9. Administration by the Parenteral Route

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Parental routes

-includes any other route other than the gastrointestinal tract

Systemic effects

Affecting the whole body or system

Parental routes with systemic effects (4)

1. Sublingual / buccal
2. Transcutaneous / transdermal
3. Inhalations
4. Injections

Local effects

Limited to one particular part ( location) of the body with very little if any effect on the rest of the body

Parental routes with local effects (4)

1. Topical
2. Mucous membrane
3. Eyes
4. Ears

Sublingual & Buccal Administration

-sublingual route is more common
-unaffected by the stomach, intestines, or liver
-rapid absorbtion

Transcutaneous /Transdermal

-delivers medications to the body by way of the skin
-slower absorption

inhalation therapy (advantages)

-rapid with local effects within the respiratory system
-potent drugs may be given in small amounts, minimizing side effects
-convenience and comfort of the patient

MDI

Metered Dose Inhaler

SVN

Small-Volume Nebulizer

IPPB

Intermittent Positive Pressure Breathing

inhalation therapy (disadvantages)

-cooperation in breathing techniques
-adverse systemic side effects may result rapidly because of extensive absorption capacity of the lungs
-improper administration, irritated trachea, bronci
-Asthmatics or COPD patients can become dependent
-small-volume nebulizer can be source of infection if not cleaned properly

Metered Dose Inhaler

-delivers a measured dose via a propellant within a canister
-portable, easy to use
-can be used with a mask in pediatric patients
-full canister provides about 200 puffs

Small-Volume Nebulizers

-aerosol form
-powered by a gas source (small air compressor)
-breathing techniques
-proper daily cleaning

Dry Powered Inhalers

-popular with children
-device delivers a drug in powdered form into the lung with no propellant or external power source
-not used for acute breathing problems
-small and easy to use
-eliminates any timing technique problems
-can be used in cold environments
-fewer drugs available

Intermittent Positive Pressure Breathing

-combines the administration of an aerosol with a mechanical breather to assist patients who are unable to take a deep breath on their own

syringes (3 parts)

1. Barrel
2. Plunger
3. Tip

Barrel

The outer, hollow cylinder that holds the medication and contains the calibrations for measuring medication

Plunger

-Inner solid rod that fits snugly into the cylinder
-Pulling back the plunger allows solution to be drawn into the syringe
-Pushing forward on the plunger ejects solution or air form the syringe

Tip

-Portion that holds the needle
-Larger syringes may contain a metal attachment called a Luer-Lok (locks the needle in place)

Needles (3 parts)

1. Hub
2. Shaft
3. Tip

Hub

The flared end that fits on the tip of the syringe

Shaft

-Long hollow tube embedded in the hub

Tip

Pointed end with a beveled edge

Syringes (3 main types)

1. Standard Syringe
2. Tuberculin Syringe
3. Insulin Syringe

Standard Syringe

-Used most frequently for subcutaneous or intramuscular injections
-cc, mL, m
-most common is 3mL or 2 1/2mL

Tuberculin Syringe

-Intradermal injections of very small substance
-calibrated in tenths of a milliliter
-holds a total of 1 cc

Insulin Syringe

-used for insulin
-calibrated in units
-common = U-100
-even numbers on one side, odd numbers on the other
-100 units = 1mL
-All insulin dosages should be double-checked by 2 caregivers before administration

intradermal

-administered into the skin or the inner surface of the lower arm
-chest & upper back for allergy testing

subcutaneous injections

-administered into fatty tissues on the upper outer arm, front of thigh, abdomen, or upper back
-no more than 2mL of medication may be administered subcutaneously

Intramuscular injections

-administered deep into muscles
-5 sites (dorsogluteal, ventrogluteal, deltoid, vastus lateralis, rectus femoris)

Dorsogluteal

Upper outer quadrant of the buttock (preferred site for adults)

Ventrogluteal

Above and to the outside of the buttock area, on the hip

Deltoid

Upper outer arm above the axilla

Vastus lateralis

front of the thigh toward the outside of the leg

Rectus femoris

Front of the thigh toward the midline of the leg

Intramuscular Injections (Advantages)

1. Larger amount of solution can be administered (up to 3mL or a max. of 1mL in children
2. Absorption is more rapid because muscle tissue is more vascular (contains many blood vessels)

Z-track method

-used for injections that are irritating to the tissue
-dorsogluteal site is used

topical medications

-for the skin (ointments, lotions, creams, solutions, soaks, baths)

What is the most common form of the parenteral route?

-Injection

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