7. Parenteral I

Question 1

Enteral means… parenteral means

Answer 1

Enteral= absorbed through GI tract (Oral, sublingual and rectal)

Parenteral= Not absorbed through GI tract 9IV, IM, IN, SM, SC)

Question 2

Uses of IM administration

Answer 2

• Can’t take oral meds
• No accessible veins
• Uncooperative
• Administer adjunction meds (anticholinergics or emergency meds)
• Preop sedation

Question 3

Technique of IM injection

Answer 3

• ID landmarks with palpation (not just visual)
• Clean skin with antiseptic
• Use long needle to penetrate into belly of the muscle (avoid injection into deep subcutaneous tissue)
• Hold syringe like dart
• Flick of wrist
• Aspirate
• Deposit

Question 4

Advantages of IM injection

Answer 4

• Requires less patient cooperation
• Onset and predictability better than oral but not as good as IV (can’t titrate but avoids first pass hepatic metabolism and GI).

Question 5

Disadvantages of IM

Answer 5

• Can’t titrate
• Can’t reverse as easily as inhalation
• Trauma from injection

Question 6

What are the four IM injection sites

Answer 6

• Gluteus maximus
• Ventrogluteal area
• Deltoid muscle
• Vastus Lateralis

Question 7

Describe injection into gluteus maximus

Answer 7

• Contrainidcated in infants (can lead to paralysis- noticed when they learn to walk)
• Lying prone
• Upper outer quadrant
  
  • Upper inner quad= sacral plexus
  • Lower Inner quad= Siatic nerve
  • Lower outer quad= Femur
• Avoid the siatic n. and superior gluteal a. and v.
• Thin skin
• Large volumes (6-8cc)

Question 8

Describe an injection in the ventrogluteal area

Answer 8

• Contraindicated in infants –> paralysis seen when start walking
• Furthest from major blood vessels and nerves
• Landmarks
  
  • Anterior superior illiac spine
  • Illiac Crest
  • Greater trochanter of the femur
• Can be done in any position

Question 9

Deltoid muscle

Answer 9

• Inject between the upper and lower portions of the deltoid
• Avoid radial n.

Question 10

Describe the vastus lateralis injection

Answer 10

• Can be used in infants
• Far away from major vessels and nerves
• One hand width below the greater trochanter of the femur and one hand width above the knee cap
• Done when supine or prone
• Can take large volumes (up to 15 cc)

Question 11

Complications of IM injection

Answer 11

• Tissue trauma at injection site
• Injury to major nerves and BVs
• Hematoma
• Broken needles (don’t insert hub)
• Infection

Question 12

Because of risk of hematoma IM injections should be avoided on what patients

Answer 12

anticoaggulated or patients with bleeding disorders

Question 13

Uses of IM injeciton

Answer 13

• Concious sedation
• Administer adjunctive meds (antibiotics, corticosteroids or emergency meds)
• Pre-med prioer to GA

Question 14

What are the different IV solutions that can be given

Answer 14

• Normal saline
• 1/2 Normal saline
• Lactated Ringers

Question 15

Where are the different locations for IV injeciton

Answer 15

dorsum of hand

antecubital fossa

Question 16

Technique for IV injeciton

Answer 16

• Apply turniquet
• Cleanse skin
• Stabilize vein distally
• Puncture skin with bevel up at 30 degrees
• Decrease angle to enter vein
• Insert catheter over needle and canulate vein
• Remove tourniquet
• Attach IV line
• Start flow of solution
• Secure with tape

Question 17

Advantages of IV injeciton

Answer 17

• Rapid onset
• Good control (titration and easier to determine dose)
• Shorter recovery time than with IM
• Can easily administer other meds (antisialogogues and emergency meds)

Question 18

Disadvantages of IV

Answer 18

• Cooperative patient
• Tough to master
• Must be NPO
• Manage patient who enters deep sedation
• Training and permits needed