Table Routes of Drug Administration PDF

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Routes of Drug Administration...

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TABLE 2-3 Routes of Administration and Related Nursing Considerations Route

Advantages

Disadvantages

Nursing Considerations

Intravenous (IV)

Provides rapid onset (drug delivered immediately to bloodstream); allows more direct control of drug level in blood; gives option of larger fluid volume, therefore diluting irritating drugs; avoids first-pass metabolism.

Higher cost; inconvenience (e.g., not self-administered); irreversibility of drug action in most cases and inability to retrieve medication; risk of fluid overload; greater likelihood of infection; possibility of embolism.

Continuous intravenous infusions require frequent monitoring to be sure that the correct volume and amount are administered and that the drug reaches safe, therapeutic blood levels. Intravenous drugs and solutions must be checked for compatibilities. Intravenous sites are to be monitored for redness, swelling, heat, and drainage—all indicative of complications, such as thrombophlebitis. If intermittent intravenous infusions are used, clearing or flushing of the line with normal saline before and after is generally indicated to keep the intravenous site patent and minimize incompatibilities.

Intramuscular (IM)

Intramuscular injections are good for poorly soluble drugs, which are often given in “depot” preparation form and are then absorbed over a prolonged period; onsets

Discomfort of injection; inconvenience; bruising; slower onset of action compared to intravenous, although quicker than oral in most situations.

Using landmarks to identify correct intramuscular site is always required and recommended as a nursing standard of care. For adults, the intramuscular site of choice is the ventral gluteal muscle with use of a 38 mm (sometimes 25 mm in

Route

Advantages

Disadvantages

extremely thin or emaciated patients) and 20- to 25-gauge needle for aqueous solutions and 18- to 25gauge needle for viscous or oilbased solutions. However, the deltoid muscle in the upper arm is the site of choice for vaccine administration in adults. Selection of the correct size of syringe and needle is key to safe administration by these routes and is based on thorough assessment of the patient as well as the characteristics of the drug.

of action differ depending on route. IM route also provides a more immediate onset of action than PO for certain drugs prior to establishment of IV access (i.e., in the emergency department) or if the patient does not require IV access but is vomiting.

Subcutaneous

Drugs given via the subcutaneous route are those that require slow, sustained absorption of a medication, such as insulin and low-molecular-weight heparin solutions. It is also often used in surgery and palliative care for slower absorption of pain medication and prolonged pain relief. The medication is injected under the epidermis into the fat and

Nursing Considerations

Discomfort of injection; inconvenience; bruising; slower onset of action compared to intravenous/intramuscular, although quicker than oral in most situations. A wide variety of insulin pens and preloaded heparin syringes with tiny needles are available, enabling the 90degree angle for injection. Subcutaneous injection into the abdomen should be to the right or left of and 5 cm away from the umbilicus to avoid the umbilical veins and the risk of

Using landmarks to identify the correct subcutaneous site is always required and recommended as a nursing standard of care. Common sites for injection include the lateral and posterior aspects of the upper arm and under the greater trochanter of the femur in the thigh and abdominal area. Subcutaneous injections are recommended to be given at a 90-degree angle with a proper-size syringe and needle (4 to 8 mm); in emaciated or extremely thin patients, the subcutaneous

Route

Oral

Advantages

Disadvantages

Nursing Considerations

connective tissue beneath the dermis, where there is less blood flow and consequently a slower, steadier absorption rate compared with that of the intramuscular route.

bleeding.

angle is 45 degrees. Subcutaneous injections require a 26- to 30-gauge, 8 mm needle. Selection of correct size of syringe and needle is key to safe administration by the subcutaneous route and is based on thorough assessment of the patient as well as the characteristics of the drug.

Usually easier, more convenient, and less expensive; safer than injection as dosing more likely to be reversible in cases of accidental ingestion (e.g., through induction of emesis, administration of activated charcoal).

Variable absorption; inactivation of some drugs by stomach acid or pH; problems with first-pass effect or presystemic metabolism; greater dependence of drug action on patient variables.

