VAGINAL INSTILLATION

Prepared by-Aashish Pariharm.sc. nursing

VAGINAL INSTILLATION

IntroductionAdvantagesDisadvantagesForms of medication

General instructions

Articles requiredProcedure

Introduction Vagina is route for administration for

contraceptives, antifungal and anti microbial. It is used for the achievement of local and systemic

absorption. Vaginal medications include suppositories, creams,

gels, and ointments. Suppositories melt when they contact the vaginal

mucosa, and their medication diffuses topically (as effectively as creams, gels, and ointments).

Vaginal medications usually come with a disposable applicator that enables placement of medication in the anterior and posterior fornices.

VAGINAL INSTILLATION

Advantages Prolonged release. Minimal systemic side effects. An increase in bioavailability. Use of less total drug than an oral dose. First-pass metabolism can be avoided. Self medication is possible.

VAGINAL INSTILLATION

Disadvantages Patient incompliance. Only a few drugs are administered by this route. Variability in drug absorption related with

menstrual cycle, menopause and pregnancy, can also limit vaginal drug delivery route usage.

Influence with sexual intercourse. Gender specificity.

VAGINAL INSTILLATION

Forms of vaginal medicationMany different types of formulations have been applied

vaginally as- Tablets Vaginal suppositories or pessaries (globular, oviform or

cone-shaped, and weighing about 5 g each. ) Douches (aqueous solutions that are administered into the

vagina for cleansing purpose. ) Foams Sprays Gels Creams Vaginal rings(Creams, gels, sprays and foams are used as vehicles for

drugs such as anti-infective or contraceptive agents.)

VAGINAL INSTILLATION

General instructions To prevent damage, suppositories must be stored in

refrigerator. Foams, jellies, and cream are administered with an

inserter or applicator. Perineal pads may be used to collect excess drainage

after inserting a suppository. Good aseptic technique must be followed. Good perineal hygiene must be maintained. The patient should be encouraged to empty her bladder

as she has to lie down for 20 minutes The patient can either lie supine with knees up or lateral

with knees up Always lubricate the pessary or applicator before

inserting

VAGINAL INSTILLATION

Articles requiredA clean tray containing- Medication administration record (MAR) Nonsterile gloves Mackintosh Prescribed vaginal suppository or any other form of vaginal

medication Perineal pads Water-soluble lubricant Disposable applicator Tissue paper/ cotton balls Paper bag Kidney tray

And Side screen

VAGINAL INSTILLATION

ProcedurePreliminary assessment- Review the physician’s order, patient’s name, name and form of

vaginal medication, dosage and time. Explain procedure to patient. If client plans to self-administer, be

very specific with instructions. Gather necessary equipment. Follow the rights of medication administration. Ask the client to void. Provide for privacy. Wash hands Don Nonsterile gloves. Position the client in a dorsal recumbent position with knees flexed

and hips rotated laterally or in a Sims’ position. Assess perineal area, inspect vaginal orifice, note any odor or

discharge from the vagina, and inquire about any problems such as itching or discomfort.

VAGINAL INSTILLATION

Procedure If secretion or discharge is present, cleanse the perineal

area with soap and water. Remove suppository from the foil wrapper and, if

applicable, insert into applicator tip. Apply a small amount of lubricant to rounded tip of

suppository. If not using an applicator, apply a small amount of

lubricant to gloved index finger. With non dominant hand, spread labial folds. Insert the

suppository into the vaginal canal at least 2 inches (5 cm) along the posterior wall of the vagina or as far as it will go

If using an applicator, insert as described above and depress plunger to release suppository.

VAGINAL INSTILLATION

ProcedureAfter care- Wipe the perineum with clean, dry tissue. Instruct the client to remain in bed for 15 minutes. Wash applicator under cool running water to clean and return to

appropriate storage in the client’s room. Remove gloves, turning them inside out, dispose them. Wash hands. Record on the MAR the drug’s name dosage, route, and date and

time of administration; document any evidence of discharge or odor from the vagina.

Check with the client in 15 minutes to ensure that the suppository did not slip out and to allow the client to verbalize any problems or concerns.

Observe for effectiveness of the medication; inspect the condition of the vaginal canal and external genitalia between applications.

VAGINAL INSTILLATION