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MedicamentsAdministering Injections
University of Pécs Faculty of Health SciencesInstitute of Nursing Sciences, Basic Health Sciences and Health Visiting
Dr. András Oláh1, Noémi Fullér2, Gyula Szebeni-Kovács3, Zsuzsanna Germán3, Szilvia Szunomár3
1 associate professor, vice dean, head of the department2 assistant professor, deputy head of the department3 subject teacher
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Forms of medicine
• Solid medicines• Semi-solid medicines• Liquid medicaments• Pharmaceutical preparation made by extraction• Other pharmaceutical forms
Main principles, main concepts and the main areasof pharmacology – not within this lecture
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Solid medicines
• Teas – whole, chopped, filters• Powders, body powders – internal-external use• Pills, tablets – the most frequently applied
medications• Capsules – must not be opened
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Semi-solid medicines
• Ointment - for treatment of the skin and mycoderm
• Creams – soft ointments with large watercontent
• Paste – with a high powder content• Rectal and vaginal medicines - Solid at room
temperature• Pellets - out-of-date
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Liquid medicaments• Solutions – For internal or external use
• Liquid medicines for external use – eyedrops, ear drops, nosedrops
• Ingested liquid medicine forms - syrup
• Other liquid forms of medicine
• Emulsion – have to be shaken before use
• Solutions for parenteral use – sterile, rapid effect, no absorption
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Pharmaceutical preparation made byextraction
• Decoction - from loose-structure parts of plants
• Extract - extraction with appropriate solvent
• Tincture - from phytogenic drugs with alcoholor ether
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Other pharmaceutical forms
• Aerosol - 0,001-100 µm particles
• Transdermal Therapeutic System (TTS)–avoiding first pass effect
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Guidelines in medication• right patient
• right drug
• right time
• right dose
• right route
• right form
• right action
• right response
• right documentation
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Medicine storage in healthcareinstitutions
• separated room, in locker, 15 - 25°C
• fridge only for medicaments (3-7 °C)
• infusion solutions, disinfection solutions, bandages, flammable and explosive materials –separated room
• physician and nurse responsible for themedicaments
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Medicine storage in healthcareinstitutions
• storage of narcotics, opiates:– in a strong-box within a locker– strict registration – uncorrectable
• storage of medicaments in ABC order
• storage within the original wrapping
• prohibited to wrap back the medicaments if itwas delivered to the patient
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Oral (Per os ) administration of medicine
• cooperation, swallowing properly• appropriate amount of liquid• appropriate body position• sublingual• buccal
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Otological treatment
• external auditory passage• ear drops, aerosol sparys, ear powder, ear
rinse liquids• only body temperature products• positioning the patient• external auditory passage can be straightened
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Vaginal treatment• vaginal suppository• vaginal pill• vaginal capsule• vaginal solution• vaginal emulsion
• vaginal suspension• vaginal foam• tablets for vaginal solutions or
suspensions• semi-solid vaginal preparation• medicated vaginal tampon
Aquatus system is a Hungarian inventionUse of the applicatorVaginal suppositoryPositioning the patient
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Nasal administration• high permeability of the nasal membrane• large surface for absorption• local or systemic effect• first pass fails to come• free airways are needed• disadvantage: condition of the nasal membrane,
diseases (rhinitis) can alter the absorption; elimination is fast
• oily solutions should be avoided>pneumonia• drops and sprays• powders, ointments, gels• positioning the patient
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Ophtalmologic treatment
• sterile preparations excusively• liquid solutions, solid or semi-solid
preparations• positioning the patient• drop in the temporal canthus• ointment- from nasal to temporal canthus
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Rectal treatment
• local and systemic effect• for therapeutic and diagnostic purposes• first pass fails to come• unreliable dosage (dosages with 20-30%
more)• positioning the patient
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Transdermal patchesConsistent drug level-continuous absorption
No first pass
Comfortable, simple
Local side effects
Water, local warmth
nitro-glycerine• Introducing nitrate free
periods in order to avoidtolerance
• Applying the patches
contraceptive patches• Three patches in a period• placement
opioids• 48-72 hours• varied plasma level
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Aerosol therapy
part of the Oxygen therapy lecture
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Administering injections
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Injection
• it is a parenteral administration of medicine• invasive technique
• with or without syringes• choosing the site for injection
– General characteristics of the patient– State of skin and tissues– State of circulation (chimino shunt)
intracutaneusbetween the
layers of the skin
subcutaneusunder the layers
of the skin
intramuscularin the muscles
intravenousdirectly into
the vein
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disposable - re-usable
Syringes
centric - Eccentric cone
Luer-Slip and Luer-Lock types
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two-part - three-part
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Low-dose syringes, high capacity syringesCalibration scale (0.25-450ml)
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Tools for administering injectionSyringes
• Hypodermic syringe• Oral syringe• Vaginal, rectal syringes
Safety Systems – Infusion therapy lecture• safety needles• safety syringes
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Prefilled syringesFor intravenous catheters:
Generally physiological salineNeedle is needless
Anticoagulants
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Needle cone
bevelshaft
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Needle
• risk of needlestick injuries• place the plastic covering on the needle after
the intervention???
