would the nurse perform first when preparing an injection using a safety syringe with a full protective sheath? Hold the needle and the syringe by the flanges and twist the needle.
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