Chapter08

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Chapter 8 Vascular Access and Medication Administration : 

Chapter 8 Vascular Access and Medication Administration

Introduction : 

Introduction Vascular access Cannulation of a peripheral extremity vein External jugular vein cannulation Intraosseous infusion

Fluids and Electrolytes : 

Fluids and Electrolytes

Fluids : 

Fluids Body composed mostly of water Chemical reactions Transport medium

Total Body Water : 

Total Body Water Constitutes 60% of total body weight Intracellular fluid (ICF) (45% of body weight) Extracellular fluid (ECF) (15% of body weight) Interstitial fluid (10.5% of body weight) Intravascular fluid (4.5% of body weight)

Fluid Composition : 

Fluid Composition Dissolved elements and water (solution) Solvent Solute

Electrolytes : 

Electrolytes Organic molecule Inorganic molecule

Ions : 

Ions Reactive and dangerous Energy Regulation Metabolic functions necessary for life

Properties of Electrolytes : 

Properties of Electrolytes Cation Sodium, potassium, calcium, and magnesium Anion Bicarbonate, chloride, and phosphorus

Measurement for Electrolytes (1 of 2) : 

Measurement for Electrolytes (1 of 2) Milliequivalent (mEq) based on ionic charges Sodium (Na+) Potassium (K+) Hypokalemia Hyperkalemia Calcium (Ca++) Hypocalcemia Hypercalcemia

Measurement for Electrolytes (2 of 2) : 

Measurement for Electrolytes (2 of 2) Magnesium (Mg++) Bicarbonate (HCO3-) Chloride (Cl-) Phosphorus (P)

Nonelectrolytes : 

Nonelectrolytes Solutes with no electrical charge Glucose and urea

Fluid and Electrolyte Movement : 

Fluid and Electrolyte Movement Chemical and biologic tenets Balance of compounds Balance of charges (positive or negative) Concentration gradient

Diffusion : 

Diffusion Movement across cellular membrane Areas of higher concentration to areas of lower concentration

Filtration : 

Filtration Kidneys Tubules Antidiuretic hormone (ADH)

Active transport : 

Active transport Metabolic purpose ATP

Osmosis : 

Osmosis Concentration of fluid in compartments Tonicity of the solution

Abnormal States of Fluid and Electrolyte Balance : 

Abnormal States of Fluid and Electrolyte Balance Homeostasis Ill or injured body Excesses or deficits

Dehydration : 

Dehydration Inadequate total systemic fluid volume Chronic condition of elderly or very young Signs and symptoms Causes

Overhydration : 

Overhydration Total systemic fluid volume increases Signs and symptoms Causes <Insert Fig. 8-6>

Slide 22: 

You and your partner are dispatched for a chest pain call. You arrive on scene to a restaurant and find a 52-year-old man complaining of chest pain in the center of his chest. He tells you this started after he ate dinner.

IV Fluid Composition (1 of 3) : 

IV Fluid Composition (1 of 3) Types of IV solutions Isotonic solutions Normal saline Lactated Ringer’s (LR) solution D5W (5% dextrose in water) Hypotonic solutions Osmolarity less than serum Dilutes serum Hydration

IV Fluid Composition (2 of 3) : 

IV Fluid Composition (2 of 3) Hypertonic solutions Osmolarity higher than serum Stabilize blood pressure Increase urine output Reduce edema Rarely used in prehospital setting Crystalloid solutions Dissolved crystals Best choice for body fluid replacement 3-to-1 replacement rule

IV Fluid Composition (3 of 3) : 

IV Fluid Composition (3 of 3) Colloid solutions Very high osmolarity Reduce edema Oxygen-carrying solutions Best fluid to replace lost blood is whole blood. O-negative blood (universally compatible blood type) Synthetic blood substitutes

IV Techniques and Administration (1 of 4) : 

IV Techniques and Administration (1 of 4) Assembling your equipment Gather and prepare equipment. Sterilize equipment. Two ports Injection port Access port

IV Techniques and Administration (2 of 4) : 

IV Techniques and Administration (2 of 4) Choosing a solution Identify the needs of the patient. Is the patient’s condition critical? Is the patient’s condition stable? Does the patient need fluid replacement? Will the patient need medications? Usually limited to two isotonic crystalloids Normal saline LR solution

IV Techniques and Administration (3 of 4) : 

IV Techniques and Administration (3 of 4) Choosing an administration set Piercing spike Drip sets Microdrip: 60 drops = 1 mL Macrodrip: 10, 15, or 20 drops = 1 mL

IV Techniques and Administration (4 of 4) : 

IV Techniques and Administration (4 of 4) Preparing an administration set Expiration date Solution clarity Solution color Prepare to spike the bag.

