19.1 Parenteral drug delivery

Question 1

Parenteral administration

Answer 1

administration by injection, infusion, or implantation

Question 2

Intra-arterial

Answer 2

Administration within an artery

Question 3

Intrathecal

Answer 3

Administration into the cerebrospinal fluid

Question 4

Epidural

Answer 4

Administration into epidural space

Question 5

Intra-articular

Answer 5

Administration into a joint

Question 6

Intraosseous

Answer 6

Administration directly into the bone marrow

Question 7

Pyrogen

Answer 7

a substance that induces a fever in a fever; e.g. viruses, bacteria, endotoxins, lipopolysaccharides, cytokins

Question 8

Endotoxins

Answer 8

cell membrane components of gram-negative bacteria

Question 9

Two primary types of lines

Answer 9

-peripheral line
-central line

Question 10

Peripheral line

Answer 10

-administered through a peripheral vein
-veins of the hand, cephalic vein of the arm, veins in the neck (jugular vein) or leg (saphenous vein)

Question 11

Central line

Answer 11

-indwelling catheter inserted into a larger vein (subclavian, jugular, femoral)

Question 12

Central lines are required for administration for:

Answer 12

1. long-term antibiotics
2. highly concentrated drugs
3. drugs that cause phlebitis
4. vesicant drugs
5. drugs with low or high pH (<5 or >9)
6. drugs with high or low osmolarity (i.e. TPNs)

Question 13

Non-tunneled catheter

Answer 13

-catheter exits the skin near the venous cannulation site
-used for temporary venous access

Question 14

Tunneled catheter

Answer 14

-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

Question 15

Port

Answer 15

-Catheter is totally implantable and is inserted completely under the skin
-risk of infection is lower
-used for long-term venous access

Question 16

Peripherally Inserted Central Catheter (PICC lines)

Answer 16

catheter inserted into the cephalic vein in the arm and threaded into the subclavian vein until it ends at the superior vena cava

Question 17

Risks with IV administration

Answer 17

-Phlebitis
-Thrombosis
-air emboli
-hemolysis

Question 17

air emboli

Answer 17

the injection of air into the blood vessel

Question 18

Phlebitis

Answer 18

-inflammation/irritation of a vein
-more common with peripheral lines

Question 19

Thrombosis

Answer 19

-blood clot formation
-can lead to superficial vein thrombosis (SVT) or deep vein thrombosis (DVT)
-to minimize, flush catheters

Question 20

Infiltration

Answer 20

unintentional administration of a non-vesicant medication into tissue around a vessel

Question 21

vesicant

Answer 21

-a drug that will cause severe tissue damage if enters the tissues around a catheter
-should only be administered through a central line

Question 22

Extravasation

Answer 22

-the escape of a vesicant drug into the extravascular space, either by leakage from a vessel or by direct infiltration

Question 23

Hemolysis

Answer 23

-lysis of red blood cells
-can be due to hypotonic solutions or membrane active drug such as amphotericin

Question 24

IV formulation requirements

Answer 24

-sterile
-free of endotoxins and pyrogens
-particulate matter (free of visible particles)
-ideal to have near physiological pH

Question 25

isosmotic

Answer 25

two solutions with the same osmotic pressure

Question 26

hyper-osmotic

Answer 26

a solution with a higher osmotic pressure (and more species in solution) relative to another

Question 27

hypo-osmotic

Answer 27

a solution with a lower osmotic pressure (and fewer species in solution) relative to another

Question 28

For children under 3, inject IM into…

Answer 28

vastus lateralis

Question 29

For children over 3, inject IM into…

Answer 29

deltoid

Question 30

Muscles for IM injection

Answer 30

-deltoid
-gluteal muscles
-lateral thigh muscles (vastus lateralis)

Question 31

IM volume limits of deltoid, gluteal and vastus lateralis

Answer 31

deltoid: up to 2 ml
gluteal: up to 5 ml
vastus lateralis: up to 5 ml

Question 32

Subcutaneous areas of injections

Answer 32

“fat pad” areas
-abdomen
-thigh
-back of upper arm
-upper buttocks/hip

Question 33

Intradermal injection site and examples

Answer 33

-injection into the skin just beneath the epidermis
-used primarily for vaccines and administering antigens for allergic reaction testing
-volume = 0.1 ml

Question 34

Intra-arterial injection uses

Answer 34

-injection into an artery
-cancer/chemotherapy

Question 35

CNS injection examples and uses

Answer 35

-intrathecal
-epidural
-must be preservative-free
-used for the treatment of CNS infections or cancers, for inducing spinal anesthesia, and for relieving chronic pain