Drug Administration 2011

7/30/2019 Drug Administration 2011

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DRUG ADMINISTRATION

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dr. Prajogo Wibowo, M. Kes


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THE PREPARATION CAN BE

DISTINGUISHED INTO

INTERNAL PREPARATION

ORAL

STOMACH

INTESTINAL

DRUGS LABEL : WHITE

EXTERNAL PREPARATION

ALL OF MEDICATION

but

ORAL INTESTINAL

DRUGS LABEL : BLUE


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SYSTEMIC & NON SYSTEMIC MEDICATIONS

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1. INTERNAL PREPARATION

SYSTEMIC : ANTIBIOTIC (SYSTEMIC)

ANTIHYPERTENSION, ANALGESIC

NON SYSTEMIC : ANTIHELMINTIC

LOCAL ANAESTHETIC, ANTIMICROBIAL(INTESTINAL), LOCAL ANTACID

2. EXTERNAL PREPARATION

SYSTEMIC : PARENTERAL INJECTION

INHALER, SUPPOSITORIA

NON SYSTEMIC : VAGINAL TABLET,

TOPICAL STEROID, GARGLE,SUPP


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MANAGEMENT OF MEDICATION

1. INTERVAL OF MEDICATION

2. TIMING OF MEDICATION

3. TECHNIQUE OF MEDICATION

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1. INTERVAL OF MEDICATION

examples :* HOURLY

* EVERY (THREE-HOURS)* THREE TIMES A DAY

2. TIME OF MEDICATION

examples :* in the morning, in the midday, in the night

* before, after, or during meals; before sleeping

* during episode, during attack, after attack

3. TECHNIQUES OF MEDICATION

* ROUTE OF ADMINISTRATION : TOPICAL AND NON-TOPICAL DRUGS

* DRUG DOSAGE FORMS


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INTERVAL OF MEDICATION

Determined by :

* HALF-LIFE TIME (t 1/2) OF DRUGS :

Ultrafast, Fast, slow, very slow

Example :

Reserpin has t 1/2 15 minutes and 36 hours of duration

DURATION OF DRUG ACTION / EMERGENCY SETTING

In emergency condition, in particular clinical treatment

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HALF-LIFE TIME (T 1/2)

ULTRAFAST :amoxicillin, cloxacillin, flurosemide, penicillin-G

FAST :

paracetamol, ampicillin, hydrocortison

SLOW :

doxicillin, griseofulvine, proctolol

VERY SLOW :

barbiturate, diazepam, digitoxin, phenylbutazon

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STANDARD ADMINISTRATION TIMES

DAILY

Once : 10.00 (morning)/22.00 (night)

Twice : 10.00 , 14.00

Three times : 10.00 , 14.00, 18.00

Four times : 10.00, 14.00, 18.00, 22.00

EVERY12-hourly : 10.00, 22.00

8-hourly : 06.00, 14.00, 22.00

6-hourly : 06.00, 12.00, 18.00, 24.004-hourly : 06.00, 10.00, 14.00, 18.00. 22.00, 02.00

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TIMING OF MEDICATION

BASED ON :

* CHEMICAL PROPERTIES OF DRUGS* PHYSIOLOGICAL PROPERTIES OF GASTROINTESTINAL

TRACT

POSSIBLE INTERACTIONS :

1. DRUG AGAINST DRUG2. DRUG AGAINST GASTROINTESTINAL CHYME

3. DRUG AGAINST GASTROINTESTINAL PHYSIOLOGY

THE CONSEQUENCES :1. DRUG : reaction occurs --> impaired absorption; break-

down of drug

2. GASTROINTESTINAL TRACT : drug irritation, impairedmotility, delayed gastric emptying, reduced absorption.

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OVERCOME

1. DETERMINATION OF APPROPRIATE TIMING

IN DRUG ADMINISTRATION

2. MANAGING THE PRIORITY ORDER OF

DRUGS.