Skill Drill 8-1 Preparing an Administration Set (1 of 2) : 

Skill Drill 8-1 Preparing an Administration Set (1 of 2) Step 1 Step 2 Step 3

Skill Drill 8-1 Preparing an Administration Set (2 of 2) : 

Skill Drill 8-1 Preparing an Administration Set (2 of 2) Step 4 Step 5

Other Administration Sets : 

Other Administration Sets Blood tubing Volutrol Select-a-Flow

Choosing an IV Site (1 of 3) : 

Choosing an IV Site (1 of 3) Most appropriate vein Avoid valves. Avoid rolling veins.

Choosing an IV Site (2 of 3) : 

Choosing an IV Site (2 of 3) Criteria Straightest appearance Firm, round appearance Springy when palpated Avoid joints. Avoid edematous extremities. Avoid extremities with a dialysis fistula. Avoid extremities on the side a mastectomy.

Choosing an IV Site (3 of 3) : 

Choosing an IV Site (3 of 3) Start distally, work proximally. Distal site ruptures or infiltrates. Large protruding arm veins can be deceiving. Often roll from side to side Apply manual traction distally to the venipuncture site.

Choosing an IV Catheter (1 of 2) : 

Choosing an IV Catheter (1 of 2) Criteria Purpose of the IV Age of the patient Location for the IV Available vessels for venipuncture Needle types Over-the-needle catheters Butterfly catheters Through-the-needle catheters

Choosing an IV Catheter (2 of 2) : 

Choosing an IV Catheter (2 of 2)

Contaminated Stick : 

Contaminated Stick Paramedic punctures skin with the same catheter used to cannulate the vein

Inserting the IV Catheter (1 of 4) : 

Inserting the IV Catheter (1 of 4) Each paramedic has a unique technique to insert an IV. Keep the beveled side of the catheter up. Maintain adequate distal traction on the vein. Apply a constricting band above the site. Remove band after the catheter insertion, obtain blood samples, and attach the line. Have tape or securing devices ready.

Inserting the IV Catheter (2 of 4) : 

Inserting the IV Catheter (2 of 4) Prep the site. Alcohol or iodine swab Apply gentle downward or lateral traction. Clean the site with iodine first in a circular motion, starting |with small circles and moving to larger circles. Use the alcohol to clean the iodine.

Inserting the IV Catheter (3 of 4) : 

Inserting the IV Catheter (3 of 4) Insertion angle of 45˚ Advance the catheter through the skin until the vein is pierced. Flash of blood in the flash chamber

Inserting the IV Catheter (4 of 4) : 

Inserting the IV Catheter (4 of 4) Immediately drop the angle down to 15˚. Advance the catheter 1–2 mm to ensure the catheter sheath is in the vein. Slide the sheath off the needle and into the vein. Apply pressure to the vein just proximal to the end of the indwelling catheter. Remove the needle. Dispose of it in a sharps container.

Securing the Line : 

Securing the Line Tape the area. Tear the tape before you start the IV. Double back the tubing. Cover the insertion site with sterile gauze. Avoid circumferential taping around any extremity.

Skill Drill 8-2 Obtaining Vascular Access (1 of 4) : 

Skill Drill 8-2 Obtaining Vascular Access (1 of 4) Step 1 Step 2 Step 3 Step 4

Skill Drill 8-2 Obtaining Vascular Access (2 of 4) : 

Skill Drill 8-2 Obtaining Vascular Access (2 of 4) Step 5 Step 6 Step 7 Step 8

Skill Drill 8-2 Obtaining Vascular Access (3 of 4) : 

Skill Drill 8-2 Obtaining Vascular Access (3 of 4) Step 9 Step 10 Step 11 Step 12

Skill Drill 8-2 Obtaining Vascular Access (4 of 4) : 

Skill Drill 8-2 Obtaining Vascular Access (4 of 4) Step 13 Step 14 Step 15 Step 16

Changing an IV Bag (1 of 2) : 

Changing an IV Bag (1 of 2) Do not allow an IV fluid bag to become completely depleted. Replacing the bag is a sterile process. Always ensure that some fluid remains in the drip chamber and tubing of the set.

