II-3 Drug Preparation

7/27/2019 II-3 Drug Preparation

1/14

DRUG PREPARATION

Drug forms for parenteral administration:

1. Solutions- clear liquids that contain a drug dissolved in water

2. Suspensions- solid particles of a drug dispersed in a liquid3. Powders- are dry, finely ground drugs that are reconstituted according to

directions. Three facts should be written on the label: the date, the nurses

initial, and the solution made.

Drug forms for parenteral use are sterile and sterile technique is used to

prepare and administer them.

Gauge (g)

Indicates the diameter or width of the needle.

The higher the gauge number, the finer the needle.

Length of the needle

Depends on the route of injection Deep IM injections-long needle Subcutaneous injections- short needle

The nurse should determine the ff:

Type of needle (adult, pedia) Size and condition of patient Amount of adipose tissue present at the site Bevel- angle at which the needle tip is opened Length- distance from the tip to the hub of the needle

Needles

Intradermal3/8 to 5/8 (1 to 1.5 cm) long.

25 g

Short bevels

Subcutaneous

5/8 to 7/8 (1.5 to 2cm ) long

25g to 23g

With medium bevels

Intramuscular1to 3 (2.5 to 7.5 cm) long

23g to 18g

With medium bevels Intravenous

1 to 3 long

25g to 14g

Have long bevels

( Barrel ) Parts of Syringes that holds medication


2/14

Plunger ) Part of Syringes that is designed for insertion in barrel , providesmechanism by which meds are drawn into or pushed out of barrel

( Flange ) Part of Barrel of syringe where the plunger is inserted. the flange

forms a rim around the barrel, prevents syringe from rolling

( Tip ) part of the barrel of syringe, where needle is attached

( Barrel ) Parts of Syringes that holds medication Plunger ) Part of Syringes that is designed for insertion in barrel , provides

mechanism by which meds are drawn into or pushed out of barrel

( Flange ) Part of Barrel of syringe where the plunger is inserted. the flangeforms a rim around the barrel, prevents syringe from rolling

( Tip ) part of the barrel of syringe, where needle is attached

REMOVING MEDICATION FROM AN AMPULE

AMPULE

PARTS OF THE NEEDLE


3/14

A glass container usually designed to hold a single dose of a drug.

Made of clear glass and has a distinctive shape with a constricted neck.

Most have colored marks around them indicating where they are PRESCOREDfor easy opening.

PURPOSEUsed to package multidose or single dose parenteral medication

ASSESSMENTa. assess the clients body built, muscle size, weight and the desired route of

administration if medication is to be injected.

b. check medication expiration date printed on ampule

Contains single doses of medication in a liquid.

Available in several sizes, from 1 ml to 10 ml or more

Made of glass with a constricted neck that must be SNAPPED off to allow accessto the medication

A COLORED RING around the neck indicates where the ampoule isPRESCORED to be broken easily

Aspiration of the medication into a syringe is completed with a filter needle to

prevent small glass fragments from entering the syringe

AMPULE PREPARATION

1.Tap top of ampoule lightly and quickly with finger until fluid moves from neck ofampoule.

2. Place small gauze pad or unopened alcohol swab around neck of ampoule

3. Snap neck of ampoule quickly and firmly away from hands.4. Draw up medication quickly, using filter needle long enough to reach bottom of

ampoule

5. Hold ampoule upside down, or set it on a flat surface. Insert filter needle into center ofampule opening. Do not allow needle tip or shaft to touch rim of ampoule.


4/14

6. Aspirate medication into syringe by gently pulling back on plunger

7. Keep needle tip under surface of liquid. Tip ampule to bring all fluid within reach

of the needle.8. If air bubbles are aspirated, do not expel air into ampule.

9. To expel excess air bubbles, remove needle from ampule. Hold syringe with

needle pointing up. Tap side of syringe to cause bubbles to rise toward needle. Draw

back slightly on plunger, and then push plunger upward to eject air. Do not eject

fluid.

10. If syringe contains excess fluid, use sink for disposal. Hold syringe vertically

with needle tip up and slanted slightly toward sink. Recheck fluid level in syringe by

holding it vertically.

