Sites of IM injections : 1. Ventrogluteal site: site is in the gluteus medius muscle, which lies over the gluteus minimus. 2. Vastus lateralis site:

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1 Sites of IM injections : 1. Ventrogluteal site: site is in the gluteus medius muscle, which lies over the gluteus minimus. 2. Vastus lateralis site: is the thick and well developed in both adults and children. It is situated on the anterior lateral aspect of the thigh. 3. Dorsogluteal site: This site is closed to sciatic nerve and the superior gluteal nerve and artery. As a result, complications (numbness, pain, paralysis) occurred if the nurse injected medication near or into sciatic nerve. In addition there tends to be more subcutaneous tissue at the dorsogluteal site. 4. Rectus femoris site: It is situated on the anterior aspect of the thigh. 5. Deltoid muscle: Found on the lateral aspect of the upper arm, it is not used often for IM injections because it is a relatively small muscle and is very close to the radial nerve and radial artery. No more than 1 ml solution can be administered in deltoid muscle.

2 A. Intravenous (IV) Injections: Injection into a vein (25 to the skin). Used when a rapid drug effect is desired or when the medication is irritating to tissue. IV administration provides immediate release of medication

3 into the bloodstream; consequently, it can be dangerous. The nurse should apply a septic techniques when given IV injections. IV medications are administered by one of the following methods: 1) Large volume IV infusion: Mixing a medication (e.g., potassium chloride, vitamins) into a large-volume solutions (250, 500, or 1,000 ml of compatible fluids) e.g., Normal Saline or Ringers Lactate. Is the safest and easiest way to administer a drug intravenously. The main danger of infusing a large volume of fluid is circulatory overload (hypervolemia). 2) Intermittent IV infusion: Mixing a medication in a small amount of IV solutions (such as 50 or 100 ml) and given with a regular intervals. It is important for the label on an IV intermittent medication to be designed to prevent medication errors. 3) Volume controlled infusion: small fluid container (100 to 150 ml in size) attached below the primary infusion container so that the medication is administered through the client s IV line. Volume-control sets are frequently used to infuse solutions into children and older clients when the volume administered is critical and must be carefully monitored. 4) IV bolus or push: is the intravenous administration of an undiluted drug directly into the systemic circulation. It is used when a medication cannot be diluted or in an emergency. There are two major disadvantages to this method of drug administration: (1) any error in administration cannot be corrected after the drug has entered the client, and (2) the drug may be irritating to the lining of the blood vessels. 5) Intermittent injection ports (device): attached to an IV catheter or needle to allow medication to administer IV without requiring a continues IV infusion. B. Other parenteral route: such as Intrathecal or intraspinal (into spinal canal), Intracardiac (into heart muscle), Intrapleural (into the pleural space),

4 Intra-arterial (into artery), Epidural (into epidural space), Intra-articular (into a joint), and Intraaosseous (into a bone). 1) Topical Route: Administer Topical Medications: Topical medications may be administered to the skin or mucous membrane in eyes, external ear canal, nose, throat, rectum, and vagina. The medication generally provides a local effect but can also cause systemic effects. 1) Skin application: Drugs directly applied to the skin to produce a local effect include lotions, pastes, ointments, creams, powders, and aerosol sprays. The nurse should cleanse the area by washing with soap and warm water, unless contraindicated by a specific order. Also the nurse should be wearing gloves when administers skin applications and used surgical asepsis when broken in skin integrity is present. 2) Ophthalmic Medications: Medications administered to the eye using irrigations or instillations (eye drops or ointment). Irrigations used to wash out the conjunctival sac to remove secretions, foreign bodies or chemicals. The nurse should adhere to the following safety measures to prevent cross contamination: a. Each client should have his or her own bottle of eye drops. Clients should never share eye medications. b. Discard any solution remaining in the dropper after instillation. c. Discard the dropper if the tip is accidentally contaminated, as by touching the bottle or any part of the client s eye. The risk of transferring infection from one eye to the other is increased if the tip touches any part of the client s eye. 3) Otic (Ear) Medications: Eardrops and irrigations may be instilled to soften ear wax, to relieve pain, to produce local anesthesia, to treat infection or inflammation, or to facilitate removal of a forgien body, such as an insect of a perforated tympanic membrane. Eardrops are usually contraindicated when the tympanic membrane is perforated. If the tympanic membrane is damaged, all procedures must be performed using sterile aseptic technique. 4) Nasal Medications: Nasal instillations (drops or sprays). Nasal drugs are administered to shrink swollen mucous membranes, to loosen secretions and facilitate drainage, to treat infections of the nasal cavity or sinuses. 5) Rectal medications:

5 Rectal medications can be in the form of enemas, suppositories, and ointments. Rectal ointments are used to treat local conditions and symptoms such as pain, inflammation, and itching caused from hemorrhoids. 6) Vaginal medications: Medications inserted into the vagina are in the form of suppositories, creams, gels, ointments, foams, or douches. These medications may be used to treat inflammation, infections, and discomfort, or as a contraceptive measure. 2) Respiratory or (Inhalants): Nebulizers (inhalers) are used to deliver a fine spray (fog or mist) containing medication droplets. The nurse should administer or assist clients with the usage of nebulizers: a. Instruct the client to clear the nostrils by blowing the nose. b. Client should be in an upright position with head tilted back slightly. Documenting medication administration: Medication record is a legal document. The medication name, dosage, administration route, time given, and nurse s initials are noted in the record. Also site for injection, pulse rate when administered some cardiac drug should be recorded. Do not record medication before they are given. Medication Errors: Nurses have learned the ten rights as a guideline to safe administration of medications. Medication errors must be reported in a timely manner. A report of a medication error must include the name of the medication, dose given, the route, the time the medication was administered, the specific error that occurred, the time the health care practitioner was contacted about the error, and what counter measures were taken. Common types of medication errors include the following: a. Inappropriate prescribing of the drug (e.g., incorrect dose, quantity, or route, or inadequate instruction). b. Extra, omitted, or wrong doses. c. Administration of a medication to a patient that was not ordered for him. d. Incorrect preparation of drug before administration. e. Incorrect route, time or rate. f. Improper administration techniques. g. Giving drug that has deteriorated. Note to be alert: Never administer medications that are prepared by another nurse. You are responsible for a medication error if you administer a medication that was inaccurately prepared by another nurse.

6 Do not leave medications at the client s bedside for any reason. The client may forget to take the medication, medications can accumulate, and the client could take two or more of the same medication, causing an overdose. Use only medications that are in a clearly labeled container. Do not use liquid medications that are cloudy or have change color.