3. CHOOSING THE APPROPRIATE DRUG

TYPES

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TIMING OF MEDICATION

IN THE MORNING :

* Steroid * Laxative Bisacodyl tablet

* Diureticum * Suppositoria

* Antihypertension * Vaginal tablets

* Hypnotics

* Cimetidine

* Anticholesterolemia

IN THE NIGHT :

* Contraceptive pills

DURING DAILY ACTIVITIES

DURING MEALWith meal : - promptly after meal

- During Meal

Empty Stomach : 1 hour before meal

2 hours after meal

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DURING EPISODE

* Pectoral angine drugs

* Drugs for migraine-cephalgy

* Antiasthmatic drugs


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DRUGS & PHYSIOLOGY OF GIT

Factors affecting drug

1. Chemical properties

2. Gastric pH3. GI tract motility

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ANTICHOLINERGIC DRUGS reduce :

* Secretion* Intestinal peristaltic

These drugs should be taken one hour before meal

BELLADONA ALKALOID GROUP : Tinct.BelladonaAtropin extr. Belladona Hormotropin

Scopolamin Oxypheninium

Methylscopolamine Mepenzolate

Butylscopolamine Bevonium

QUATERNARY COMPOUNDS Clidinium

Propanteline


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DRUGS AND FOODS

1. Drugs interferred by gastric chyme

ANTIMICROBES :

Ampicillin

AmoxicillinErythromycin

Lincomycin

Oxytetracycline

Penicilline G/VTetracycline

All these drugs should better be taken during "emptystomach"

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Isoniazide

Rifampicin

OTHERS :

Levodopa

Penicillinamine

PropantelineParacetamol


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2. DRUGS THAT SYNCHRONIZED

WITH CHYME (FOOD)ANTIMICROBES :

Doxycycline

Doxycycline hyclateErthromycin ethylsuccinate

Griseofulvin

Nitrofurantoin

The above mentioned drugs should be taken "with meals"

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OTHERS :

Hydralazine

HydrochlortiazidePropanolol

Metroprolol

Reserpine


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3. STOMACH-IRRITATING DRUGS

Aminophylline

Acetyl salicilic acid

Codein

PhenylbutazonFerrosulphate

Hydrocortison

Indomethacine

Isoniazide

1. The possibility not to be taken by patients with gastritis

2. Some are administered in contained stomach or excessive water drinking

3. Some are in favour given with milk 16

Chlorpromazine

Metronidazole

Nitrofurantoin

PrednisoneReserpine

Mephenamic acid

Pirazolone


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INTERACTIONS BETWEEN DRUGS

DRUGS THAT INTERACT WITH ANTACIDS IN STOMACH :ANTBIOTICS :

Amoxicillin

Ampicillin

Cloxacillin

Nitrofurantoin

OxytetracyclinePenicillin V

Sulphonamide

Tetracycline

EXAMPLE OF MEDICATION TIMING OF THE INTERACTIVE DRUGSR/ Ampicillin 500 mg cap No. XV

S 3. dd.cap.I (1) hac 1 hour before mealR/ Antacid tab No.XX

S3.dd.tab.I (1) hpc 1 hour after meal 17

OTHERS :

Acetylsalicilic acid

Digitalis

Dicumarol

Phenotiazine

Ferrous preparation

Isoniazid

Chlordiazepoxide

Levodopa

IndomethacinePropanolol


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MEDICATION TECHNIQUE

DRUG DOSAGE FORMS

ROUTE OF ADMINISTRATIONSPECIFIC- DRUG MEDICATION

PARENTERAL DRUG MEDICATION

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METHOD OF MEDICATION

TERMS : SITES :

* Oral Mouth

* Peroral (per os) GI tract system via mouth

* Sublingual Under the tongue* Parenteral Other sites than GI tract (by injection)

* Intravenous into vena

* Intraarterial into artery

* Intracardiac into the heart

* Intraspinal/intrathecal into spine* Intraosseous into bone

* Intraarticular into joint

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Intrasynovial Synovial fluid cavity

