Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Division 1Introduction to Advanced

Prehospital Care

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Chapter 7

Intravenous Access and Medication Administration

Part 1Principles and Routes of Medication Administration

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Topics

Aseptic Technique

Medication Administration Routes

Medication Package

Anatomy and Physiology Related to Medication Administration

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Six Rights of Drug Administration

Right person

Right drug

Right dose

Right time

Right route

Right documentation

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Knowing all drug administration protocols is essential.

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Always take appropriate body substance isolation measures to

reduce your risk of exposure during medication administration.

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Body substance isolation equipment

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Medical Asepsis

It is important to keep the ambulance and all the equipment clean.

Sterile– Free of all forms of life

Medically clean– Involves careful handling to prevent

contamination

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Treat all blood and body fluids as potentially infectious.

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Needle Handling Precautions

Minimize the tasks performed in a moving ambulance.

Immediately dispose of used sharps in a sharps container.

Recap needles only as a last resort.

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Medication Administration and Documentation

Record all information concerning the patient and medication including:– Indication for drug administration– Dosage and route delivered– Patient response to the medication

Both positive and negative

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Percutaneous drug administration is drugs applied to and absorbed through

the skin or mucous membranes.

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Transdermal

Absorbed through the skin at a slow, steady rateMethod:– BSI– Clean administration site– Apply medication– Leave medication in place for required

time. Monitor the patient for desirable or adverse effects.

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Mucous Membranes

Absorbed through the mucous membranes at a moderate to rapid rate

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Place the pill or direct spray between the underside of the tongue and the floor of the oral cavity.

Sublingual Medication Administration

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Place the medication between the patient’s cheek and gum.

Buccal Medication Administration

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Use a medication dropper to place the prescribed dosage on the conjunctival sac.

Eye Drop Administration

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Nasal Medication Administration

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Manually open the ear canal and administer the appropriate dose.

Aural Medication Administration

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Pulmonary Drug Administration

Medications are administered into the pulmonary system via inhalation or injection.

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Small volume nebulizer

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Nebulizer with attached face

mask, bag-valve mask, and

endotracheal tube

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Metered dose inhaler

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Endotracheal Tube

Several medications can be administered through an endotracheal tube:– Lidocaine– Epinephrine– Atropine– Naloxone

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Enteral Drug Administration

The delivery of any medication that is absorbed through the gastrointestinal tract

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Gastrointestinal tract

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Oral Drug Administration

Any medication taken by mouth and swallowed into the GI tract.

Be sure the patient has an adequate level of consciousness to prevent aspiration.

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Oral Drug Forms

Capsules

Tablets

Pills

Enteric coated/time releasecapsules andtablets

Elixirs

Emulsions

Lozenges

Suspensions

Syrups

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Equipment forOral Administration

Soufflé cup

Medicine cup

Medicine dropper

Teaspoon

Oral syringe

Nipple

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General Principles of Oral Administration

Use appropriate BSI measures.Note whether to administer medication with food or on empty stomach.Gather any necessary equipment.Have patient sit upright when not contraindicated.Place the medication into your patient’s mouth. Allow self-administration; assist when needed.Follow administration with 4-8 ounces of water and ensure that patient has swallowed the medication.

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Gastric Tube Administration

Gastric tubes provide access directly to the GI system.

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Confirm proper tube placement.

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Withdraw the plunger while observing for the presence of gastric fluid or contents.

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Instill the medication into the gastric tube.

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Gently inject the saline.

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Clamp off the distal tube.

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Rectal Administration

The rectum’s extreme vascularity promotes rapid drug absorption.

Medications do not travel through the liver, and are not subject to hepatic alteration.

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Catheter placement on needleless syringe

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Syringe attached to endotracheal tube

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Prepackaged enema container

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Parenteral Drug Administration

Drug administration outside of the gastrointestinal tract

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Syringes and Needles

Syringe Hypodermic needle

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Kinds of Parenteral Drug Containers

Glass ampules

Single and multidose vials

Nonconstituted syringes

Prefilled syringes

Intravenous medication fluids

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AmpulesVials

Ampules and Vials

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Information on Drug Labels

Name of medication

Expiration date

Total dose and concentration

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Obtaining Medication from a Glass Ampule

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Hold the ampule upright and tap its top to dislodge any trapped solution.

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Place gauze around the thin neck…

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…and snap it off with your thumb.

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Draw up the medication.

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Obtaining Medicationfrom a Vial

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Confirm the vial label.

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Prepare the syringe and hypodermic needle.

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Cleanse the vial’s rubber top.

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Insert the hypodermic needle into the rubber top and inject the air

from the syringe into the vial.

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The nonconstituted drug vial actually

consists of two vials, one containing a

powdered medication and one containing a liquid mixing solution.

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Nonconstituted drugs come in separate vials. Confirm the labels.

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Remove all solution from the vial containing the mixing solution.

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Cleanse the top of the vial containing the powdered drug and inject the solution.

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Agitate or shake the vialto ensure complete mixture.

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Prepare a new syringe and hypodermic needle.

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Withdraw the appropriate volume of medication.

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In the Mix-O-Vial system, the vials are joined at the neck. Confirm the labels.

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Squeeze the vials together to break the seal. Agitate or shake to mix completely.

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Withdraw the appropriate volumeof medication.

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Prefilled or Preloaded Syringes

Confirm medication indications and patient allergies.Confirm prefilled syringe label (name, dose, and expiration date).Assemble the prefilled syringe. Remove the pop-off caps and screw together.Reconfirm indication, drug, dose, and route of administration.Administer appropriately via the indicated route.Properly dispose of the needle and syringe.

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Parenteral Routes

Intradermal injection

Subcutaneous injection

Intramuscular injection

Intravenous access

Intraosseous infusion

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Intradermal Injection

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Assemble and preparethe needed equipment.

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Check the medication.

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Draw up the medication.

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Prepare the administration site.

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Pull the patient’s skin taut.

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Insert the needle, bevel up ata 10-degree to 15-degree angle.

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Remove the needle and cover the puncture site with an adhesive bandage.

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Monitor the patient.

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Subcutaneous Injection

45º

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Subcutaneous Injection Sites

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Prepare the equipment.

© Scott Metcalfe

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Check the medication.

© Scott Metcalfe

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Draw up the medication.

© Scott Metcalfe

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Prep the site.

© Scott Metcalfe

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Insert the needle at a 45-degree angle.

© Scott Metcalfe

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Remove the needle and cover the puncture site.

© Scott Metcalfe

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Monitor the patient.

© Scott Metcalfe

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Intramuscular Injection Sites

Deltoid

Dorsal gluteal

Vastus lateralis

Rectus femoris

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Intramuscular Injection

90º

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Intramuscular Injection Sites

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Prepare the equipment.

© Scott Metcalfe

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Check the medication.

© Scott Metcalfe

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Draw up the medication.

© Scott Metcalfe

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Prepare the site.

© Scott Metcalfe

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Insert the needle at a 90-degree angle.

© Scott Metcalfe

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Remove the needle and cover the puncture site.

© Scott Metcalfe

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Monitor the patient.

© Scott Metcalfe

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Summary

Aseptic Technique

Medication Administration Routes

Medication Package

Anatomy and Physiology related to Medication Administration