ADMINISTRATION OF

PARENTAL MEDICATION
BY,
ZAHOOR YASEEN
 Definition
• When the medications are administered
directly into the body tissues.
• Or when the medications are administered by
the routes other that digestive tract.
• It can be also defined as the forcing of fluid
into a cavity, blood vessel or a body tissue
through hollow tube or needle
 Purposes of parental administration
• To get a rapid and systemic effect of drug.
Drugs given by mouth take time for their
absorption. Hence oral administration delays.
• To provided a needed effect even when the
client is unconscious, unable to swallow due
to neurological and surgical alterations.
 …
• Assures that the total dosage will be
administered and the same will be absorbed
for systemic actions of the drug.
• Provides the only means of administration for
medications That can not be given orally.
• To obtain a local effect at the sight of injection.
e.g. local anaesthesia
 ..
• To replace the blood volume by replacing the
fluid.
• To give nourishment when it can not be taken
orally.
 Principles of parental administration
• The knowledge of anatomy and physiology of
the body is essential for the safe
administration of injection.

• 1). To avoid injury to underlying tissues

• 2). To minimize pain
• 3). To aid in absorption of drug
 …
• If carelessly given, injections are means of
introducing infections into the body.
• Drugs that change the chemical composition
of blood, will endanger the life of the client, if
not used cautiously.
 …
• Any unfamiliar situation produces any anxiety.
• Once a drug is injected, it is irretrievable.
Antidote may be available for particular
medications but the best antidote is
prevention.
• Organization and planning results in the
economy of time, material and comfort.
Routes of parental administration
• Intra-muscular injections
• Intra-venous injections
• Subcutaneous injections
• Intra-dermal injections
 Intra-muscular injection
• An intramuscular injection is defined as the
parental route in which medications is
delivered/injected directly/deep into the
muscles.
• This allows the medications to be absorbed
into the blood stream quickly.
 Articles needed
A clean tray containing
• Prescription card
• Sterile medication
• Syringes
• Needles
• Alcohol swabs.
• Clean gloves
• Kidney tray
 Procedure
Before procedure
• Check physician order and identify patient
• Explain procedure to the patient, the purpose
of medication, the site of injection, expected
effect and how he has to cooperate.
During procedure
• Wash hands
• Preparation medication from ampoule or vial
 …
• Wash hands and don gloves
• Provide privacy
• Provide Position like supine, lateral or prone
depending on the site chosen
• Select the site and clean it.
– Site should be free from lesions, tenderness, localized
inflammation and one that has not been frequently
used.
– Clean the site with alcohol swab in a circular motion
moving from center to periphery and allow the site to
dry.
 …
• Dorsal gluteal site:- identify the greater
trochanter of the femur and posterior
superior iliac supine. Draw an imaginary line
between these two boney landmarks. Site will
be upper and outer quadrant.
• Or divide the buttocks into four regions by
imaginary lines. Select the site as upper and
outer quadrant for the intra-muscular
injection.
 …
• Ventro-gluteal site:- place the tip of the index
finger on the anterior superior iliac supine of
the client, middle finger just below the iliac
crest. The v shaped area is the area in which
injection can be given safely.
 …
• Vastus lateralis: it is located on the lateral
aspect of the thigh. It is the area between mid
anterior thigh and mid lateral thigh, one
hands breadth from the greater trochanter to
the one hands breadth above knee.
• Mid deltoid site:
 …
• Load the medication into a syringe.
• Hold the syringe in upright position and tap to
remove any air bubble trapped.
• Push the medicine up till the tip of the syringe
where needle hub rests.
• Inject the medication
– Grasp and pinch the area surrounding the injection site.
– Hold the syringe between the thumb and forefinger in a
pen holding manner and pierce the skin at 90 degree
angle and insert the needle.
 …
– Aspirate by holding the barrel steady with non
dominant hand and pulling back the plunger with
your dominant hand.
– Withdraw the needle if blood appears in the
syringe, discard and prepare new injection.
– Inject the medication slowly and steadily if blood
does not appear in the syringe on aspiration
 …
• Withdraw the needle slowly and steadily while
supporting at the hub of syringe and needle.
Support the skin surface using a cotton swab
for applying counter traction at the site.
• Apply gentle pressure at the site with a dry
sponge and if bleeding is present, continue
applying pressure till bleeding stops. Do not
massage.
 …
After procedure
• Discard the uncapped needle and syringe into
appropriate receptacle.
• Remove gloves, wash hands
• Record procedure
• Assess effectiveness of medication
 Intravenous injections
• An intravenous injection is defined as giving
something such as drugs into vein through
syringe.
• Or an intravenous injection is defined as an
injection made into the vein when rapid
absorption is called for, when fluid can not be
taken by mouth or when the substance to be
administered is too irritating to be injected
into the skin or muscle.
 Articles
A sterile tray containing
• Clean gloves
• Medications
• Syringe
• Sterile needle
• Alcohol swab
• Wrist watch
• Prescription card.
 …
• Tourniquet
• Kidney tray
• A bowel containing cotton swabs.
• Infusion set
• Intravenous catheter
• IV poles
• Adhesive tap
 Procedure
• Check the prescribed order.