• needle inner diameter measured by Gauge (G) • length of the needle measured by inch (1 inch
= 2,54 cm)
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bevel
Short and long bevelsCone tips and blunt tips
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Way of administering
injectionsLumen of needle Length of needle
inch (mm)
Intracutaneous/intradermic
25 G - 27 G ¼inch/6mm -5/6inch/21mm
subcutaneous 25 G - 26 G ½inch/13mm -1inch/25mm
Intramuscular 21 G - 23 G 5/8 inch/16mm -2inch/50mm
Intravenous/venipuncture
21 G - 23 G ¾inch/19mm -1½inch/38mm
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Choosing the suitable needle:• Fat tissue• Gender• Site of administration
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PEN
• for insulin administration – but not excusively• comfortable, simple, discreet
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re-usable - disposablechoosing the suitable device
• dosage• right-left handedness• patients with poor eye-sight• possibilities of correction
new needle for each administrationstoring the cartridges
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cartridge
doubletipped needle
shooter
setting button
cartridge house
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Administering injections withoutneedles
• not so common• in case of needle phobia• simple, comfortable• high pressure liquid jet (spring power)• intramuscular use is possible• opening with lumen 200 µ at the end of ampoule• infectious previously
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Tools for drawing up medicine
• filter needle• wheel/syringe filter• filter connector• filter aspiration
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Tools for drawing up and mixing medicine
transfer cup spyke
passing spyke
syringe connectors
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Tools for drawing up and mixing medicine
syringe closing cap closing cone
syringe cone
aspiration straw
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Drawing up medicine
• from an ampoule
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Drawing up medicine
• from an injection bottle
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Drawing up medicine
• from an ampoule with powder
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Mixing different medicines in an injection
inject air draw up „A” medicine
draw up „B” medicine
never injectback med. „A” into „B”
always turnaheadampoule
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into the layers of skin
slow absorption
generally diagnosticinterventions (goal:
triggering local reaction)
small amount of agent
Intracutaneous/Intradermic (ID) Injection
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Intracutaneous/Intradermic (ID) Injection
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rotating the sitesof administration
retraction?
Subcutaneous Injection (under the skin,sub-q, SC,SQ)
slowly, consistently and continuouslyabsorption
1-2 ml pharmaceuticalis delivered
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insulin, vitamins, heparin, vaccins, interferon, narcotics
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Intramuscular Injection (IM)max. 5 mlabsorption is faster
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Intramuscular Injection (IM)• Obese patients (Site of injection? Length of
needle?)
• Site of injection: advantages-disadvantages
• Adult or child?
• Appropriate body position
• Dorsogluteal -> more complications
• Ventrogluteal -> less complications
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Intramuscular Injection (IM)
ventrogluteal areashould be the most preferredfor the professional
Hungarian practice:• Kós-Votin-method
lower parts of thepalm is on thegreater trochanter
index finger on thespina iliaca anteriorsuperior
opposite handand hip
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Intramuscular Injection (IM)dorsogluteal areaon this area we canexpect the thickestfat tissue
greatertrochanter
spina iliacaposterior
point of thepuncture
Hungarian practice:spina iliaca anteriorand posterior
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Intramuscular Injection (IM)
vastus lateralisbroad muscle
rectus femorisin case of infants, small children
and self injection
one palm transversebelow the greater
trochanter
one palm transverseabove the knee
point of the puncter is the upperpart of the intermediate area
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Intramuscular Injection (IM)
deltoid musclecomfortable for the patientand the professional too
max. amount – 2 ml
with two transversefinger below theacromion
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Intramuscular Injection (IM)
• Traditional method• Air lock/ air bubble technique• Z-track technique
• Retraction• Recommended velocity of administration is
1ml/10 sec• Do not massage the site of injection
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Injection complications• pain• redness of the skin• swelling• itching• infection• nerve injury• bleeding• change of colour of the
tissues• abscess resulting from
injection• injection site fibrosis• allergic reaction• breaking of the needle
between the tissues• Nicolau syndrome
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Reducing pain
• Communication• Applying manual pressure on the site of
injection• Appropriate body position• Appropriate tools (needle, injection without
needle)• Amount of fluid to be administered• Angle of administration
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Intravenous Injection (I.v.)
• through secured venous access or without it• the drug is delivered directly to the blood
circulation• we cannot talk about absorption• immediate effect• risk of overdosing• medicine must be injected slowly
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Intravenous Injection (I.v.)