DRUG ADMINISTRATION

dr. Prajogo Wibowo, M. Kes

THE PREPARATION CAN BE DISTINGUISHED INTO

INTERNAL PREPARATION ORAL STOMACH INTESTINAL DRUGS LABEL : WHITE

EXTERNAL PREPARATION ALL OF MEDICATION but ORAL INTESTINAL

DRUGS LABEL : BLUE

SYSTEMIC & NON SYSTEMIC MEDICATIONS

SYSTEMIC : ANTIBIOTIC (SYSTEMIC) ANTIHYPERTENSION, ANALGESIC

1. INTERNAL PREPARATION

NON SYSTEMIC : ANTIHELMINTIC LOCAL ANAESTHETIC, ANTIMICROBIAL (INTESTINAL), LOCAL ANTACID

2. EXTERNAL PREPARATION

SYSTEMIC : PARENTERAL INJECTION INHALER, SUPPOSITORIA NON SYSTEMIC : VAGINAL TABLET, TOPICAL STEROID, GARGLE,SUPP

MANAGEMENT OF MEDICATION

1. 2. 3.

INTERVAL OF MEDICATION TIMING OF MEDICATION TECHNIQUE OF MEDICATION

1. INTERVAL OF MEDICATION examples : * HOURLY * EVERY (THREE-HOURS) * THREE TIMES A DAY 2. TIME OF MEDICATION examples : * in the morning, in the midday, in the night * before, after, or during meals; before sleeping * during episode, during attack, after attack 3. TECHNIQUES OF MEDICATION * ROUTE OF ADMINISTRATION : TOPICAL AND NONTOPICAL DRUGS * DRUG DOSAGE FORMS
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INTERVAL OF MEDICATION

Determined by : * HALF-LIFE TIME (t 1/2) OF DRUGS : Ultrafast, Fast, slow, very slow Example : Reserpin has t 1/2 15 minutes and 36 hours of duration DURATION OF DRUG ACTION / EMERGENCY SETTING In emergency condition, in particular clinical treatment
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HALF-LIFE TIME (T 1/2)

ULTRAFAST : amoxicillin, cloxacillin, flurosemide, penicillin-G FAST : paracetamol, ampicillin, hydrocortison SLOW : doxicillin, griseofulvine, proctolol VERY SLOW : barbiturate, diazepam, digitoxin, phenylbutazon
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STANDARD ADMINISTRATION TIMES

DAILY
Once : 10.00 (morning)/22.00 (night) Twice : 10.00 , 14.00 Three times : 10.00 , 14.00, 18.00 Four times : 10.00, 14.00, 18.00, 22.00

EVERY
12-hourly 8-hourly 6-hourly 4-hourly : 10.00, 22.00 : 06.00, 14.00, 22.00 : 06.00, 12.00, 18.00, 24.00 : 06.00, 10.00, 14.00, 18.00. 22.00, 02.00

TIMING OF MEDICATION
BASED ON :
* CHEMICAL PROPERTIES OF DRUGS * PHYSIOLOGICAL PROPERTIES OF GASTROINTESTINAL TRACT

POSSIBLE INTERACTIONS :
1. DRUG AGAINST DRUG 2. DRUG AGAINST GASTROINTESTINAL CHYME 3. DRUG AGAINST GASTROINTESTINAL PHYSIOLOGY

THE CONSEQUENCES :
1. DRUG : reaction occurs --> impaired absorption; breakdown of drug 2. GASTROINTESTINAL TRACT : drug irritation, impaired motility, delayed gastric emptying, reduced absorption.
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OVERCOME

1. DETERMINATION OF APPROPRIATE TIMING IN DRUG ADMINISTRATION 2. MANAGING THE PRIORITY ORDER OF DRUGS. 3. CHOOSING THE APPROPRIATE TYPES DRUG

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TIMING OF MEDICATION
IN THE MORNING : * Steroid * Diureticum * Antihypertension
* Laxative Bisacodyl tablet * Suppositoria * Vaginal tablets * Hypnotics * Cimetidine * Anticholesterolemia

