Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper...

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Division 1Introduction to Advanced

Prehospital Care

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Chapter 7

Intravenous Access and Medication Administration

Part 1Principles and Routes of Medication Administration

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Topics

Aseptic Technique

Medication Administration Routes

Medication Package

Anatomy and Physiology Related to Medication Administration

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Six Rights of Drug Administration

Right person

Right drug

Right dose

Right time

Right route

Right documentation

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Knowing all drug administration protocols is essential.

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Always take appropriate body substance isolation measures to

reduce your risk of exposure during medication administration.

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Body substance isolation equipment

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Medical Asepsis

It is important to keep the ambulance and all the equipment clean.

Sterile– Free of all forms of life

Medically clean– Involves careful handling to prevent

contamination

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Treat all blood and body fluids as potentially infectious.

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Needle Handling Precautions

Minimize the tasks performed in a moving ambulance.

Immediately dispose of used sharps in a sharps container.

Recap needles only as a last resort.

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Medication Administration and Documentation

Record all information concerning the patient and medication including:– Indication for drug administration– Dosage and route delivered– Patient response to the medication

Both positive and negative

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Percutaneous drug administration is drugs applied to and absorbed through

the skin or mucous membranes.

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Transdermal

Absorbed through the skin at a slow, steady rateMethod:– BSI– Clean administration site– Apply medication– Leave medication in place for required

time. Monitor the patient for desirable or adverse effects.

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Mucous Membranes

Absorbed through the mucous membranes at a moderate to rapid rate

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Place the pill or direct spray between the underside of the tongue and the floor of the oral cavity.

Sublingual Medication Administration

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Place the medication between the patient’s cheek and gum.

Buccal Medication Administration

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Use a medication dropper to place the prescribed dosage on the conjunctival sac.

Eye Drop Administration

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Nasal Medication Administration

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Manually open the ear canal and administer the appropriate dose.

Aural Medication Administration

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Pulmonary Drug Administration

Medications are administered into the pulmonary system via inhalation or injection.

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Small volume nebulizer

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Nebulizer with attached face

mask, bag-valve mask, and

endotracheal tube

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Metered dose inhaler

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Endotracheal Tube

Several medications can be administered through an endotracheal tube:– Lidocaine– Epinephrine– Atropine– Naloxone

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Enteral Drug Administration

The delivery of any medication that is absorbed through the gastrointestinal tract

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Gastrointestinal tract

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Oral Drug Administration

Any medication taken by mouth and swallowed into the GI tract.

Be sure the patient has an adequate level of consciousness to prevent aspiration.

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Oral Drug Forms

Capsules

Tablets

Pills

Enteric coated/time releasecapsules andtablets

Elixirs

Emulsions

Lozenges

Suspensions

Syrups

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Equipment forOral Administration

Soufflé cup

Medicine cup

Medicine dropper

Teaspoon

Oral syringe

Nipple

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

General Principles of Oral Administration

Use appropriate BSI measures.Note whether to administer medication with food or on empty stomach.Gather any necessary equipment.Have patient sit upright when not contraindicated.Place the medication into your patient’s mouth. Allow self-administration; assist when needed.Follow administration with 4-8 ounces of water and ensure that patient has swallowed the medication.

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Gastric Tube Administration

Gastric tubes provide access directly to the GI system.

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Confirm proper tube placement.

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Withdraw the plunger while observing for the presence of gastric fluid or contents.

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Instill the medication into the gastric tube.

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Gently inject the saline.

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Clamp off the distal tube.

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Rectal Administration

The rectum’s extreme vascularity promotes rapid drug absorption.

Medications do not travel through the liver, and are not subject to hepatic alteration.

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Catheter placement on needleless syringe

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Syringe attached to endotracheal tube

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Prepackaged enema container

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Parenteral Drug Administration

Drug administration outside of the gastrointestinal tract

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Syringes and Needles

Syringe Hypodermic needle

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Kinds of Parenteral Drug Containers

Glass ampules

Single and multidose vials

Nonconstituted syringes

Prefilled syringes

Intravenous medication fluids

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

AmpulesVials

Ampules and Vials

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Information on Drug Labels

Name of medication

Expiration date

Total dose and concentration

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Obtaining Medication from a Glass Ampule

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Hold the ampule upright and tap its top to dislodge any trapped solution.

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Place gauze around the thin neck…

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

…and snap it off with your thumb.

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Draw up the medication.

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Obtaining Medicationfrom a Vial

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Confirm the vial label.

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Prepare the syringe and hypodermic needle.

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Cleanse the vial’s rubber top.

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Insert the hypodermic needle into the rubber top and inject the air

from the syringe into the vial.

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

The nonconstituted drug vial actually

consists of two vials, one containing a

powdered medication and one containing a liquid mixing solution.

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Nonconstituted drugs come in separate vials. Confirm the labels.

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Remove all solution from the vial containing the mixing solution.

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Cleanse the top of the vial containing the powdered drug and inject the solution.

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Agitate or shake the vialto ensure complete mixture.

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Prepare a new syringe and hypodermic needle.

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Withdraw the appropriate volume of medication.

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

In the Mix-O-Vial system, the vials are joined at the neck. Confirm the labels.

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Squeeze the vials together to break the seal. Agitate or shake to mix completely.

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Withdraw the appropriate volumeof medication.

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Prefilled or Preloaded Syringes

Confirm medication indications and patient allergies.Confirm prefilled syringe label (name, dose, and expiration date).Assemble the prefilled syringe. Remove the pop-off caps and screw together.Reconfirm indication, drug, dose, and route of administration.Administer appropriately via the indicated route.Properly dispose of the needle and syringe.

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Parenteral Routes

Intradermal injection

Subcutaneous injection

Intramuscular injection

Intravenous access

Intraosseous infusion

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Intradermal Injection

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Assemble and preparethe needed equipment.

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Check the medication.

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Draw up the medication.

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Prepare the administration site.

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Pull the patient’s skin taut.

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Insert the needle, bevel up ata 10-degree to 15-degree angle.

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Remove the needle and cover the puncture site with an adhesive bandage.

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Monitor the patient.

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Subcutaneous Injection

45º

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Subcutaneous Injection Sites

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Prepare the equipment.

© Scott Metcalfe

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Check the medication.

© Scott Metcalfe

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Draw up the medication.

© Scott Metcalfe

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Prep the site.

© Scott Metcalfe

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Insert the needle at a 45-degree angle.

© Scott Metcalfe

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Remove the needle and cover the puncture site.

© Scott Metcalfe

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Monitor the patient.

© Scott Metcalfe

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Intramuscular Injection Sites

Deltoid

Dorsal gluteal

Vastus lateralis

Rectus femoris

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Intramuscular Injection

90º

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Intramuscular Injection Sites

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Prepare the equipment.

© Scott Metcalfe

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Check the medication.

© Scott Metcalfe

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Draw up the medication.

© Scott Metcalfe

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Prepare the site.

© Scott Metcalfe

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Insert the needle at a 90-degree angle.

© Scott Metcalfe

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Remove the needle and cover the puncture site.

© Scott Metcalfe

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Monitor the patient.

© Scott Metcalfe

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Summary

Aseptic Technique

Medication Administration Routes

Medication Package

Anatomy and Physiology related to Medication Administration