Changing an IV Bag (2 of 2) : 

Changing an IV Bag (2 of 2) Steps Stop the flow of fluid. Prepare the new IV bag. Insert the piercing spike. Ensure that the drip chamber is appropriately filled.

Discontinuing the IV line : 

Discontinuing the IV line Steps Shut off the flow. Peel back the tape toward the IV site. Stabilize the catheter while you loosen the tape. Do not remove the IV tubing. Place a 4” x 4” piece of gauze over the site. Gently pull the catheter and the IV line.

Slide 51: 

The patient is slightly sweaty; his blood pressure is 100/60 mm Hg; heart rate is 51 beats/min; respiratory rate is 16 breaths/min; and room air pulse oximetry is 100%. He tells you the pain is rated a 6 on a 1 to 10 pain scale. What do you need to know about this patient? (continued)

External Jugular Vein Cannulation : 

External Jugular Vein Cannulation External jugular vein (EJ vein) Easy to cannulate Rolls easily Near other vessels (carotid artery)

Factors Affecting IV Flow Rates (1 of 2) : 

Factors Affecting IV Flow Rates (1 of 2) Perform the following checks: Check the IV fluid. Check the administration set. Macrodrips are used for rapid fluid delivery. Microdrips deliver a more controlled flow.

Factors Affecting IV Flow Rates (2 of 2) : 

Factors Affecting IV Flow Rates (2 of 2) Check the height of the IV bag. The IV bag must be hung high. Check the type of catheter used. Check the constricting band. Do not leave the constricting band on the patient’s arm after completing the IV.

Potential Complications of IV Therapy : 

Potential Complications of IV Therapy Local IV site reactions Discontinue the IV and reestablish the IV in the opposite extremity. Infiltration Thrombophlebitis Occlusion Vein irritation Hematoma Nerve, tendon, or ligament damage Arterial puncture

Infiltration : 

Infiltration The escape of fluid Causes The IV passes completely through the vein. The catheter enters the tissue surrounding the vein. Signs and symptoms Edema at venipunture site Patient complains of pain at venipunture site.

Thrombophlebitis : 

Thrombophlebitis Inflammation of the vein Caused by lapses in aseptic technique Signs and symptoms Pain/tenderness along the vein Redness/edema at venipuncture site Far better to prevent than to treat it. Prevention methods Use iodine/alcohol to clean the site. Wear gloves. Cover the venipuncture site with a sterile dressing. Secure the catheter and IV tubing to prevent movement.

Occlusion : 

Occlusion Physical blockage of a vein or catheter Signs and symptoms Decreased drip rate or blood in the tubing Causes Positional IV (near a valve) Near-empty IV bag Patient’s BP exceeds infusion pressure.

Skill Drill 8-3 Determining Whether an IV Is Viable : 

Skill Drill 8-3 Determining Whether an IV Is Viable Step 1 Step 2 Step 3 Step 4

Vein Irritation : 

Vein Irritation Patients often complain immediately. Observe the patient closely for allergic reaction. Causes

Hematoma : 

Hematoma Accumulation of blood in the tissues surrounding an IV site Blood can be seen rapidly pooling around the IV site (tenderness and pain). If it occurs, stop and apply direct pressure.

Nerve, Tendon, or Ligament Damage : 

Nerve, Tendon, or Ligament Damage Improper identification of anatomic structures Selecting an IV site near joints Sudden and severe shooting pain Immediately remove the catheter and select another IV site.

Arterial Puncture : 

Arterial Puncture Risk is especially high when cannulating an external jugular vein. Bright red blood will spurt back into the catheter. Immediately withdraw the catheter and apply direct pressure. Always check for a pulse in any vessel.