11. Cover needle with its safety sheath or cap. Replace filter needle with needle for

injection.Nursing Considerations

a. When expelling air bubbles, do not eject fluid.

b. Hold plunger with firm pressure; plunger may be forced backward by air

pressure within the vial

Removing Medication from a Vial

Vial


5/14

Is a small glass bottle with a sealed rubber cap. Come In different sizes, from single to multidose vial.

Usually have a metal or plastic cap that protects the rubber seal.

REMOVING MEDICATION FROM A VIAL

Remember:

1. To access the medication in a vial, the vial must be pierced with a needle.

2. Air must be injected into a vial before the medication can be withdrawn.

3. Failure to inject air before withdrawing the medication leaves a vacuum

within the vial that makes withdrawal difficult.

Reconstitution it is a technique of adding a solvent to a powdered drug to

prepare to prepare it for administration.

***** Powdered drugs usually have printed instructions (enclosed with each

packaged vial) that describe the amount and kind of solvent to be added.***** Commonly used solvents are sterile water or sterile normal saline.

Examples of the preparation of powdered drugs:

1. Single-dose vial

2. Multidose vial

PURPOSE

1. Vials are used to package multidose or single dose parenteral medication

ASSESSMENT

1. Observe the 10 R of drug administration

2. Assess the vial for damaged, expiration and indication

Planning

1. Check the administration order

2. Organize equipment

a. MAR or computer print our

b. Vial of sterile Medication

c. Antiseptic wash

d. Needle and syringe

e. Filter needle

(according to the agency policy)

f. Sterile water or normal saline for powdered form

Implementation:

1. Gather equipments.

2. Compare the medication against the medical order.

3. Wish hands and observe other appropriate infection control procedures.

4. Prepare the Medication Vial for withdrawal

a. Remove the metal or plastic cap in the vial that protects the

rubber stopper


6/14

b. Clean the rubber top with an antiseptic solution in a circular

motion from inner going outer

5. Withdraw the medication

a. Remove the cap from the needle by pulling it straight offb. Aspirate an equal amount air for withdrawal

c. Pierce the rubber stopper in the center with the needle tip

d. Ensure that the needle is firmly attached to the syringe.

e. Inject the air into the space above the solution keeping the bevel of the

needle above the surface of the solution.

f. Position the vial upright on a flat surface or on a inverted position.

g. Withdraw the medication using either of the following:g.1. Hold the vial down, move the needle tip bellow the fluid level and

withdraw the medication. Avoid drawing the last drop of the vial.

g.2. Invert the vial, needle tip should be below the fluid level and

gradually withdraw the medication

g.2. Invert the vial, needle tip should bebelow the fluid level and graduallywithdraw the medication


7/14

6. Draw the prescribed amount of medication while holding the syringe and vial

at eye level to determine that the correct dosage of medication is drawn into

the syringe.7. Eject air remaining at the top of the syringe into the vial.

8. Once correct dosage is obtained, withdraw the needle in the vial.

9. Replace the cap over the needle using scoop method, thus maintaining

sterility.

10. If necessary, tap the syringe barrel to dislodge any air bubbles present in the

syringe

11.If a multidose vial is being used, store the vial containing the remainingmedication according to agency policy

a. Read the manufacturers direction

b. Withdraw the equivalent amount of air from the vials

before adding the diluents, unless otherwise indicated by the direction

c. Add amount of sterile water or saline as indicated

d. If to be used again, label the vial with the date and time it was

prepared, amount of drug contained in each millimeter of solution

and your initials

e. Once reconstituted store in a refrigerator

12. Wash your hands.

INTRAMUSCULAR INJECTION

ANGLE OF INSERTION


8/14

INTRAMUSCULAR INJECTION

Definition:

An intramuscular injection is an injection given directly into the central areaof a specific muscle. In this way, the blood vessels supplying that muscle

distribute the injected medication via the cardiovascular system.

.