IN THE NIGHT : * Contraceptive pills DURING DAILY ACTIVITIES DURING MEAL With meal : - promptly after meal - During Meal Empty Stomach : 1 hour before meal 2 hours after meal

DURING EPISODE * Pectoral angine drugs * Drugs for migraine-cephalgy * Antiasthmatic drugs
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DRUGS & PHYSIOLOGY OF GIT

Factors affecting drug

1. Chemical properties 2. Gastric pH 3. GI tract motility

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ANTICHOLINERGIC DRUGS reduce : * Secretion * Intestinal peristaltic These drugs should be taken one hour before meal BELLADONA ALKALOID GROUP : Tinct.Belladona Atropin extr. Belladona Hormotropin Scopolamin Oxypheninium Methylscopolamine Mepenzolate Butylscopolamine Bevonium QUATERNARY COMPOUNDS Clidinium Propanteline

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DRUGS AND FOODS

1. Drugs interferred by gastric chyme
ANTIMICROBES : Ampicillin Amoxicillin Erythromycin Lincomycin Oxytetracycline Penicilline G/V Tetracycline Isoniazide Rifampicin
OTHERS : Levodopa Penicillinamine Propanteline Paracetamol

All these drugs should better be taken during "empty stomach"

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2. DRUGS THAT SYNCHRONIZED WITH CHYME (FOOD)

ANTIMICROBES :
Doxycycline Doxycycline hyclate Erthromycin ethylsuccinate Griseofulvin Nitrofurantoin

OTHERS :
Hydralazine Hydrochlortiazide Propanolol Metroprolol Reserpine

The above mentioned drugs should be taken "with meals"

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3. STOMACH-IRRITATING DRUGS
Aminophylline Chlorpromazine Metronidazole Nitrofurantoin

Acetyl salicilic acid

Codein Phenylbutazon

Prednisone
Reserpine Mephenamic acid

Ferrosulphate
Hydrocortison Indomethacine Isoniazide

Pirazolone

1. The possibility not to be taken by patients with gastritis 2. Some are administered in contained stomach or excessive water drinking 3. Some are in favour given with milk 16

INTERACTIONS BETWEEN DRUGS

DRUGS THAT INTERACT WITH ANTACIDS IN STOMACH :
ANTBIOTICS : Amoxicillin Ampicillin Cloxacillin Nitrofurantoin Oxytetracycline Penicillin V Sulphonamide Tetracycline OTHERS : Acetylsalicilic acid Digitalis Dicumarol Phenotiazine Ferrous preparation Isoniazid Chlordiazepoxide Levodopa Indomethacine Propanolol

EXAMPLE OF MEDICATION TIMING OF THE INTERACTIVE DRUGS R/ Ampicillin 500 mg cap No. XV S 3. dd.cap.I (1) hac 1 hour before meal R/ Antacid tab No.XX S3.dd.tab.I (1) hpc 1 hour after meal

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MEDICATION TECHNIQUE

DRUG

DOSAGE FORMS ROUTE OF ADMINISTRATION SPECIFIC- DRUG MEDICATION PARENTERAL DRUG MEDICATION

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METHOD OF MEDICATION
TERMS :
* Oral * Peroral (per os) * Sublingual * Parenteral * Intravenous * Intraarterial * Intracardiac * Intraspinal/intrathecal * Intraosseous * Intraarticular

SITES :
Mouth GI tract system via mouth Under the tongue Other sites than GI tract (by injection) into vena into artery into the heart into spine into bone into joint

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Intrasynovial Intracoutaneous or intradermal Subcutaneous Intramuscular

Synovial fluid cavity into skin under skin into muscle

Epicutaneous (Topical) Transdermal Conjunctival Intraoccular Intranasal Aural Intrarespiratory

