Basic Guidelines for Parenteral Medication Administration

General

All of the safety factors for non-parenteral medication apply to parenteral medications

  1.  Do not contaminate the sterile needle, syringe plunger, tip of syringe, inside of the syringe, inside of the ampule or vial
  2. Standard Precautions state that you will not recap a used needle or attempt to manipulate the needle/syringe in anyway.  Place the contaminated needle/syringe in a sharps container immediately after use or recap using the one handed scoop technique
  3. Wear clean gloves since contact with blood is a possibility
  4. With friction, cleanse a patient's skin in a circular motion, starting at the point where you will pierce the skin and working outward
  5. As a general rule, for ALL IM medication and many SQ medications, ASPIRATE before you inject the medication
  6. When mixing 2 types of insulin in the same syringe, draw up the clear first and then the cloudy intermediate acting insulin
  7. Insulin administration requires a 2 nurse check to facilitate accuracy
  8.   Insulin must be drawn up in an insulin syringe
  9. Check expiration date on all vials, ampules, and preprepared medication cartridges
  10. As a general rule, most IM are given at a 90 degree angle, SC at a 45 degree for long needles and 90 degree for shorter needles
  11. For needles, as the gauge size gets larger the lumen size gets smaller
  12. In order to choose the correct size needle and syringe, consider size of your patient, route of administration, viscosity of the medication and amount of medication
  13. If the integrity of a sterile needle or syringe package is questionable, assume contamination and don't use it
  14. Dart the needle into the skin quickly, but inject the medication slowly and steadily.  Withdraw the needle quickly
  15. A 0.2cc air lock in the syringe may be used for IM injections
  16. To measure the medication in a syringe, all air bubbles must be removed from the syringe to determine if you have the correct volume of medication. Add air lock only after correct measurement of the volume.
  17. There is sometimes a little bit more medication in a single-dose vial or ampule than you will need.  Calculate how much you need and be sure that you have prepared the correct volume
  18. Before you mix 2 drugs in the same syringe, check compatibility
  19. For “cloudy” intermediate acting insulins, roll the container between your palms to mix the solution
  20. For SQ, usually no more than 1 cc of fluid in one site; IM, 5 cc is the absolute largest amount of fluid in one injection site (for an adult). Three seems more reasonable.

Vials

  • Use friction to cleanse rubber top of vial
  • Insert exact amount of air into a vial to displace the desired volume of fluid

Ampules

  • When you are trying to snap off the head of an ampule, cover the narrowed neck with an alcohol wipe to protect your fingers.  Protect yourself and others from broken glass
  • No air needs to be added to an ampule
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