Systemic Complications (1 of 6) : 

Systemic Complications (1 of 6) Evolve from reactions to IV insertion Allergic reactions Minor Anaphylaxis Signs and symptoms Redness/itching/hives Edema of the face and hands Bronchospasm and wheezing Hypotension

Systemic Complications (2 of 6) : 

Systemic Complications (2 of 6) Pyrogenic reactions Pyrogens Signs and symptoms Fever/chills/achy Weakness Nausea/vomiting Total vascular collapse and shock in rare cases

Systemic Complications (3 of 6) : 

Systemic Complications (3 of 6) Circulatory overload 2 to 3 extra liters Complications Causes Signs and symptoms Dyspnea (crackles in lungs) JVD HTN

Systemic Complications (4 of 6) : 

Systemic Complications (4 of 6) Air embolus Any air can be dangerous. Proper flushing of an IV Signs and symptoms Onset of dyspnea Cyanosis despite oxygenation Anxiety/decreasing LOC/unresponsive Respiratory arrest Decreasing O2 saturation ETCO2 changes in waveforms and numbers

Systemic Complications (5 of 6) : 

Systemic Complications (5 of 6) Vasovagal reactions Anxiety Signs and symptoms

Systemic Complications (6 of 6) : 

Systemic Complications (6 of 6) Catheter shear Catheter is pinched against the needle. Free-floating segment Pulmonary embolus Treatment

Slide 70: 

You apply the ECG monitor and note an ever so small ST elevation segment in leads II and III. You place the patient in a supine position on your stretcher and bring him out to the ambulance (because he’s in the middle of the restaurant). What treatment do you want to consider next? (continued)

Obtaining Blood Samples (1 of 4) : 

Obtaining Blood Samples (1 of 4) At the time of the IV Equipment needed Red-topped tube May be Tiger-topped instead of red Blue-topped tube Green-topped tube Lavender-topped tube

Obtaining Blood Samples (2 of 4) : 

Obtaining Blood Samples (2 of 4) Steps Occlude the catheter proximal to the puncture site. Attach a 15- or 20-mL syringe to the hub. Draw the necessary amount of blood. Detach the syringe, attach the IV tubing, and begin infusion. Attach an 18-gauge or larger needle to the syringe. Fill the blood tubes with the necessary amounts. Immediately dispose of needle in a sharps container.

Obtaining Blood Samples (3 of 4) : 

Obtaining Blood Samples (3 of 4) Without an IV Vacutainer

Obtaining Blood Samples (4 of 4) : 

Obtaining Blood Samples (4 of 4) Steps Apply a constricting band, and locate a suitable vein. Prep the vein. Insert the needle. Remove the constricting band. Insert blood tubes into the Vacutainer. Remove the needle from the vein, and apply direct pressure. Dispose of the needle in a sharps container. Label all tubes. Gently turn the tubes back and forth. Tubes must be at least three-fourths full.

Intraosseous Infusion : 

Intraosseous Infusion “Within the bone” Noncollapsible vein Quickly absorbs IV fluids and medications Rapidly gets them to the central circulation Historically used for children younger than 6 Now there are various adult IOs.

Equipment for IO Infusion (1 of 4) : 

Equipment for IO Infusion (1 of 4) Manually inserted IO needles Original devices Solid boring needle (trocar) inserted through a sharpened hollow needle Pushed into the bone with a screwing, twisting action Solid needle is removed, leaving the hollow needle in place, and the IV tubing is attached to this catheter. Requires immobilization

Equipment for IO Infusion (2 of 4) : 

Equipment for IO Infusion (2 of 4) F.A.S.T.1 (First Access for Shock and Trauma) First IO device approved for use in adults (not usedin children) Placement in the sternum

Equipment for IO Infusion (3 of 4) : 

Equipment for IO Infusion (3 of 4) EZ-IO Hand-held battery-powered driver to which a special needle is attached Used to insert an IO needle into the proximal tibia of adults and children Different sized needles for adults and children Courtesy of Wolfe Tory Medical, Inc.