Skin surface Skin surface Conjunctiva Eye globe Nose Ear Lung

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THE USAGE OF DOSAGE FORMS

Sublingual tablet

trochition and lozenges

Parenteral

solution, suspension

Epicutaneous/Transdermal intment, cream, paste, powder, aerosol, lotion, and transdermal, disc, and solution

attachment

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THE USAGE OF DOSAGE FORMS

Conjunctival ointment

Intraoccular/intraaural
Intranasal Intrarespiratory

solution, suspension
solution, spray, inhalant, ointment aerosol

Rectal
Vaginal

solution, ointment, suppositoria

solution, ointment, emulsified foam, tablet, insert, suppositoria, sponge solution, suppositoria

Urethral

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DRUGS THAT ARE USED SPECIFICALLY

1. SUBLINGUAL TABLET For cardiac diseases : angina / asthma (nitroglycerin, isoprenalin)

2. CHEWING TABLET Drugs for gastritis

3. LOZENGES Mouth freshener (anti inflammation)

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MULTI-LAYER TABLET
Tablets that are destroyed in intestine Tablet :

* Unchewed but powdered

* Without milk, alkaline drinks, or antacid

DRUGS THAT NEED EXCESSIVE DRINK (200-300 ml)

* Sulfa group * Metronidazol

* Erythromycin
* Amoxicillin * Aspirin
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DRUGS THAT ARE WITHOUT EXCESSIVE DRINK

Antigastritis drug/antacid suspension

DRUGS THAT ARE TAKEN WITHOUT MILK

Vitamin C+ Ferrous Antienteretis Enteric coated tablet Tetracycline

PEDIATRIC DRUG ADMINISTRATION Tablet powder/pulveres dissolved into :

Honey Sugar water Jelly Corn oil

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THE APPLICATION OF OPTHALMIC OINTMENT / EYE DROP 1. The hand holds the ointment after washed first to be clean 2. Open the tube's cap then discard the first 1/4 inch length of the ointment, because this portion is often dry. 3. With one finger, press downward the lower lid meanwhile the patient is staring upward 4. Press and rub the eye ointment as long as 1/4 - 1/2 inch onto the inner side of the lid without touching it nor eye globe.

5. Close the eye and rotate the eye globe in all direction (possibly the vision will become slightly blurred ).
6. Cap the tube immediately without touching the tips of cap nor tube. 26

1. Cough out the sputum as much as possible. Aerosol is shaked before use 2. Place it as the recommendation of the manufacterer. It is usually set upside down. 3. Place the oral edge of tube inside the mouth, face upward by moving head posteriorly. 4. Breath out slowly, empty the lung volume as much as possible. 5. Press the tube content in order to spray meanwhile immediately inhalate it deeply with tounge position remains still below. 6. Hold the breath within 10 - 15 seconds. 7. Then, expire the air through nares. 27

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INHALANT MEDICATION
1. Cough out the sputum as much as possible. 2. Place the capsule into the inhaler container as the manufacturer's recommendation 3. Breath out slowly, empty the lung volume as much as

possible.
4. Place the oral tip of tube inside the mouth. 5. Face upward by moving head posteriorly.

6. Breth in deeply through inhaler

7. Hold the breath for 10 -15 seconds 8. Exhale the breath through nares.
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NASAL DROP
1. Sit with your head facing upward, or pad your shoulder with a pillow under. 2. Insert the tip of dropper asdeep as 1cm into the nares.

3. Drip some drops of the drugs as recommended.

4. Nod downward your head so that the head is over the knee. 5. Sit up repetitively for several times so that drop can enter the pharynx. the

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NASAL SPRAY
Nod down the head slightly. The other nose is closed by pressing the nares with your finger. The sprayer is inserted into the opened nares by pressing the vial, so that its content will be out and inhalte gently, then do the same as the abovementioned.
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EAR DROP
The best is the head in slanting position Gently the

upper part of the ear lobe is slightly attracted upward (in adult) and the middle one in children in order to let the opening is seen clearly. minutes before doing the same into another one.

Drip some ear drops and wait for approximately 5

In some products, it is recommended to close the

ear opening with cotton ball.

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SUPPOSITORIA
Suppositoria is prepared to be out of the container. When it

is too flaccid, it would better be cooled first, whereas if it is too hard, heat it by placing it inside your fist.
Lay down with slanting position and one of the lower

extremities is abducted to the abdomen.