• Identify the patient

 …
• Communicating with the patient: it is crucial
for the nursing officer to thoroughly explain
the procedure, outlining both its benefits and
potential drawbacks. Subsequently, the
nursing officer should inquire whether the
patient wishes to proceed with the procedure
or not. This process ensures that the patient is
well-informed, enabling them to make an
informed decision about their health.
 …

• Hand Washing.

• Glowing
 …

• Preparation of articles

• Preparation of medications
 ….
• Patient preparation (Positioning,
selection of site, preparation of site)
[Palpation of the vein. Positioning the
tourniquet. After placing the tourniquet, the
patient may be asked to close and open his
hand several times to facilitate venous
drainage.]
 …
• Fix the vein with the non-dominant
hand: This fixation helps for a more stable
puncture of the vein as it will mobilize at least
under the skin.
 ….
• Penetration of the vein: keep the syringe as in
the picture. We puncture the Vein at an angle of
approximately 10-30º. The closer the vein is to the
surface of the skin the injection could be done with
a narrower angle. A deep vein may need a 450 angle
of approach. After exposing a drop of blood in the
needle bevel, we do not advance to avoid piercing
the vessel walls. It is also recommended to reduce
the angle so as not to puncture the veins posterior
wall.
 …
• For intravenous injection we need
to make sure we are in the vein: we
will slowly aspire by pulling the syringe
plunger toward us. If the blood enters the
syringe easily, we have the confirmation that
the needle is inside the vessel. Unfold the
tourniquet. Inject the substance, respecting
the injection rate specific to each drug.
 …
• Withdrawing the needle: always before
pulling the needle out of the vein, make sure
the tourniquet is loose! Compress the
puncture region with a disinfectant pad. At the
same time, the needle is withdrawn from the
patient's vein. Keep compression for at least 5
minutes.
 …
• Provide comfortable position

• Replace the articles

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• Disposal of waste in the appropriate
containers.

• Remove the gloves.

 …
• Wash hands.

• Recording and reporting.

 Complications
• Allergic reactions: certain drugs e.g. penicillin,
sera etc. can produce allergic reactions in the
client. it can be prevented by test dose.
 ….
• Infections: infections may be introduced
through careless handling and improper
sterilization of syringes, needles and the fluids
used for injections. It can lead to abscess
formation and sloughing of the tissue.
 ….
• Pyrogenic reactions (producng fever): for
example the clients getting intravenous fluids
may develop fever due to the pyrogens
present in the fluids.
• Tissue trauma:
…
– repeated injections on the same spot can lead to
indurations of the skin, scar formation etc.
– Injury to periosteum
– Injury to nerves
– Injury to walls of blood vessels
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• Psychic trauma: especially in children
 ….
• Pain
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• Accidental intravascular injections:
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• Foot drop, persistent paralysis of the limbs
due to nerve injury
 ….
• Air embolism: due to the introduction of air
bubbles into the blood vessels.
 ….
• Over dose and under dose of medications
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• Errors in administration of medicine
 ….
• Circulatory overload: when large quantities of
fluids are introduced into the body within
short time
 …
• Serum hepatitis: infectious hepatitis have
been attributed to improperly disinfected
syringes and needles. Inoculation of 0.0004ml
of the infected blood may transmit the serum
hepatitis
Role of nurse in administration of parental
administration
Preliminary assessment:
• Check the diagnosis and age of client
• Check the purpose of injection
• Check physicians order for type of injection,
the dosage, time and route of administration
 …
• Check the clients name and bed no.
• Check the nurses record to find the time to
which the last dose was given.
• Check the symptoms of overdose or allergic
reactions
 …
• Check the necessity for giving test dose
• Check the conscious level of patient and
ability to follow directions
• Check the clients previous experience with
injections
 …
• Preparation of articles
• Preparation of client and environment
– Identify the client correctly
– Explain the procedure to the patient to gain his
confidence and cooperation
– Provide privacy with curtains and drapes
– Restraint the site of injection, in case of children
– Keep the attention of client away from injection by
friendly conversations
– Offer bedpan
 …
– Provide needed position to the client
– Select the site suitable for route of administration,
quantity of medication to be given and the
characteristics of medication.
 …
• After procedure:
• Inspect the area for bleeding, if bleeding takes
place apply pressure
• Help the client to dress up and take
comfortable position
• Ask client to take rest for 15 minutes to 1 hour
especially when the drug is expected to
produce some form of allergic reactions in the
client.
 ….
• Watch the signs of any allergic reaction.
• Replace the articles
• Recording and reporting of procedure