Intracoutaneous or intradermal into skin

Subcutaneous under skin

Intramuscular into muscle

Epicutaneous (Topical) Skin surface

Transdermal Skin surface

Conjunctival Conjunctiva

Intraoccular Eye globe

Intranasal Nose

Aural Ear

Intrarespiratory Lung


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THE USAGE OF DOSAGE FORMS

Sublingual tablet

trochition and lozenges

Parenteral solution, suspension

Epicutaneous/Transdermal intment, cream, paste, powder,

aerosol, lotion, and transdermal, disc, and solutionattachment

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THE USAGE OF DOSAGE FORMS

Conjunctival ointment

Intraoccular/intraaural solution, suspension

Intranasal solution, spray, inhalant, ointment

Intrarespiratory aerosolRectal solution, ointment, suppositoria

Vaginal solution, ointment, emulsified

foam, tablet, insert, suppositoria,

sponge

Urethral solution, suppositoria

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DRUGS THAT ARE USED SPECIFICALLY

1. SUBLINGUAL TABLET

For cardiac diseases : angina / asthma(nitroglycerin,

isoprenalin)

2. CHEWING TABLET

Drugs for gastritis

3. LOZENGESMouth freshener (anti inflammation)

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MULTI-LAYER TABLET

Tablets that are destroyed in intestine

Tablet :

* Unchewed but powdered

* Without milk, alkaline drinks, or antacid

DRUGS THAT NEED EXCESSIVE DRINK (200-300 ml)

* Sulfa group

* Metronidazol

* Erythromycin

* Amoxicillin

* Aspirin

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DRUGS THAT ARE WITHOUT

EXCESSIVE DRINK

Antigastritis drug/antacid suspension

DRUGS THAT ARE TAKEN WITHOUT MILK Vitamin C+ Ferrous

Antienteretis

Enteric coated tablet Tetracycline

PEDIATRIC DRUG ADMINISTRATION

Tablet powder/pulveres dissolved into : Honey

Sugar water

Jelly

Corn oil

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THE APPLICATION OF OPTHALMIC OINTMENT / EYE DROP

1. The hand holds the ointment after washed first to be clean

2. Open the tube's cap then discard the first 1/4 inch length of the

ointment, because this portion is often dry.

3. With one finger, press downward the lower lid meanwhile the

patient is staring upward

4. Press and rub the eye ointment as long as 1/4 - 1/2 inch onto

the inner side of the lid without touching it nor eye globe.

5. Close the eye and rotate the eye globe in all direction (possibly

the vision will become slightly blurred ).

6. Cap the tube immediately without touching the tips of cap nor

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1. Cough out the sputum as much as possible.

Aerosol is shaked before use2. Place it as the recommendation of the

manufacterer. It is usually set upside down.

3. Place the oral edge of tube inside the mouth,face upward by moving head posteriorly.

4. Breath out slowly, empty the lung volume asmuch as possible.

5. Press the tube content in order to spraymeanwhile immediately inhalate it deeply withtounge position remains still below.

6. Hold the breath within 10 - 15 seconds.

7. Then, expire the air through nares. 27


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INHALANT MEDICATION

1. Cough out the sputum as much as possible.

2. Place the capsule into the inhaler container as the

manufacturer's recommendation

3. Breath out slowly, empty the lung volume as much as

possible.

4. Place the oral tip of tube inside the mouth.

5. Face upward by moving head posteriorly.

6. Breth in deeply through inhaler

7. Hold the breath for 10 -15 seconds

8. Exhale the breath through nares.

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NASAL DROP

1. Sit with your head facing upward, or pad your

shoulder with a pillow under.

2. Insert the tip of dropper asdeep as 1cm into the

nares.

3. Drip some drops of the drugs as recommended.

4. Nod downward your head so that the head is over

the knee.

5. Sit up repetitively for several times so that the

drop can enter the pharynx.

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NASAL SPRAY

Nod down the head slightly.

The other nose is closed by pressing the nares with

your finger.

The sprayer is inserted into the opened nares by

pressing the vial, so that its content will be out andinhalte gently, then do the same as the

abovementioned.

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EAR DROP

The best is the head in slanting position

Gently the upper part of the ear lobe is slightlyattracted upward (in adult) and the middle one in

children in order to let the opening is seen clearly.

Drip some ear drops and wait for approximately 5minutes before doing the same into another one.

In some products, it is recommended to close theear opening with cotton ball.

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SUPPOSITORIA

Suppositoria is prepared to be out of the container. When itis too flaccid, it would better be cooled first, whereas if it istoo hard, heat it by placing it inside your fist.