Insert

gently the suppositoria into the anal opening meanwhile it is rotated foreward with one of your hands. Keep lying for several minutes.

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INTRAVAGINAL MEDICATION
In general, intravaginal medication is limited to the localized application for which ointments or tablets are available to insert into vagina and usually by the time of going to bed, such as metronidazole and primaricin for vaginitis caused by trichomonas and candida. The drugs may be used in the form of swabbing liquid, others in the forms of spermaticide (to kill spermatocyte), foam tablet,and cream.

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SKIN DRUGS
THE TOPICAL DRUGS USED FOR SKIN IN GENERAL

INCLUDE :
1. 2.

WATTER (SOLUTION) ALCOHOL (TINCTURE)

3.
4. 5.

POWDER
WET POWDER (SHAKED POWDER) CREAM

6.
7.

PASTE
OINTMENT
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LOCATION

Back and chest Genitalia Scalp Hand and arm Skin fold Lower extremities Face

All types Powder, watered powder, cream solution. Powder, watered powder, cream solution. Water (solution), alcohol, cream. Powder, water solution, alcohol, ointment, wet powder, paste, cream. Watered powder (solution), alcohol, ointment, wet powder, cream. All types except for eye skin.

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THE CHOOSING OF DRUGS IS ON THE BASIS OF THE SKIN DISORDERS, THUS THE WET CONDITION OF THE SKIN WHILE DISORDERS THE DRY SKIN NEEDS USES

APPLICATION OF WET PREPARATION, SEMISOLID PREPARATION.

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Vesicles, edema, erythrema Crust, itching infection Water (solution) - wet compression Powder, lotion, sprays Cream (o/w) Cream (w/o) and and ointment

Desquamation, erythrematous, itching, drying

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Parenteral medication can be undertaken : 1. By injection with syringe 2. Through infusion liquid (more than 10 ml volume)

THE ADVANTAGES OF PARENTERAL MEDICATION : 1. The drug action can be reached rapidly, strong, and complete 2. No irritation or not destroyed by gastric acid 3. Can be administered to the patients with unconsciousness or swallowing unability
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ADVANTAGES
1. In general, it is expensive and impractical

2. Easy to contaminate
3. Able to damage blood vessel, tissue, and nerve 4. The administration methods should be adjusted, because of being slow and rapid

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CONCLUSIVELY, PARENTERAL MEDICATION ARE BASED ON 2 MAIN CONSIDERATIONS :

1. Expectation of rapid drug action
2. the required drugs are in the form of parenteral dosage forms

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INTRAVENOUS ADMINISTRATION IS ONE OF THE MOST IMPORTANT CLINICAL TREATMENT COMPARED TO THE OTHER PARENTERAL ADMINISTRATIONS, BECAUSE :

1. Injected directly toward the blood vessel

2. Rapid and immediate onset 3. Inversely, giving danger such as anaphylactic shock or severe anaphylactic reactions.

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INTRAVENOUS ADMINISTRATION NEEDS THE SKILLFULNESS, GREAT ATTENTION, AND PRECATIOUSLY WITH ANTISEPTIC TECHNIQUES AND ALSO NEED CLOSE MONITORING OF DRUG ACTION. Physicians judge the decision of intravenous medication based on as follows : 1. whenever other routes of administration are considere impossible whereas the terapy management must be implemented promptly. For example : * Methicillin in stomach will be broken down by acid, whereas via intramuscular method is impossible because of large volume required, then the chosen appropriate method is intraveous route. * The multiple drug medication in large volume is impossible to give intramuscularly regarding to giving rise painfulness; similarly, subcutaneous method will result in wider inflammation. * In very irritative drug by intramuscular and subcutaneous method, it can be diluted into infussion.
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In the specific clinical settings, the rapid administration is required for patients with serious condition.