Purpose: Intramuscular injection is used for the delivery of certain drugs not

recommended for other routes of administration, for instance intravenous,

oral, or subcutaneous. The intramuscular route offers a faster rate of

absorption than the subcutaneous route, and muscle tissue can often hold a

larger volume of fluid without discomfort. In contrast, medication injected

into muscle tissues is absorbed less rapidly and takes effect more slowly that

medication that is injected intravenously. This is favorable for some

medications

SITES OF INJECTION

Deltoid muscle The deltoid muscle located laterally on the upper arm can be used for

intramuscular injections. Originating from the Acromion process of the

scapula and inserting approximately one-third of the way down the humerus,

the deltoid muscle can be used readily for IM injections if there is sufficient

muscle mass to justify use of this site. The deltoid's close proximity to the

radial nerve and radial artery means that careful consideration and

ANGLE OF INSERTION


9/14

palpation of the muscle is required to find a safe site for penetration of the

needle. There are various methods for defining the boundaries of this muscle.

Vastus lateralis muscleThe vastus lateralis muscle forms part of the quadriceps muscle group of the

upper leg and can be found on the anteriolateral aspect of the thigh. This muscleis more commonly used as the site for IM injections as it is generally thick and

well formed in individuals of all ages and is not located close to any major

arteries or nerves. It is also readily accessed. The middle third of the muscle is

used to define the injection site. This third can be determined by visually

dividing the length of the muscle that originates on the greater trochanter of the

femur and inserts on the upper border of the patella and tibial tuberosity

through the patella ligament into thirds. Palpation of the muscle is required to

determine if sufficient body and mass is present to undertake the procedure.

Gluteus medius muscle

The gluteus medius muscle, which is also known as the ventrogluteal site, isthe third commonly used site for IM injections. The correct area for injectioncan be determined in the following manner. Place the heel of the hand of the

greater trochanter of the femur with fingers pointing towards the patient's

head. The left hand is used for the right hip and vice versa. While keeping

the palm of the hand over the greater trochanter and placing the index finger

on the anterior superior iliac spine, stretch the middle finger dorsally

palpating for the iliac crest and then press lightly below this point. The

triangle formed by the iliac crest, the third finger and index finger forms the

area suitable for intramuscular injection.

Action: Systemic effect

More rapid effect of drug than subcutaneous injection.

Used for irritating drugs, aqueous suspension and solution in oils.

Special Considerations:

Serve as alternative to dorsogluteal and vastus lateralis for deep IM or Z-

track injection. Considered secondary to vastus lateralis site for infants

and children.

PREFERRED IM INJECTION SITES:

1. VENTROGLUTEAL

Volume of Drug Administration: Usual: 1.0 to 4.0 Ml

Maximum: 5.0 mL

Commonly Used Needle Size:

20 23 Gauge, 1.25- 2.5 inches

Client Position:

Supine position (with appropriate restrain if pediatric)

Angle of Injection:


10/14

Angle the needle slightly toward

the iliac crest.

Advantages:

Relatively free of major nerves and vascular branches.

Well defined by bony anatomical landmarks. Thinner layer of fat than dorsogluteal site.

Sufficient muscle mass for deep IM or Z-track injections.

Readily accessible from several client positions.

Disadvantages:

Should a hypersensitivity reaction occur, tourniquet cannot be applied to delay

absorption.

Health professionals unfamiliarity with site.

2. DORSOGLUTEAL

VOL. OF DRUG USUAL: 1.0-3.0 ml; MAXIMUM: 3.0mL

NEEDLE SIZE 18- 23 GUAGE, 1.25- 23.0 INCHES

CLIENT POSITION PRONE

ANGLE 90 ANGLE TO FLAT SURFACE UPON

WHICH CLIENT IS LYING PRONE.

SPECIAL

CONSIDERATION

Requires strict adherence to

correct anatomical site location

and injection technique.

Advantages:

Large muscle mass accommodates deep IM or Z- track injection.

Injection not visible to client.

Disadvantages:

Boundaries of the upper outer quadrant are arbitrarily selected and may

exceed margin safely.

Danger of injury to major nerves and vascular structures if incorrect site or

technique.

Fat is often very thick; an injection intended for muscle may be

subcutaneous.


11/14

If hypersensitivity reaction occurs, tourniquet cannot be used

I and D of any abscesses complicated by proximity of large nerves and

vascular structures.

