Chapter 15: Parenteral Therapy o Latter stages: vein appears palpable,

tender red cord

Parenteral Drug Preparation and Dispensing
Parenteral ( injectable ) intended for injection
through one / more layers of skin, rather than
through the alimentary (enteral) canal, so that
the active substances are administered directly
into a blood vessel, organ, tissue, or lesion
RPh decides whether the dose is given
continuously, what diluent, concentration of
drug, hours of administration
Parenteral routes of administration for fluid &
electrolyte replacement, nutrition, etc
Ampuls single-use container composed
entirely of glass, vials plastic/glass with a
rubber closure secured to its top by a metal ring,
prefilled syringes, cartridges, glass/plastic
bottles
Most injections are aqueous solutions but others
may be in the form of colloidal dispersions,
emulsions, or suspensions
Small volume parenteral (SVP) may conatin a
single dose or multiple doses of a drug in a
volume not greater than 100 ml
o IV-piggyback container ( minibags in
50ml or 100 ml sizes )
Large Volume Parenteral (LVP) manufactured in
bags or bottles up to 1000ml
o Common container sizes are 150ml,
250ml, 500ml, 1000ml
o Sodium chloride 0.9%
o Nutrients ( dextrose )
o Electrolytes dissolved ions that
include Na, K, Cl, Ca, Phosphate, etc
o Plasma volume expanders ( albumin )
Advantages:
o Immediate physiological response can
be achieved
o If oral routes / destruction by digestive
enzymes occur
o Medications for nauseated
unconscious patients
o Continued treatment & prolonged drug
action ; Can results in local effects
o Correct serious disturbances of fluid &
electrolyte balances
o When food cannot be taken in by mouth
o Factors associated: type of needle,
duration, chemically irritating drugs, pH
of infusion, osmolality, location of IV site
or thrombophlebitis ( inflammation and a clot in
a vein )
Necrosis ( tissue damage ) infiltration,
extravasation inadvertent administration of
vesicant med into the tissue, and ADE ,
accidental intra-arterial injection
o Caustic or vesicant drugs or
vasoconstricting drugs
Particulate matter ( mobile, undissolved,
unintended particles other than gas bubbles )
o May clog capillary beds, granulomas,
foreign body reactions
o Errors: failure to
To screen incompatibilities that for ppt
To dissolve solutes
To filter out glass particles
To fully dissolve dry powders /
lyophilized powders
Check CSPs against light & dark backgrounds
Filtering IV fluids w/ a 0.22 micron, 0.45
micron, or 5micron filter before entering
cannula
o 0.22 & 0.45 micron slow the rate of IV
Administering Parenteral Medications
syringe and needle to withdraw drug from vial
must be careful not to core a piece of rubber
from the stopper w/ needle
5 micron filter needle to withdrawn an ampuls
/ (avoids glass particles drawn up from ampuls)

Hazards of Parenteral Therapy

Requires strict adherence to aseptic procedures
& can cause pain on injection
Becomes difficult to reverse the physiological
effects
More expensive than similar drugs given orally
Infusion into a vein can lead to phlebitis (
inflammation of vein) early sign: tenderness at
the insertion site of IV needle/cannulatube
like a needle or catheter used to infuse
parenteral fluids into body spaces
o Vein becomes red, warm & painful w Parenteral Routes of Administration
edema and stiffness Intradermal (ID) drug inserted into superficial
layer of skin bet. epidermis and dermis
 o Small volumes & slow absorption
o Diagnostic skin test & vaccines
Subcutaneous (SC / SQ) given in the loose
tissue beneath skin (outer surface of arm or
thigh )
o More rapid absorption
o Continuous subcutaneous infusion
(hypodermoclysis)
Intramuscular (IM) made into a muscle mass (
deltoid muscle of upper arm)
o More rapid absorption than SQ & much
more rapid than ID
o Can be formulated for delayed release in
an aqueous / oil-based vehicle
o ID, SQ, IM soln, suspension, emulsion
Intravenous (IV) can deliver small/large
volumes ; rapid dilution with blood
Intra-arterial (IA) can go directly to a targeted
area ( organ/limb)
Central nervous system intra-spinal (includes
epiduralspace superior to the dura matter of
the brain & spinal cord, where cerebrospinal
fluid flows & intrathecalspace w/in spinal
canal routes) ; brain ( intra-cranial & intra-
ventricular)
Intracardiac directly into a heart chamber
Intrasynovial into a joint fluid area
Intra-articular into the cavity of a joint
Intraosseous w/ a vascular access device w/
tip placement w/in the bone matrix
Methods of Administration
Infusions administered with and IV set
o Continuous may be given at a steady rate
or may be adjusted periodically
titrations in the rate periodic
adjustments
o Intermittent prescribed at intervals w/
periods of infusion cessation
IV push
Piggyback method eliminates the
need for another venipuncture &
achieves appropriate drug dilution &
gains peak drug blood levels ( often
used for antibiotics )
o Syringe pump alternative for intermittent
Slow, measured direct IV bolus dosing
; pump device that slowly injects the
contents into a y-site
o Burette set in-line volume measuring
container made as part of the primary IV
set
Allow rapid measurements &
administration of an emergency dose
Greater likelihood of error &
contamination
Infusion Pumps
Makes infusion of critical drugs more accurate
and uniform
Peristaltic pumps, piston pumps, pulsatile
pumps, elastomeric chambers
Should suit the patient as to age, condition,
prescribed IV therapy, type of vascular access
Safety features: audible alarm
o battery life & operation indicators
o anti-free flow protection
o adjustable occlusion pressure levels
o in-line pressure monitoring
o anti tampering mechanisms
for vesicant drugs (chemotherapy), should be
capable of administering under low pressure
for arterial chambers high pressure to
overcome the back pressure of blood
Elastomeric chambers consist of a balloon-like
chamber or fluid reservoir w/in a cylinder
o Pre-attached IV adminis set w/ flow-control
clamp
o Infusions of antibiotics, chemotherapy, pain
meds, continuous/intermittent
o Lack of safety features, dose indicators
IV Pumps
Involved in 35% to 60% of 770,00 ADE per year
Caregiver manually programs the pump
Smart Pumps
Checking of programmed settings against the
hospitals guidelines
Can intercept potentially serious program errors
Has a software that contains a drug library
Records data about all
Special Purpose Infusion Devices
Include implantable pumps and
o Have a catheter surgically placed into a
blood vessel, body cavity / organ, attached to
a reservoir surgically implanted under the
skin
o Provide a long-term injectable access
Patient-controlled analgesia pumps
o Patients can determine when and how much
medication they receive
o w/ a button that activates a bolus dose of
analgesic
o deliver low-level continuous infusion
o w/ a lockout interval & limit
Waste Disposal
all blood contaminated & sharps: discarded into
nonpermeable, puncture-resistant, tamper-proof
biohazard container sharps must not be capped,
broken, bent

Infusion Therapy Documentation

Pt., caregiver, or representatives participation in
understanding of therapy
Type, brand, length, size of vascular access device
Date and time of insertion, pts response
Identification of insertion site
Infusion site condition

Parenteral Medication Safety

Parenteral errors were 3 times as likely to cause
harm/death ( Insulin, opioid analgesics, blood
coagulation modifiers )

Ensure all staff are educated to work on behalf of

neonates, infants, children, adolescents
Mandate pts weight and allergy status
Provide medications in the most ready-to-use format
Have appro. Measuring devices
Have a formulary process
Limit the number of concentration & dosage
Ensure RPh review all orders prior to dispensing
Use bar-code technology
Limit availability of medications on override in ADCs
regular data of drug library use in smart pumps