In patients with high tendency to be hemorrhagic (thrombocytopenia or hemophilia and anticoagulant administration), intramuscular and subcutaneous medication will cause formation of hematoma which is painful and extensive or bleeding.
For supplementary nutrition, in patients with GI disturbances, peroral intake is not adequate, and so does patient with gastrointestinal post-operative condition.
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* Patients with vomiting and nausea at certain level, such as severe hyperemesis gravidarum, unconsciousness, or swallowing unability.
Beside intravenous drugs and liquid administration, it is also important to give blood or bloodcomp[onen in certain cases.

INTRODUCTION TO INJECTION DRUGS

Injection drug is a sterilized preparation in the forms of : 1. Liquid, consisting of : Solution, the active ingredient disolves in it and the available packaging is in ampule or vial. Suspension, unsoluble active ingredient, is suspended thoroughly in the suspension using suspension agent. Emulsion, the liquid containing the mixture of water and oil. 2. Dry Powder, including : Soluble Ingredient, mixed with solvent before use, this ingredient is not long-standing that breaks down in the solution. Insoluble Ingredient, mixed with liquid when it will be used, because it is not long-standing in solution, but broken down.

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DELAYING THE DRUG ABSORPTION INTO THE BLOOD VESSELS, IN THE REASON TO LENGTHEN THE DRUG ACTION, SUSPENSION OR SOLUTION IN BEAN OIL OR SESAME OIL IS FREQUENTLY USED, FOR EXAMPLES, PENICILLIN AND SEXUAL HORMONE SUSPENSION, GIVEN INTRAMUSCULARLY.

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THE CONTAINER OF INJECTION DRUGS

1. AMPULES It is made from glass or plastics with various sizes, from 1 ml (adrenalin) up to 10 ml (aminophyline) generally for once usage.

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THE PREPARATION TO USE :

With clean hands, align the fine wound line on the ampule neck, then using alcohol cotton clean it and break it ; if the ampule head is made from plastics, rotate the ampule head untill it is separated completely.

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2. VIAL
It is made from glass with rubber cap fixed with film metal surrounding the bottle lip, generally can be used repetitively. The filling of drug solution into syringe is as follows : Solution : Suck the air as much as needed Make the vial rubber clean using sterilized alcohol cotton Prick the syringe into the vial while the upsidedown position of the vial . Press the air into the vial then directly pump-in the solution as much as needed, the needle should be always in the solution border. Make the syringe free from air and clean it, wash the hands.
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HYPODERMIC EQUIPMENTS
SYRINGE is an equipment to get water or solution into the body or body cavities. HYPODERMIC SYRINGE is syringe to use for subcutanous, intramuscular, and intravenous methods. It is a sucking type and characterized by the main components including a metal piston and a tube made from glass with various sizes. 1. Tuberculin syringe : small size with capacity no more than 1 ml . 0.1 - 0.001 ml. Hypodermic Syringe : Larger size with capacity 2 - 50 ml.

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DISPOSABLE SYRINGE :
Made from plastics with larger size than Tuberculin syringe (5 ml) for once use only, packed with steril state and separated needle.
In general, it is used the administration of antibiotics,antihistamine,heparin, tranquilizer, vitamin, etc.

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HYPODERMIC NEEDLES
This needle typically is made from stainless steel, hyperchromed steel, carbon steel, chromium, platinum, silver or gold. The form of hypodermic needles based on :
1. Length 2. Thickness needle 3. Sectioning: sharp-angle sectioned needle

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LONG, SHARP-ANGLED OR LONG THICK NEEDLES ARE USED FOR INJECTION, LOCAL ANESTHESIA, SUCKING,

HYPODERMOLYSIS AND SUBCUTANEOUS INJECTION.

