Introduction:
In the medical field, drug administration is a critical aspect of patient care, ensuring the effective delivery of medications to achieve therapeutic outcomes. While oral administration is the most common route, there are situations where drugs must be administered through parenteral routes, bypassing the gastrointestinal tract. Parenteral routes offer rapid onset of action and are often utilized in emergency situations or when patients are unable to take medications orally. In this article, we will explore various parenteral routes of drug administration and the responsibilities of nurses in each route.
- Intravenous Route (IV) :
Description: Drugs are administered directly into the bloodstream through a vein.
- Insertion angle – 20-30
- Onset of action – less than 1 minute(30-60sec).
- Volume transfused – unlimited
Nurse’s Responsibilities:
– Ensure proper placement of the IV catheter.
– Monitor the infusion rate and adjust as necessary.
– Assess for signs of complications such as infiltration or phlebitis.
– Administer IV medications safely and accurately.
- Intramuscular Route (IM) :
Description: Drugs are injected into the muscle tissue, allowing for slower absorption compared to IV administration.
Commonly used sites for IM drug administration are as follows :-
- In adult – ventrogluteal
- In infants – vastus lateralis (in the mid of lateral side of the thigh)
Most common vaccination sites :-
- In adults- Deltoid muscle
- In children – vastus lateralis
- IM Injection site for self administration – vastus lateralis
- volume of drug used for IM administration- 1ml to 3ml
Nurse’s Responsibilities:
– Select appropriate injection site and needle size.
– Aspirate to ensure no blood is drawn back before administering the medication.
– Massage the injection site gently to enhance absorption.
– Monitor for adverse reactions such as pain or swelling at the injection site.
- Subcutaneous Route (SC) :
Description: Drugs are injected into the subcutaneous tissue, just below the skin.
This route is also known as hypodermis route
Commonly used sites for SC route :
- Abdomen: The area around the navel, specifically the lower abdomen. It provides a relatively large area with good access and is easily accessible for self-administration.
- Thigh: The outer aspect of the thigh, midway between the hip and knee, is another common site. This area is suitable for injections in both adults and children and is often chosen for its accessibility and minimal discomfort
- Upper arm: The area at the back of the upper arm, between the shoulder and elbow and is commonly used for vaccines and other medications.
- Upper back: The area between the shoulder blades on the upper back. This site may be used when other areas are not accessible or suitable, particularly in patients with limited mobility.
Nurse’s Responsibilities:
– Rotate injection sites to prevent tissue lypodystrophy.
– Needle used – 25 gauze.
– Length of needle – 5/8th inch or 0.62 inches.
– Administer medications at a 45 to 90-degree angle.
– Monitor for signs of infection or allergic reactions.
– Educate patients on proper injection technique for self-administration.
- Intradermal Route (ID) :
Description: Drugs are injected into the dermis layer of the skin.
Nurse’s Responsibilities:
– Use a small-gauge needle for precise delivery of medication.
– Volume of drug used will be less than 0.2 ml ( 0.1-0.2ml )
– Administer injections at a shallow angle usually 10-15 degrees to avoid entering muscle tissue.
– Assess for the formation of a wheal or blister at the injection site.
– Educate patients on the purpose of intradermal testing, such as tuberculin skin tests.
- Intra-arterial Route (IA) :
Description: Drugs are injected directly into an artery, typically for diagnostic or therapeutic purposes.
Nurse’s Responsibilities:
– Collaborate with the healthcare team to ensure proper placement of arterial catheter.
– Monitor for signs of arterial occlusion or ischemia.
– Administer medications as prescribed by the healthcare provider.
– Provide patient education on post-procedural care and potential complications.
- Intra-cardiac Route (IC) :
Description: Drugs are administered directly into the heart, often during cardiac resuscitation.
Nurse’s Responsibilities:
– Follow advanced cardiac life support (ACLS) guidelines for drug administration during resuscitation.
– Ensure proper placement of the needle or catheter for intra-cardiac injection.
– Monitor for signs of successful drug delivery and response.
– Document all interventions and responses accurately.
- Intra-peritoneal Route (IP) :
Description: Drugs are injected into the peritoneal cavity, typically for dialysis or chemotherapy.
Nurse’s Responsibilities:
– Assist with the placement of peritoneal catheter under sterile conditions.
– Monitor for signs of infection or leakage at the catheter site.
– Administer medications according to prescribed protocols.
– Educate patients on self-care techniques and signs of peritonitis.
- Intra-spinal Route (IS) :
Description: Drugs are injected into the spinal canal, either intrathecally or epidurally.
Nurse’s Responsibilities:
– Collaborate with anesthesiologists or physicians for proper placement of spinal needle or catheter.
– Monitor for signs of spinal headache, nerve damage, or infection.
– Administer medications slowly to prevent rapid spread within the spinal canal.
– Provide patient education on post-procedural care and potential complications.
- Intra-osseous Route (IO) :
Description: Drugs are administered directly into the bone marrow, typically in emergency situations when IV access is not feasible.
Nurse’s Responsibilities:
– Obtain proper training and certification for intra-osseous access.
– Ensure appropriate site selection and needle placement.
– Monitor for signs of extravasation or compartment syndrome.
– Administer medications as directed by the healthcare provider.
- Intra-articular Route (IAr) :
Description: Drugs are injected directly into a joint space, often for pain relief or treatment of inflammation.
Nurse’s Responsibilities:
– Assist with proper positioning of the patient for joint access.
– Collaborate with physicians for accurate needle placement.
– Monitor for signs of infection, bleeding, or allergic reaction.
– Educate patients on post-injection care and potential side effects.
Conclusion:
As nurses, it is essential to have a thorough understanding of various parenteral routes of drug administration and their associated responsibilities. By following best practices and adhering to established protocols, nurses can ensure safe and effective delivery of medications, ultimately contributing to improved patient outcomes and satisfaction.