Lay down with slanting position and one of the lowerextremities is abducted to the abdomen.

Insert gently the suppositoria into the anal openingmeanwhile it is rotated foreward with one of your hands.Keep lying for several minutes.

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INTRAVAGINAL MEDICATION

In general, intravaginal medication is limited to thelocalized application for which ointments ortablets are available to insert into vagina andusually by the time of going to bed, such as

metronidazole and primaricin for vaginitis causedby trichomonas and candida.

The drugs may be used in the form of swabbingliquid, others in the forms of spermaticide (to killspermatocyte), foam tablet,and cream.

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SKIN DRUGS

THE TOPICAL DRUGS USED FOR SKIN IN GENERAL

INCLUDE :

1. WATTER (SOLUTION)

2. ALCOHOL (TINCTURE)

3. POWDER

4. WET POWDER (SHAKED POWDER)

5. CREAM

6. PASTE

7. OINTMENT

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LOCATION

Back and chest

Genitalia

Scalp

Hand and arm

Skin fold

Lower extremities

Face

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All types Powder, watered powder,

cream solution.

Powder, watered powder,

cream solution. Water (solution), alcohol,

cream.

Powder, water solution,alcohol, ointment, wet powder,paste, cream.

Watered powder (solution),alcohol, ointment, wet powder,cream.

All types except for eye skin.


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THE CHOOSING OF DRUGS IS ON THE

BASIS OF THE SKIN DISORDERS,

THUS THE WET CONDITION OF THE

SKIN DISORDERS NEEDSAPPLICATION OF WET PREPARATION,

WHILE THE DRY SKIN USES

SEMISOLID PREPARATION.

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Vesicles, edema, erythrema Crust, itching infection Water (solution) - wet compression Powder, lotion, sprays Cream (o/w) Cream (w/o) and and ointment

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Desquamation, erythrematous, itching,

drying


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THE ADVANTAGES OF PARENTERAL MEDICATION :

1. The drug action can be reached rapidly, strong, and

complete

2. No irritation or not destroyed by gastric acid

3. Can be administered to the patients with unconsciousness

or swallowing unability

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Parenteral medication can be undertaken :

1. By injection with syringe

2. Through infusion liquid (more than 10 ml volume)


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ADVANTAGES

1. In general, it is expensive and impractical

2. Easy to contaminate

3. Able to damage blood vessel, tissue, and nerve

4. The administration methods should be adjusted,

because of being slow and rapid

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CONCLUSIVELY, PARENTERAL MEDICATION ARE

BASED ON 2 MAIN CONSIDERATIONS :

1. Expectation of rapid drug action

2. the required drugs are in the form of parenteral

dosage forms

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INTRAVENOUS ADMINISTRATION NEEDS THE


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SKILLFULNESS, GREAT ATTENTION, AND

PRECATIOUSLY WITH ANTISEPTIC TECHNIQUES AND

ALSO NEED CLOSE MONITORING OF DRUG ACTION.

Physicians judge the decision of intravenous medication basedon as follows :

1. whenever other routes of administration are considereimpossible whereas the terapy management must beimplemented promptly. For example :

* Methicillin in stomach will be broken down by acid,whereas via intramuscular method is impossible because oflarge volume required, then the chosen appropriate

method is intraveous route.

* The multiple drug medication in large volume is impossible

to give intramuscularly regarding to giving risepainfulness; similarly, subcutaneous method will result inwider inflammation.

* In very irritative drug by intramuscular and subcutaneousmethod, it can be diluted into infussion.

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In the specific clinical settings, the rapid administration isrequired for patients with serious condition.

In patients with high tendency to be hemorrhagic(thrombocytopenia or hemophilia and anticoagulantadministration), intramuscular and subcutaneousmedication will cause formation of hematoma which ispainful and extensive or bleeding.

For supplementary nutrition, in patients with GIdisturbances, peroral intake is not adequate, and sodoes patient with gastrointestinal post-operative condition.

* Patients with vomiting and nausea at certain level,

such as severe hyperemesis gravidarum,unconsciousness, or swallowing unability.