Figure: Short-sectioned needle Long-sectioned needle

Short, sharp- angled needles are used for injections : intravenous, infusion, and transfusion, whereas the special short, sharp-angled needles are used for intradermal and spinal injections.
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NEEDLE SIZE
The choosing of needle size on the basis of 1. Safety 2. Flow volume 3. Patient's convenience 4. Penetration depth

The unit of needle size is GAUGE referring to the outer diameter of canula or needle shaft. In general the size is 1 - 27 gauge, with the length not less than 1/4 inch and more than 3.5 inches. For several biopsies and spinal tranfusion, the needles are 16 - 19 gauge in size and 0.5 - 3.5 inches in length For local anesthesia, the needles are from 26 gauge with 1/2 inch to 20 gauge with ? inches. For intravenous transfusion, the needles are from 19 gauge with 1.25 inches to 15 gauge with 2.5 inches.
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THERE ARE UTILITIES :

ALSO

MANY

OTHER

1. Caudal needle 2. Epidural needle 3. Intravenously anesthetic needle 4. Blood transfusion needle 5. Spinal needle 6. Biopsy needle 7. Cerebral angiographic needle

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ROUTES OF ADMINISTRATION IN INJECTION DRUGS

1. INTRADERMAL OR INTRACUTANEOUS Dosage form : Solution and Suspension Volume Purpose Equipments : 100- 200 I.U per I.C : Tuberculine Test and Immunization : Disposable syringe with small, short size needle, Desinfected cottons

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ROUTES OF ADMINISTRATION IN INJECTION DRUGS

2. SUBCUTANEOUS OR HYPODERMAL INJECTION Dosage form : Solution or oil Volume : No more than 2 ml The injection under skin should be conducted with non-irritant drugs which are soluble either in water or oil, but the effect is not as rapid as IM or IV method. It is easy to do by patients themselves, such as insulin administration.

3. In BCG administration for infants, injection via dermal and subcutaneous methods may develop lymphadenitis.

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THIS METHOD IS ALSO USED IN THE ADMINISTRATION OF HEPARIN AND

EPINEPHRINE SUSPENSIONS.
Skin has poor blood vasculature, thereby the drugs that will be absorbed by blood vessels and the nonsoluble drugs diffuse into lymphatic vessels.

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INJECTION TECHNIQUES
1. Wash the hands thoroughly 2. Localize the injection site on the lateral surface of upper arm, anterior surface of thigh or abdominal region. 3. Clean the skin area with desinfectant 4. Pinch the skin as thick as the skin itself 5. Prick the needle into the skin on the base of skinfold with the angle of 20 - 30 degrees 6. The pinch is then released 7. Re-suck the syringe to ascertain that it did not prick the blood vessel (if there is blood in it, repeat the procedure) 8. Inject the drug slowly and gradually within 0.5 - 2 minutes; if too quick, possibly edema or collapse of blood vessel develops 9. The needle is immediately removed, cover the injection site with adhesive plaster. 10. Observe the patient condition; attention should be given that 74 the repeated injection may appear overdosis.

3. INTRAMUSCULAR INJECTION
Dosage form oil : Solution, suspension in water or

Volume : No more than 4 ml In injection into muscles, the soluble drug resorption will last within 10 - 30 minutes. The adventages : Easy, safer, good tolerated, rapid resorption, and rarely develops necrosis. For very irritative drugs, this intramuscular method is preferred than subcutanous method.

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INJECTION PROCEDURE
Localize the muscle to choose: Ventro Gluteal : thicker, no main nerve fibers and blood vessels. Choose the upper lateral quadrant, in Medial Gluteal, take attention on ischiadic nerves and Superior Gluteal Artery.And patient position should be facing laterally, facing downward, or standing.

It is not performed to infants and young children.

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VASTUS LATERALIS
Middle aspect of thigh : very poor nerve fibers and blood vasculature.

Position : supine, or sitting Volume : 2.5 - 3 ml

Deltoid muscle : Easy, with position of facing laterally, sitting, or standing, needs attention that the area is very limited and the existance of large bone, bood vessels, and nerve fibers. Drug volume : 1. no more than 2 ml. 2. Wash hands thoroughly 3. Make the patient ensure and explain the procedure 4. Rub desinfectant on the skin 5. Ask the patient to let the muscles relaxed, because if the muscle is in contraction will the drug liquid flow into the surrounding tissue leading to irritation and pain sensation.