3. DELTOID

VOL. OF DRUG USUAL: 0.5 mL

MAXIMUM: 1.0 mL

NEEDLE SIZE 23-25 GUAGE, - 1.5 inches

CLIENT POSITION SITTING, PRONE, SUPINE, LATERAL

ANGLE OF

INJECTION

90angle to the surface of the skin (or angled

slightly to the acromion).

SPECIAL

CONSIDERATION

Preferred site for administration of vaccine.

Advantages:

Easily accessible

General acceptance by the client.

If hypersensitivity occurs, tourniquet can be used.

Disadvantages:

Small muscle mass relative to other site Close proximity to nerves and vascular structures; small margin of safety

with any deviation from site.

Not suitable for repeated or large volume(>2.0mL) injection.

4. Vastus Lateralis:

VOL. OF DRUG USUAL:


12/14

ANGLE OF POSITION 45 ANGLE TO FRONTAL,SAGITAL AND

HORIZONTAL PLANES OF THE THIGH

SPECIAL

CONSIDERATION

IM site of choice for children

Advantages:

Relatively large muscles mass at birth: suitable for infants

Area of sufficient size for several injections

Free of major nerves and vascular branches.

Disadvantages:

Use of long needle relative to small extremely may reach sciatic nerve or

femoral structures if improper technique is used.

INTRADERMAL INJECTION

Intradermal injection are ued for administering small amounts of local

anesthetic and skin testing.

PURPOSE:

To administer medication into the dermal layer of the skin just beneath the

epidermis.

This method of administration is frequently indicated for allergy and

tuberculin tests and for vaccination.

ASSESSMENT:

Review physicians medication order for clients name, drug name,dose, time and route of administration.

Collect drug reference information regarding expected reaction with testing skin with specific allergens or

medication and appropriate time to read site.

Assess clients history of allergies. Assess clients knowledge of purpose and reactions of skin testing.

PLANNING:

Perform hand hygiene. Prepare correct dose. Check dose carefully.

Identify client. Compare against medication administration record.

Explain step of procedure, and tell client that injection will cause a slightburning or sting.

IMPLEMENTATION:

Assemble equipment and check the physicians order. Identify the client. Explain the procedure to the client.

Wash hands and done gloves.

- Prepare the medication:


13/14

a) cleanse the rubber top w/ alcohol swab.

b) open the wrapper of the syringe and detach the needle onto the

syringe

c) Attach the tuberculin syringe into the aspirating needle.

d) Secure and remove the cap straight off, then aspirate an equal amount of air(0.9 ml) and inject into the diluents. Withdraw same amount of diluents.

e) Pierce the rubber cap of medication vial and aspirate 0.1 ml.

f) Remove the aspirating needle into the syringe and replace it with tuberculin

needle.

Select an area on the inner aspect of the forearm that is not heavilypigmented or covered with hair.

Cleanse with alcohol swab while wiping with a firm circular motion and

moving outward the injection site. Allow the skin to dry, if the skin is oily,

clean the area with a pledge moistened with acetone.

Remove the needle cap with nondominant hand by pulling it straight off.

Use the nondominant hand to spread the skin taut over the injection site. Use the nondominant hand to spread the skin taut over the injection site. Place the needle almost flat against the clients skin, bevel side up, and inert

the needle. Insert needle only about 1/8 inch. Move the thumb of

nondominant hand to secure the syringe.

Slowly inject the agent while watching for a small wheal or blister to appear.If none appears, withdraw the needle slightly.

Withdraw the needle at the same time. Do not massage the area after removing the needle. Mark the exact size of

the wheal place a tape 1inch above or below the wheal indicating the

medicine and due time.

Do not recap the used needle. Discard the needle and syringe in theappropriate receptacle.

Assist a client to a position of comfort. Wash your hands. Chart the administration of medication.

Do not recap the used needle. Discard the needle and syringe in the

appropriate receptacle.

Assist a client to a position of comfort.

Wash your hands. Chart the administration of medication.

INTRAVENOUS INJECTION


14/14

II-3 Drug Preparation

Documents

Transcript of II-3 Drug Preparation