Beside intravenous drugs and liquid administration, itis also important to give blood or bloodcomp[onen in

certain cases.

INTRODUCTION TO INJECTION DRUGS


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INTRODUCTION TO INJECTION DRUGS

Injection drug is a sterilized preparation in the forms of :

1. Liquid, consisting of :

Solution, the active ingredient disolves in it and theavailable packaging is in ampule or vial.

Suspension, unsoluble active ingredient, issuspended thoroughly in the suspension using

suspension agent.Emulsion, the liquid containing the mixture of waterand oil.

2. Dry Powder, including :

Soluble Ingredient, mixed with solvent before use,this ingredient is not long-standing that breaks downin the solution.

Insoluble Ingredient, mixed with liquid when it will beused, because it is not long-standing in solution, but

broken down. 51


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DELAYING THE DRUG ABSORPTION INTO THE BLOOD

VESSELS, IN THE REASON TO LENGTHEN THE DRUG

ACTION, SUSPENSION OR SOLUTION IN BEAN OIL OR

SESAME OIL IS FREQUENTLY USED, FOR EXAMPLES,PENICILLIN AND SEXUAL HORMONE SUSPENSION,

GIVEN INTRAMUSCULARLY.

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THE CONTAINER OF INJECTION DRUGS

1. AMPULES

It is made from glass or plastics with various sizes,from 1 ml (adrenalin) up to 10 ml (aminophyline)

generally for once usage.

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THE PREPARATION TO USE :

With clean hands, align the fine wound line on the

ampule neck, then using alcohol cotton clean it and

break it ; if the ampule head is made from plastics,

rotate the ampule head untill it is separated completely.

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2 VIAL


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2. VIAL

It is made from glass with rubber cap fixed with filmmetal surrounding the bottle lip, generally can be usedrepetitively.

The filling of drug solution into syringe is as follows :

Solution :

Suck the air as much as needed

Make the vial rubber clean using sterilized alcoholcotton

Prick the syringe into the vial while the upside-down position of the vial .

Press the air into the vial then directly pump-in thesolution as much as needed, the needle shouldbe always in the solution border.

Make the syringe free from air and clean it, washthe hands.

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HYPODERMIC EQUIPMENTS

SYRINGE is an equipment to get water or solution into the

body or body cavities.

HYPODERMIC SYRINGE is syringe to use for subcutanous,

intramuscular, and intravenous methods. It is a sucking typeand characterized by the main components including a metal

piston and a tube made from glass with various sizes.

1. Tuberculin syringe : small size with capacity no more than

1 ml .

0.1 - 0.001 ml.

Hypodermic Syringe : Larger size with capacity 2 - 50 ml.

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DISPOSABLE SYRINGE :

Made from plastics with larger size thanTuberculin syringe (5 ml) for once use only,packed with steril state and separated

needle.

In general, it is used the administration ofantibiotics,antihistamine,heparin, tranquilizer,vitamin, etc.

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HYPODERMIC NEEDLES

This needle typically is made from stainless steel,

hyperchromed steel, carbon steel, chromium, platinum,

silver or gold.

The form of hypodermic needles based on :

1. Length

2. Thickness needle

3. Sectioning: sharp-angle sectioned needle

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LONG, SHARP-ANGLED OR LONG THICK NEEDLES ARE

USED FOR INJECTION, LOCAL ANESTHESIA, SUCKING,

HYPODERMOLYSIS AND SUBCUTANEOUS INJECTION.

Figure:

Short-sectioned needle

Long-sectioned needle

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Short, sharp- angled needles are used for

injections : intravenous, infusion, and transfusion,whereas the special short, sharp-angled needles

are used for intradermal and spinal injections.

NEEDLE SIZE


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NEEDLE SIZE

The choosing of needle size on the basis of

1. Safety2. Flow volume

3. Patient's convenience

4. Penetration depth

The unit of needle size is GAUGE referring to the outerdiameter of canula or needle shaft.

In general the size is 1 - 27 gauge, with the length not lessthan 1/4 inch and more than 3.5 inches.

For several biopsies and spinal tranfusion, the needles are

16 - 19 gauge in size and 0.5 - 3.5 inches in length For local anesthesia, the needles are from 26 gauge with

1/2 inch to 20 gauge with ? inches.