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Drug volume :
6. Shoot the needle in perpendicular position (90 degrees) to the skin surface 7. Re-suck to ensure if it shot blood vessel (if it did so, repeat the procedure from point 4, or replace with new syringe, if any) 8. Inject the drug by pressing the pump slowly and gradually to diminish pain sensation 9. Remove the needle quickly 10. The injection site is press using the other hand with sterilized cotton, fix it with plaster 11. Observe the patient's reaction, necessarily keep the patient calm 12. Clean the hands and used equipments

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4. INTRAVENOUS DRUG ADMINISTRATION

Materials : Syringe filled with air-free drug liquid, Needle of 20 gauge, long and moderate thickness Desinfectant Cotton, plasters, and tourniquette

Injection Procedure : 1. Wash the hands thiroughly 2. Ensure the patient and explain what will be done 3. Localize the injection site, choose forearm slightly lower from cubital fossa. The vein lies more superficially and is not covered and easy to ligate. 4. The patient is asked to be relaxed with fisting the related hand. 5. Tourniquette is set up, then see the vein to be swollen while giving desinfectant on to the skin area.
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4. INTRAVENOUS DRUG ADMINISTRATION

Injection Procedure : 6. Vein is stabilized by replacing the pressing hand to the skin in line with the vein longitudinal axis, using the other hand. 7. Direct cardially the needle to vein with 35 degree of angle, shoot the needle slowly into 3-5 mm depth of vein 8. Do aspiration, if there is blood inside the syringe, it means that the needle has aimed to the vein, instead, try again. 9. Tourniqette then is removed 10. Inject the drug slowly, observe the pain sensation, swelling or hematoma; if the needle is still in vein, try to suck again. 11. The needle then should be removed immediately while the injection site is press with cotton and subsequently cover it with plaster. 12. Observe the patient's reaction, meanwhile wash your hands and clean the used equipments
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INTRAVENOUS ADMINISTRATION OF FLUID

Intravenous fluids refers to fluid that is administered intravenously in large amount through infusion.
It is estimated that about 40% of the drug administration at hospitals were conducted by injection and it is likely increasing recently.

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THE CONTAINER OF INFUSION FLUID

1. It is made from glass, consisting of 2 types based on the difference in air ventilation : a. Air ventilation is outside of the bottle, at the tip of infusion set through filter at a bottle spike. b. Air ventilation through the tube in the bottle, the tube opening is able to be passed through.

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2. THE CONTAINER IS MADE FROM FELXIBLE PLASTICS POLYVINYL CHLORIDE OR SEMIRIGID POLYOLIVIN.

The supporting equipments for infusion administration are infusion set that is to move the fluid into blood vein. It should meet the requisites of being sterilized, free-pirogen, and disposable Though it is produced by a variety of manufacturers, the main components and parts are the same, including : 1. Spike as the breaker against rubber seal in the spike hole. 2. Drip chamber

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THE PURPOSE OF INTRAVENOUS FLUID ADMINSTRATION IN SOME CLINICAL SETTINGS IS : To correct the imbalanced body fluid (as replacement) To correct the imbalanced body electrolytes To provide basic nutritional elements Voluminous parenteral hyperalimentation that overwhelming the normal nutrition As the carrier of other drug adminstration

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NAME 1. AminoAcids (synthetic) Aminosyn Veinamine Dextrose (Glucose,D5/W) Dextrose&NaCl Lactate's Ringer (Harmann) NaCl KCl CaCl2 Na Lactate Protein (hydrolized) Aminosol CPH-5 Ringer's NaCl KCl CaCl2 Natrium Lactate

CONCENTRATION 5.5-&% 8% 2.5 - 50% 5-20% NaCl 0.11 - 1.9% 0.60% 0.03% 0.02% 0.30 5% casein&fibrin

PURPOSE

Fluid &nutrition

2.
3.

Fluid & Nutrition

Nutrition & Electrolytes Systemic alkalizer & nutrient supplement

4.

5.

6.

Fluid & nutrient supplement

0.86%
0.03% 0.033% 1/6M
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7.