Enteral routes include oral administration and involve a variety of dosage forms (e.g., liquids, solutions, tablets, and entericcoated pills or tablets). Some medications are recommended to be taken with food, while others are recommended not to be taken with food; it is also suggested that oral dosage forms of drugs be taken with a sufficient amount of fluid, such as 180 to 240 mL of water. Other factors to consider include other medicines being taken at the same time and concurrent use of dairy products or antacids. If oral forms are given via nasogastric tube or gastrostomy tube, tube placement in stomach must be assessed prior to

Route

Advantages

Disadvantages

Nursing Considerations giving the medication and the patient's head is to remain elevated; flushing the nasogastric tube with at least 30 to 60 mL of water before and after giving the drug is recommended to help maintain tube patency and prevent clogging; enteric-coated drugs cannot be crushed and administered via nasogastric tube, while capsules may be opened but granules are not to be crushed for administration.

Sublingual, buccal (subtypes of oral, but more parenteral than enteral)

Absorbed more rapidly from oral mucosa than oral route and leads to more rapid onset of action; avoids breakdown of drug by stomach acid; avoids first-pass metabolism because gastric absorption is bypassed.

Patient may swallow pill instead of keeping under tongue until dissolved; pills often smaller to handle. Salivary secretions are necessary for the absorption of sublingual medications.

Drugs given via the sublingual route are to be placed under the tongue; once dissolved, the drug may be swallowed. When using the buccal route, medication is placed between the cheek and gum. Both of these dosage forms are relatively nonirritating; the drug usually is without flavour and is water-soluble.

Rectal

Provides relatively rapid absorption; good alternative when oral route not feasible; useful for local or systemic drug delivery; usually leads to

Possible discomfort and embarrassment to patient; often higher cost than oral route.

Absorption via this route is erratic and unpredictable, but it provides a safe alternative when nausea or vomiting prevents oral dosing of drugs. The patient must be placed on his left side so that the normal

Route

Advantages

Disadvantages

mixed first-pass and non– first-pass metabolism.

Nursing Considerations anatomy of the colon allows safe and effective insertion of the rectal dosage form. Suppositories are inserted using a gloved hand or gloved index finger and watersoluble lubricant. Drug must be administered exactly as ordered.

Topical

Delivers medication directly to affected area; decreases likelihood of systemic drug effects.

Sometimes awkward to self-administer (e.g., eye drops); can be messy; usually higher cost than oral route.

Most dermatologic drugs are given via topical route in form of a solution, ointment, spray, or drops. Maximal absorption of topical drugs is enhanced with skin that is clean and free of debris; if measurement of ointment is necessary—such as with topical nitroglycerin— application must be done carefully and per instructions (e.g., apply 2.5 cm of ointment). Gloves help minimize cross-contamination and prevent absorption of drug into the nurse's own skin. If the patient's skin is not intact, sterile technique is needed.

Transdermal (subtype of topical)

Provides relatively constant rate of drug absorption; one patch can last 1 to 7 days, depending on drug;

Rate of absorption can be affected by excessive perspiration and body temperature; patch may peel off; cost is higher; used patches must be

Transdermal drugs should be placed on alternating sites and on a clean, nonhairy, nonirritated area, and only after the previously applied patch

Route

Inhalational

Advantages

Disadvantages

Nursing Considerations

avoids first-pass metabolism.

disposed of safely; may cause skin irritation.

has been removed and that area cleansed and dried. Transdermal drugs generally come in a singledose, adhesive-backed drug application system.

Provides rapid absorption; drug delivered directly to lung tissues, where most of these drugs exert their actions.

Rate of absorption can be too rapid, increasing the risk of exaggerated drug effects; requires more patient education for self-administration; some patients may have difficulty with administration technique.

Inhaled medications are to be used exactly as prescribed and with clean equipment. Instructions need to be given to the patient/family/caregiver regarding medications to be used as well as the proper use, storage, and safe-keeping of inhalers, spacers, and nebulizers. Chapter 10 describes and shows how medications are inhaled....