Equipment for IO Infusion (4 of 4) : 

Equipment for IO Infusion (4 of 4) Bone Injection Gun (BIG) Spring-loaded device Used to insert an IO needle into the proximal tibia of adult and pediatric patients Comes in adult and pediatric sizes

Skill Drill 8-4 IO Infusion (1 of 2) : 

Skill Drill 8-4 IO Infusion (1 of 2) Step 1 Step 2 Step 3 Step 4

Skill Drill 8-4 IO Infusion (2 of 2) : 

Skill Drill 8-4 IO Infusion (2 of 2) Step 5 Step 6 Step 7

Potential Complications of IO Infusion (1 of 4) : 

Potential Complications of IO Infusion (1 of 4) Relatively low complication rate Same potential complications associated with IV therapy Extravasation Needle rests outside the bone. IV fluid will collect in the soft tissues. Signs and symptoms Discontinue the infusion immediately

Potential Complications of IO Infusion (2 of 4) : 

Potential Complications of IO Infusion (2 of 4) Osteomyelitis Inflammation of the bone and muscle Caused by an infection Fewer than 0.6% of IO insertions

Potential Complications of IO Infusion (3 of 4) : 

Potential Complications of IO Infusion (3 of 4) Growth plate damage Failure to identify the proper anatomic landmark Potentially results in long-term bone growth abnormalities Through-and-through insertion Needle passes through both sides of the bone. Stop inserting the needle when you feel a pop. “Pop, pop” usually means you went through the opposite side!

Potential Complications of IO Infusion (4 of 4) : 

Potential Complications of IO Infusion (4 of 4) Pulmonary embolism Particles of bone, fat, or marrow Acute shortness of breath, pleuritic chest pain, and cyanosis

Contraindications to IO Infusion : 

Contraindications to IO Infusion Peripheral vein preferred route Fractured bone Osteoporosis Osteogenesis imperfecta Bilateral knee replacements

Calculating Fluid Infusion Rates : 

Calculating Fluid Infusion Rates Flow rate Adjust as directed by medical control You must know the following: The volume to be infused The period over which it is to be infused The properties of the administration set Calculation Gtt/min = (volume to be infused x gtt/mL of administration set) x total time of infusion in minutes

Medication Administration (1 of 2) : 

Medication Administration (1 of 2) primum non nocere Mathematical principles used in pharmacology The metric system Weight and volume conversion Converting pounds to kilograms Other systems of measurement

Medication Administration (2 of 2) : 

Medication Administration (2 of 2) Calculating medical doses Desired dose Drug concentrations Volume to be administered Weight-based drug doses One extra step, conversion of the patient’s weight in pounds to kilograms

Calculating the Dose and Rate for a Medication Infusion : 

Calculating the Dose and Rate for a Medication Infusion Non–weight-based medication infusions Determine the concentration. Determine the volume to infuse per minute. Determine drops per minute (gtt/min) at which to set the IV flow rate. Weight-based medication infusions Determine the desired dose based on the patient’s weight.

Pediatric Drug Doses : 

Pediatric Drug Doses Methods Length-based measures EMS field guide with tables or charts specific to pediatric patients

Medical Direction (1 of 4) : 

Medical Direction (1 of 4) Local protocols and/or online medical direction Standing orders Online (direct) medical control

Medical Direction (2 of 4) : 

Medical Direction (2 of 4) Paramedic’s responsibility associated with drug orders Make sure the base physician understands the situation. Make sure you understand the physician’s orders clearly. Always repeat any orders. Confirm that the patient is not allergic to the drug. Read the label carefully. Check for defects. Make sure that the drugs are compatible. Notify the physician when the medication has been administered. Monitor the patient for possible adverse side effects. Dispose of the syringe and needle safely.

Medical Direction (3 of 4) : 

Medical Direction (3 of 4) The “Six Rights” of drug administration Right patient Right drug Right dose Right route Right time Right documentation

Medical Direction (4 of 4) : 

Medical Direction (4 of 4) If you did not document it, you did not do it. Name of the drug Dose of the drug Time you administered the drug Route of administration Your name or the paramedic who administered the drug Patient’s response to the medication

Slide 96: 

After a fluid bolus, you reassess the patient’s blood pressure: 118/70 mm Hg. You administer nitroglycerin: 0.4 mg SL spray. You then administer baby aspirin: 324 mg orally. What additional treatments should you consider? (continued)

Local Drug Distribution System : 

Local Drug Distribution System Medication check All medications must be checked at the start of your shift regardless of the time. You are responsible for the documentation and security of all controlled substances. Local protocols and your agency’s policies will specifically dictate the procedure and documentation.

