Chapter 7. Parenteral Medication Administration
7.2 Preparing Medications from Ampules and Vials
Parenteral refers to the path by which medication comes in contact with the body. Parenteral medications enter the body by injection through the tissue and circulatory system. Injected medications are absorbed more quickly than oral and are used with patients who are nauseated, vomiting, restricted from taking oral fluids, or unable to swallow. Parenteral medications can be effective and safe when prepared and administered correctly. However, because they are invasive, and absorbed readily and quickly into the body, there are numerous risks associated with administering them (Perry, Potter, & Ostendorf, 2014).
There are four routes for parenteral medications (also see Figure 7.1). Each type of injection requires a specific skill set to ensure the medication is prepared properly and administered into the correct location (Perry et al., 2014). The four types of injections are:
- Subcutaneous (SC): This injection places medication/solution into the loose connective tissue just under the dermis.
- Intradermal (ID): This injection places the medication into the dermis just under the epidermis.
- Intramuscular (IM): This injection places the medication into the body of a muscle.
- Intravenous (IV): This injection places the medication/solution into a vein through an existing IV line or a short venous access device (saline lock). Medications given by the intravenous route can be given as an IV bolus, as an intermittent (piggyback) medication, or in a large volume continuous infusion.
To administer parenteral medications safely, it is imperative to understand how to prevent an infection, prevent medication errors, prevent a needle-stick injury, and prevent discomfort to the patient. Tables 7.1 to 7.4 address specific practices to eliminate safety hazards to patients and health care workers.
Preventing Infection During an Injection
According to Seigel, Rhinehart, Jackson, and Chiarello (2007), research has shown that unsafe injection practices have resulted in patient exposure to infections leading to outbreaks of infectious diseases. These unnecessary exposures were the result of deficient health care practices. Injectable medications must be given in a safe manner to maintain sterility of equipment and prevent the transmission of infectious diseases between patients and health care workers. Table 7.1 summarizes how to prevent an infection during an injection.
Table 7.1 Preventing Infection During an Injection |
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Safety consideration:
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Principle |
Additional Information |
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| Perform hand hygiene. | Always perform hand hygiene before administration and after removing gloves. For hand hygiene with ABHR, use 1 to 2 pumps of product; this volume requires a minimum of 15 seconds for hands to dry. | ||
| Prevent needle/syringe contamination. | Keep sterile parts of the needle and syringe sterile. Avoid letting the needle touch unsterile surfaces such as t