19.1 Parenteral drug delivery Flashcards
Parenteral administration
administration by injection, infusion, or implantation
Intra-arterial
Administration within an artery
Intrathecal
Administration into the cerebrospinal fluid
Epidural
Administration into epidural space
Intra-articular
Administration into a joint
Intraosseous
Administration directly into the bone marrow
Pyrogen
a substance that induces a fever in a fever; e.g. viruses, bacteria, endotoxins, lipopolysaccharides, cytokins
Endotoxins
cell membrane components of gram-negative bacteria
Two primary types of lines
-peripheral line
-central line
Peripheral line
-administered through a peripheral vein
-veins of the hand, cephalic vein of the arm, veins in the neck (jugular vein) or leg (saphenous vein)
Central line
-indwelling catheter inserted into a larger vein (subclavian, jugular, femoral)
Central lines are required for administration for:
- long-term antibiotics
- highly concentrated drugs
- drugs that cause phlebitis
- vesicant drugs
- drugs with low or high pH (<5 or >9)
- drugs with high or low osmolarity (i.e. TPNs)
Non-tunneled catheter
-catheter exits the skin near the venous cannulation site
-used for temporary venous access
Tunneled catheter
-catheter is tunneled through the subcutaneous tissue and exits the skin at a location from the venous cannulation site
-limits microbial entry
-used for long-term venous access
-e.g. Hickman catheter
Port
-Catheter is totally implantable and is inserted completely under the skin
-risk of infection is lower
-used for long-term venous access
Peripherally Inserted Central Catheter (PICC lines)
catheter inserted into the cephalic vein in the arm and threaded into the subclavian vein until it ends at the superior vena cava
Risks with IV administration
-Phlebitis
-Thrombosis
-air emboli
-hemolysis
air emboli
the injection of air into the blood vessel
Phlebitis
-inflammation/irritation of a vein
-more common with peripheral lines
Thrombosis
-blood clot formation
-can lead to superficial vein thrombosis (SVT) or deep vein thrombosis (DVT)
-to minimize, flush catheters
Infiltration
unintentional administration of a non-vesicant medication into tissue around a vessel
vesicant
-a drug that will cause severe tissue damage if enters the tissues around a catheter
-should only be administered through a central line
Extravasation
-the escape of a vesicant drug into the extravascular space, either by leakage from a vessel or by direct infiltration
Hemolysis
-lysis of red blood cells
-can be due to hypotonic solutions or membrane active drug such as amphotericin
IV formulation requirements
-sterile
-free of endotoxins and pyrogens
-particulate matter (free of visible particles)
-ideal to have near physiological pH
isosmotic
two solutions with the same osmotic pressure
hyper-osmotic
a solution with a higher osmotic pressure (and more species in solution) relative to another
hypo-osmotic
a solution with a lower osmotic pressure (and fewer species in solution) relative to another
For children under 3, inject IM into…
vastus lateralis
For children over 3, inject IM into…
deltoid
Muscles for IM injection
-deltoid
-gluteal muscles
-lateral thigh muscles (vastus lateralis)
IM volume limits of deltoid, gluteal and vastus lateralis
deltoid: up to 2 ml
gluteal: up to 5 ml
vastus lateralis: up to 5 ml
Subcutaneous areas of injections
“fat pad” areas
-abdomen
-thigh
-back of upper arm
-upper buttocks/hip
Intradermal injection site and examples
-injection into the skin just beneath the epidermis
-used primarily for vaccines and administering antigens for allergic reaction testing
-volume = 0.1 ml
Intra-arterial injection uses
-injection into an artery
-cancer/chemotherapy
CNS injection examples and uses
-intrathecal
-epidural
-must be preservative-free
-used for the treatment of CNS infections or cancers, for inducing spinal anesthesia, and for relieving chronic pain