Medical Asepsis : 

Medical Asepsis Sterilization of equipment Antiseptics or disinfectants

Clean Technique Versus Sterile Technique (1 of 2) : 

Clean Technique Versus Sterile Technique (1 of 2) Some of the equipment has been sterilized for patient safety. Medication packaged using sterile technique Destruction of all living organisms Handwashing Wearing gloves Keeping equipment clean Conscious effort to prevent contamination

Clean Technique Versus Sterile Technique (2 of 2) : 

Clean Technique Versus Sterile Technique (2 of 2) Antiseptics and disinfectants Antiseptics Capable of destroying pathogens Isopropyl alcohol (rubbing alcohol) and iodine Disinfectants Never use them on a patient. Use only on nonliving objects. Virex, Cidex, and Microcide

BSI Precautions : 

BSI Precautions Body substance isolation Treat any body fluid as being potentially infectious. Minimum BSI precautions include: Wearing gloves and protective eyewear Handwashing, which is the most effective way to prevent the spread of disease

Contaminated Equipment Disposal : 

Contaminated Equipment Disposal After an IV catheter needle has penetrated a patient’s skin it is contaminated. Accidental needlesticks Sharps

Enteral Medication Administration : 

Enteral Medication Administration Gastrointestinal tract Oral medication administration Capsules, time-released capsules, lozenges, pills, tablets, elixirs, emulsions, suspensions, and syrups Absorbed at a slow rate

Oral Medication Administration (1 of 2) : 

Oral Medication Administration (1 of 2) Slow absorption rate Appropriate equipment Check for indications and contraindications

Oral Medication Administration (2 of 2) : 

Oral Medication Administration (2 of 2)

Skill Drill 8-5: Administering Medication via the Gastric Tube (1 of 2) : 

Skill Drill 8-5: Administering Medication via the Gastric Tube (1 of 2) Step 1 Step 2 Step 3

Skill Drill 8-5: Administering Medication via the Gastric Tube (2 of 2) : 

Skill Drill 8-5: Administering Medication via the Gastric Tube (2 of 2) Step 4 Step 5

Rectal Medication Administration : 

Rectal Medication Administration Certain drugs Diazepam (Valium) for pediatric patients Medication absorption is rapid and predictable. Suppository

Parenteral Medication Administration (1 of 3) : 

Parenteral Medication Administration (1 of 3) Any route other than the gastrointestinal tract Absorbed into the central circulation more quickly and at a more predictable rate

Parenteral Medication Administration (2 of 3) : 

Parenteral Medication Administration (2 of 3) Syringe and needles Prepackaged in color-coded packs with a needle Plunger, body or barrel, flange, and tip. Hypodermic needle lengths vary from 3/8” to 2” Gauge refers to the diameter (18–26) The smaller the number, the larger the diameter. The proximal end of the needle attaches to the syringe. The distal end of the needle is beveled.

Parenteral Medication Administration (3 of 3) : 

Parenteral Medication Administration (3 of 3) Packaging of parenteral medications Ampules Single dose of medication

Skill Drill 8-6: Drawing Medication from an Ampule (1 of 2) : 

Skill Drill 8-6: Drawing Medication from an Ampule (1 of 2) Step 1 Step 2 Step 3

Skill Drill 8-6: Drawing Medication from an Ampule (2 of 2) : 

Skill Drill 8-6: Drawing Medication from an Ampule (2 of 2) Step 4 Step 5

Vials : 

Vials Small glass or plastic bottles Once you remove the cover from a vial, it is no longer sterile. Some medications will need to be diluted.

Skill Drill 8-7: Drawing Medication from a Vial (1 of 2) : 

Skill Drill 8-7: Drawing Medication from a Vial (1 of 2) Step 1 Step 2 Step 3

Skill Drill 8-7: Drawing Medication from a Vial (2 of 2) : 

Skill Drill 8-7: Drawing Medication from a Vial (2 of 2) Step 4 Step 5

Prefilled Syringes : 

Prefilled Syringes Packaged in tamper-proof boxes Designed for ease of use

Intradermal Medication Administration : 

Intradermal Medication Administration Small amount of medication into the dermal layer Avoid areas that contain superficial blood. Anterior forearm or upper back Slow rate of absorption and minimal systemic distribution

Subcutaneous Medication Administration : 

Subcutaneous Medication Administration Loose connective tissue between the dermis and the muscle layer Upper arms, anterior thighs, and the abdomen Insulin

Skill Drill 8-8: Administering Medication via the Subcutaneous Route (1 of 2) : 