For intravenous transfusion, the needles are from 19 gaugewith 1.25 inches to 15 gauge with 2.5 inches.

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THERE ARE ALSO MANY OTHER

UTILITIES :

1. Caudal needle

2. Epidural needle

3. Intravenously anesthetic needle4. Blood transfusion needle

5. Spinal needle

6. Biopsy needle7. Cerebral angiographic needle

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O S O S O


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ROUTES OF ADMINISTRATION IN

INJECTION DRUGS

1. INTRADERMAL OR INTRACUTANEOUS

Dosage form : Solution and Suspension

Volume : 100- 200 I.U per I.C

Purpose : Tuberculine Test and Immunization

Equipments : Disposable syringe with small, short

size needle, Desinfected cottons

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ROUTES OF ADMINISTRATION IN

INJECTION DRUGS

2. SUBCUTANEOUS OR HYPODERMAL INJECTION

Dosage form : Solution or oil

Volume : No more than 2 ml

The injection under skin should be conducted with non-irritantdrugs which are soluble either in water or oil, but the effect is not

as rapid as IM or IV method. It is easy to do by patients

themselves, such as insulin administration.

3. In BCG administration for infants, injection viadermal and subcutaneous methods may developlymphadenitis.

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THIS METHOD IS ALSO USED IN THE

ADMINISTRATION OF HEPARIN ANDEPINEPHRINE SUSPENSIONS.

Skin has poor blood vasculature, thereby the drugs that

will be absorbed by blood vessels and the nonsoluble

drugs diffuse into lymphatic vessels.

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INJECTION TECHNIQUES1 W h th h d th hl


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1. Wash the hands thoroughly

2. Localize the injection site on the lateral surface of upper arm,anterior surface of thigh or abdominal region.

3. Clean the skin area with desinfectant4. Pinch the skin as thick as the skin itself

5. Prick the needle into the skin on the base of skinfold with theangle of 20 - 30 degrees

6. The pinch is then released7. Re-suck the syringe to ascertain that it did not prick the blood

vessel (if there is blood in it, repeat the procedure)

8. Inject the drug slowly and gradually within 0.5 - 2 minutes; if

too quick, possibly edema or collapse of blood vesseldevelops

9. The needle is immediately removed, cover the injection sitewith adhesive plaster.

10. Observe the patient condition; attention should be given that

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3. INTRAMUSCULAR INJECTION

Dosage form : Solution, suspension in water oroil

Volume : No more than 4 ml

In injection into muscles, the soluble drug resorptionwill last within 10 - 30 minutes.

The adventages :

Easy, safer, good tolerated, rapid resorption, andrarely develops necrosis. For very irritative drugs, this

intramuscular method is preferred than subcutanousmethod.

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INJECTION PROCEDURE

Localize the muscle to choose:

Ventro Gluteal : thicker, no main nerve fibers and blood

vessels. Choose the upper lateral quadrant, in Medial

Gluteal, take attention on ischiadic nerves and SuperiorGluteal Artery.And patient position should be facing laterally,

facing downward, or standing.

It is not performed to infants and young children.

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VASTUS LATERALIS

Middle aspect of thigh : very poor nerve fibers and bloodvasculature.

Position : supine, or sitting

Volume : 2.5 - 3 ml

Deltoid muscle : Easy, with position of facing laterally, sitting, or standing,

needs attention that the area is very limited and the existance of largebone, bood vessels, and nerve fibers.

Drug volume :1. no more than 2 ml.2. Wash hands thoroughly3. Make the patient ensure and explain the procedure

4. Rub desinfectant on the skin5. Ask the patient to let the muscles relaxed, because if the muscle is incontraction will the drug liquid flow into the surrounding tissue leading toirritation and pain sensation.