Fluid & nutrient supplement

THE INTERMITTEN ADMINISTRATION OF ANTIBIOTICS AND OTHERS

Such medication may be performed by one of the three following methods : A. Directly Intravenous Injection : volume of 1 - 5 ml within 1 - 5 minutes. Or inject the injector of the hanging infusion bottle into the injection site. This method is appropriate for limited amount of drug and the drug which endanger if given in multiple method. B. Volume Control Method : it refers to the infusion adminstration with accurate dosage in expected flow through volume control set consisting of a calibrated plastic chamber below the main infusion bottle which is frequently along with free liquid administration.

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THE PROCEDURE OF INTERMITTENT ADMINISTRATION OF INTRAVENOUS LIQUID WITH VOLUME CONTROL SET
1. Using aseptic technique, the spike of VC set is inserted into the main infusion bottle or separated bottle. 2. The tube line is emptied from air by opening the upper clamp so that the liquid flows. 3. Open the clamp over the calibrated chamber to let 25 50 ml of liquid enter into it from the bottle. 4. Close the upper clamp. 5. Inject the drug through the connecting hole in therubber cap of the VC set. 6. Re-open the upper clamp to let the flow up to 50 - 150 ml, then close it. 7. Open the lower clamp to make liquid flows
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The administration of this infusion drip is related to the second liquid. Through venipuncture, the drug flow will be regulated in one intravenous system.
This administration give rise the following advantages : 1. PB technique can avoid unnecessarily other venipuncture. 2. The drug solvability is achieved immediately in short time, usually within 30 - 60 minutes. 3. The drug solution that can relieve irritation and obtain high serum level rapidly is an important consideration for therapy such as serious infection,especially in antibiotic administration.
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THE EQUIPMENTS FOR THIS METHOD CONSIST OF INFUSION BOTTLES, INCLUDING A MAIN BOTTLE AND A MINI BOTTLE PEGGY BACK OF 250 ML, AND INFUSION SET. THE MINI PEGGY BACKBOTTLE USUALLY CONTAINS ANTIBIOTICS, WHILST MAIN BOTTLE IS SIMILAR TO THE CLASSICAL INFUSION SET WITH A RUBBER Y - SHAPE CHANNEL APPARATUS BELOW THE CLAMP OF THE MAIN BOTTLE. THE SECOND BOTTLE IS ALSO PROVIDED WITH THE REGULATORY CLAMP, WHILE THE OTHER HAS NOT CLAMP BUT A TAP IN THE Y-SHAPE CHANNEL APPARATUS TO REGULATE THE FLOW BY OPENING AND SHUTTING AUTOMATICALLY DEPENDING ON LIQUID PRESSURE. THIS BOTTLE IS HANGED OVER THE MAIN BOTTLE.
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TO RESERVE AIR AND CONTROL THE NUMBER OF DRIPPING, THE BOTTLES ARE CONNECTED TO THE DRIP CHAMBER WITH A CLAMP, FURTHER THE CHAMBER CONNECTED TO THE TIP OF NEEDLE THROUGH 1.5 - 3 M OF TUBE LINE. BELOW THE DRIP CHAMBER, A CLAMP REGULATES THE EXPECTED DROPS. THE PROCEDURES OF PREPARATION AND ADMINISTRATION OF INTRAVENOUS LIQUID

1. 2.

Prick the spike into the rubber bottle cap of the infusion set. Hang the infusion bottles on a stand by the patient's bed, then eject the air in the tube line by flowing the first liquid drop out, regulated by the clamp. 3. Shoot the needle into vein (aseptically, see the previousmentioned intravenous injection procedure), conducted by physician or nurse 4. Loosen the clamp gently to flow the liquid till the expected number of drops by observing the drip in the drip chamber. Generally, this medication lasts within 4 - 8 hours with the volume of 125 ml/hour. 5. The concomitant drugs given along with this infusion are : Dopamin, Lidocaine, Insulin,and Heparin. In the administration of potent drugs, the speed of dripping depends on the patient's clinical condition. The drip volume depends on the manufacturer's recommendation, ranged: 10, 15, 20, 50, and 60 drops/ml.
In another setting, sterilized solid drug is administered through rubber hole in VC set and dissolved with 50 - 150 ml main or reserved solution.
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