Skill Drill 8-8: Administering Medication via the Subcutaneous Route (1 of 2) Step 1 Step 2 Step 3

Skill Drill 8-8: Administering Medication via the Subcutaneous Route (2 of 2) : 

Skill Drill 8-8: Administering Medication via the Subcutaneous Route (2 of 2) Step 4 Step 5

Intramuscular Medication Administration : 

Intramuscular Medication Administration Penetrating a needle through the dermis and subcutaneous tissue and into the muscle layer Allows for a larger volume of medication Common sites for injection Vastus lateralis muscle Rectus femoris muscle Gluteal area Deltoid muscle

Skill Drill 8-9: Administering Medication via the Intramuscular Route (1 of 2) : 

Skill Drill 8-9: Administering Medication via the Intramuscular Route (1 of 2) Step 1 Step 2 Step 3

Skill Drill 8-9: Administering Medication via the Intramuscular Route (2 of 2) : 

Skill Drill 8-9: Administering Medication via the Intramuscular Route (2 of 2) Step 4 Step 5

IV Bolus Medication Administration : 

IV Bolus Medication Administration Places the drug directly into the circulatory system Fastest route of medication administration No room for error Needleless systems Syringe simply screws into the injection port of the administration set. Bolus is a single dose.

Skill Drill 8-10: Administering Medication via the Intravenous Bolus Route : 

Skill Drill 8-10: Administering Medication via the Intravenous Bolus Route Step 1 Step 2 Step 3

Saline Locks : 

Saline Locks Used for patients who are not in need of IV fluid but may need medication therapy

Adding Medication to an IV Bag : 

Adding Medication to an IV Bag

Electromechanical Infusion Pumps : 

Electromechanical Infusion Pumps Medication maintenance infusion Allow you to set the parameters of medication administration Safety features

IO Medication Administration : 

IO Medication Administration Critically ill or injured children and adults when IV access is difficult or impossible to obtain Large syringe to infuse the fluid Pressure infuser device should be used when infusing fluids in adults.

Skill Drill 8-11: Administering Medication via the IO Route : 

Skill Drill 8-11: Administering Medication via the IO Route Step 1 Step 2 Step 3 Step 4

Percutaneous Medication Administration : 

Percutaneous Medication Administration Applied and absorbed through the skin and mucous membranes Absorption is predictable.

Transdermal Medication Administration : 

Transdermal Medication Administration Surface of the skin

Sublingual Medication Administration : 

Sublingual Medication Administration Under the tongue

Skill Drill 8-12: Administering Medication via the Sublingual Route : 

Skill Drill 8-12: Administering Medication via the Sublingual Route Step 1 Step 2

Buccal Medication Administration : 

Buccal Medication Administration Between the cheeks and gums Tablets

Ocular Medication Administration : 

Ocular Medication Administration Drops or ointments

Aural Medication Administration : 

Aural Medication Administration Mucous membranes of the ear canal Antibiotics, analgesics, and ear wax removal preparations

Intranasal Medication Administration : 

Intranasal Medication Administration Nasal spray Rapidly absorbed Mucosal atomizer device (MAD) Courtesy of Wolfe Tory Medical, Inc.

Medications Administered by the Inhalation Route : 

Medications Administered by the Inhalation Route Nebulizer and metered-dose inhaler Respiratory emergencies Oxygen, beta-2 agonist bronchodilators, ipratropium bromide (Atrovent) Patient with a history of respiratory problems will usually have a metered-dose inhaler (MDI).

Skill Drill 8-13: Administering a Medication via Small-Volume Nebulizer : 

Skill Drill 8-13: Administering a Medication via Small-Volume Nebulizer Step 1 Step 2 Step 3 Step 4

Endotracheal Medication Administration : 

Endotracheal Medication Administration If IV or IO access is unavailable You must administer 2 to 2.5 times the standard IV dose. Only four medications (lidocaine, epinephrine, atropine, Narcan) Administration techniques

Rates of Medication Absorption : 

Rates of Medication Absorption Rate directly related to route

Slide 144: 

You should treat all chest pain calls as “cardiac” type chest pain until proven otherwise. Know what medications can be given per your protocol. You need to know not only what medications you are providing, but also why you are giving them. Summary

Summary : 

Summary Fluids and electrolytes IV fluid composition IV techniques and administration Potential complications Obtaining blood samples Medication administration

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