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Drug volume :

6. Shoot the needle in perpendicular position (90 degrees)to the skin surface

7. Re-suck to ensure if it shot blood vessel (if it did so,repeat the procedure from point 4, or replace with newsyringe, if any)

8. Inject the drug by pressing the pump slowly and

gradually to diminish pain sensation9. Remove the needle quickly

10. The injection site is press using the other hand withsterilized cotton, fix it with plaster

11. Observe the patient's reaction, necessarily keep the

patient calm12. Clean the hands and used equipments

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4. INTRAVENOUS DRUG ADMINISTRATION

Materials :

Syringe filled with air-free drug liquid,

Needle of 20 gauge, long and moderate thickness

Desinfectant

Cotton, plasters, and tourniquette

Injection Procedure :

1. Wash the hands thiroughly

2. Ensure the patient and explain what will be done

3. Localize the injection site, choose forearm slightly lower from cubital

fossa. The vein lies more superficially and is not covered and easy toligate.

4. The patient is asked to be relaxed with fisting the related hand.

5. Tourniquette is set up, then see the vein to be swollen while giving

desinfectant on to the skin area.

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4 INTRAVENOUS DRUG ADMINISTRATION


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Injection Procedure :

6. Vein is stabilized by replacing the pressing hand to the skin inline with the vein longitudinal axis, using the other hand.

7. Direct cardially the needle to vein with 35 degree of angle,

shoot the needle slowly into 3-5 mm depth of vein

8. Do aspiration, if there is blood inside the syringe, it means that

the needle has aimed to the vein, instead, try again.9. Tourniqette then is removed

10. Inject the drug slowly, observe the pain sensation, swelling or

hematoma; if the needle is still in vein, try to suck again.

11. The needle then should be removed immediately while the

injection site is press with cotton and subsequently cover itwith plaster.

12. Observe the patient's reaction, meanwhile wash your hands

and clean the used equipments

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4. INTRAVENOUS DRUG ADMINISTRATION


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INTRAVENOUS ADMINISTRATION OF FLUID

Intravenous fluids refers to fluid that is administered

intravenously in large amount through infusion.

It is estimated that about 40% of the drugadministration at hospitals were conducted by

injection and it is likely increasing recently.

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THE CONTAINER OF INFUSION FLUID

1. It is made from glass, consisting of 2 types based onthe difference in air ventilation :

a. Air ventilation is outside of the bottle, at the tip of

infusion set through filter at a bottle spike.

b. Air ventilation through the tube in the bottle, the tubeopening is able to be passed through.

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2. THE CONTAINER IS MADE FROM FELXIBLE

PLASTICS POLYVINYL CHLORIDE OR SEMIRIGID

POLYOLIVIN. The supporting equipments for infusion administration are

infusion set that is to move the fluid into blood vein. It should

meet the requisites of being sterilized, free-pirogen, and

disposable

Though it is produced by a variety of manufacturers, themain components and parts are the same, including :

1. Spike as the breaker against rubber seal in the spike

hole.

2. Drip chamber

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THE PURPOSE OF INTRAVENOUS FLUID


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THE PURPOSE OF INTRAVENOUS FLUID

ADMINSTRATION IN SOME CLINICAL SETTINGS

IS : To correct the imbalanced body fluid (as replacement) To correct the imbalanced body electrolytes

To provide basic nutritional elements

Voluminous parenteral hyperalimentation that overwhelming

the normal nutrition

As the carrier of other drug adminstration

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NAME CONCENTRATION PURPOSE


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1. AminoAcids (synthetic)

Aminosyn

Veinamine

2. Dextrose (Glucose,D5/W)3. Dextrose&NaCl

4. Lactate's Ringer

(Harmann)

NaCl

KCl

CaCl2Na Lactate

5. Protein (hydrolized)

Aminosol

CPH-5

6. Ringer's

NaClKCl

CaCl2

7. Natrium Lactate

90

5.5-&%

8%

2.5 - 50%

5-20%

NaCl 0.11 - 1.9%

0.60%

0.03%

0.02%0.30

5% casein&fibrin

0.86%

0.03%

0.033%

1/6M

Fluid &nutrition

Fluid & Nutrition

Nutrition & Electrolytes

Systemic alkalizer &

nutrient supplement

Fluid & nutrient

supplement

Fluid & nutrient

supplement


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THE INTERMITTEN ADMINISTRATION OF ANTIBIOTICS

AND OTHERS

Such medication may be performed by one of the three following methods :

A. Directly Intravenous Injection : volume of 1 - 5 ml within 1 - 5 minutes.

Orinject the injector of the hanging infusion bottle into the injection site.

This method is appropriate for limited amount of drug and the drug

which endanger if given in multiple method.

B. Volume Control Method : it refers to the infusion adminstration with

accurate dosage in expected flow through volume control set consisting

of a calibrated plastic chamber below the main infusion bottle which is

frequently along with free liquid administration.

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THE PROCEDURE OF INTERMITTENT


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THE PROCEDURE OF INTERMITTENT

ADMINISTRATION OF INTRAVENOUS LIQUID WITH

VOLUME CONTROL SET

1. Using aseptic technique, the spike of VC set is inserted intothe main infusion bottle or separated bottle.

2. The tube line is emptied from air by opening the upper

clamp so that the liquid flows.3. Open the clamp over the calibrated chamber to let 25 -

50 ml of liquid enter into it from the bottle.

4. Close the upper clamp.

5. Inject the drug through the connecting hole in therubber

cap of the VC set.6. Re-open the upper clamp to let the flow up to 50 - 150

ml, then close it.

7. Open the lower clamp to make liquid flows

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The administration of this infusion drip is related to thesecond liquid. Through venipuncture, the drug flow will beregulated in one intravenous system.

This administration give rise the following advantages :

1. PB technique can avoid unnecessarily othervenipuncture.

2. The drug solvability is achieved immediately in short time,usually within 30 - 60 minutes.

3. The drug solution that can relieve irritation and obtainhigh serum level rapidly is an important considerationfor therapy such as serious infection,especially inantibiotic administration.

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THE EQUIPMENTS FOR THIS METHOD CONSIST OF INFUSION

BOTTLES, INCLUDING A MAIN BOTTLE AND A MINI BOTTLE

PEGGY BACK OF 250 ML, AND INFUSION SET. THE MINI

PEGGY BACKBOTTLE USUALLY CONTAINS ANTIBIOTICS,

WHILST MAIN BOTTLE IS SIMILAR TO THE CLASSICAL

INFUSION SET WITH A RUBBER Y - SHAPE CHANNEL

APPARATUS BELOW THE CLAMP OF THE MAIN BOTTLE.

THE SECOND BOTTLE IS ALSO PROVIDED WITH THE

REGULATORY CLAMP, WHILE THE OTHER HAS NOT CLAMP

BUT A TAP IN THE Y-SHAPE CHANNEL APPARATUS TO

REGULATE THE FLOW BY OPENING AND SHUTTING

AUTOMATICALLY DEPENDING ON LIQUID PRESSURE. THIS

BOTTLE IS HANGED OVER THE MAIN BOTTLE.

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TO RESERVE AIR AND CONTROL THE NUMBER OF DRIPPING, THE BOTTLES

ARE CONNECTED TO THE DRIP CHAMBER WITH A CLAMP, FURTHER THE


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CHAMBER CONNECTED TO THE TIP OF NEEDLE THROUGH 1.5 - 3 M OF

TUBE LINE. BELOW THE DRIP CHAMBER, A CLAMP REGULATES THE

EXPECTED DROPS. THE PROCEDURES OF PREPARATION AND

ADMINISTRATION OF INTRAVENOUS LIQUID

1. Prick the spike into the rubber bottle cap of the infusion set.

2. Hang the infusion bottles on a stand by the patient's bed, theneject the air in the tube line by flowing the first liquid drop out,regulated by the clamp.

3. Shoot the needle into vein (aseptically, see the previousmentionedintravenous injection procedure), conducted by physician or nurse

4. Loosen the clamp gently to flow the liquid till the expected number ofdrops by observing the drip in the drip chamber. Generally, thismedication lasts within 4 - 8 hours with the volume of 125 ml/hour.

5. The concomitant drugs given along with this infusion are : Dopamin,Lidocaine, Insulin,and Heparin. In the administration of potentdrugs, the speed of dripping depends on the patient's clinical condition.The drip volume depends on the manufacturer's recommendation,ranged: 10, 15, 20, 50, and 60 drops/ml.

In another setting, sterilized solid drug is administered through rubber hole in VC set

Drug Administration 2011

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