Administer therapy - Assisting a family member

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Assisting a family member

Assisting a family member

Administer therapy

Routes of administration Intravenous therapy
  • Routes of administration
    • Some considerations on oral administration
    • Cutaneous way
    • Ophthalmic way
    • Otological pathway
    • Considerations for otological administration
    • Nasal way
    • Rectal way
    • Intramuscular route
    • Considerations for intramuscular administration
    • Intramuscular injection technique
    • Subcutaneous route
    • Considerations for subcutaneous administration
    • Intradermal route
    • Some considerations
  • Intravenous therapy

The administration of therapy is, due to its complexity, one of the most crucial aspects of assistance. A drug is a substance capable of generating particular effects, reproducible in the laboratory (in vitro) and on living organisms (in vivo). Although they have beneficial properties (therapeutic effect), these substances can have few to many undesirable effects, some completely benign, others potentially fatal.

A drug can have many names, but it contains the same pharmaceutical molecule. Currently, both commercially available drugs and drugs that only have the name of the molecule that makes them up (the so-called equivalent drugs) are available on the market.

The drugs exist in different preparations: aerosols, capsules, powder, creams, syrup and so on. Each formulation requires precautions and knowledge on the most correct way to administer it: the table on the following page provides a summary of the main types of preparation available on the market.

When you have a patient at home, it can happen that you have to give drugs; in general, the most frequently used route is the oral one, but in some cases the medicines may have to be administered by different routes. In the domestic environment, the risk of error is limited, since the patient to be followed is generally only one, but in order to reduce even the minimum margin, it is necessary to ensure that certain rules are strictly followed: see, in this regard, the box "The 6 G rule", in the following pages, where the letter "G" implies the word "right". This rule can help in making the management of medicines at home safer because it summarizes and outlines the six aspects to be kept under control before administration.

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Routes of administration

Each drug must be administered according to precise principles and following the right path.

The main routes of administration are summarized in the table on the left, while at the top right, for convenience and completeness, you will find a list of the main abbreviations used both on medical recipes and on the information sheets that accompany the drugs, the so-called burgiardini.

Orally

The most common route of administration is certainly the oral one: the drugs are introduced into the mouth and swallowed. It is a very practical way, common to a large quantity of medicines, which does not cause trauma to the oral cavity although it can, in some cases, lead to irregular absorption or cause gastric disturbances. The oral medications also include those to be dissolved under the tongue (sublingually), which is used when you want a faster effect, since the bloodstream in this area transports the medicinal substances more quickly . Finally, some types of tablet should be dissolved in the mouth, as per the method of intake specified on the recipe, placing them in contact with the inside of the cheek.

Before proceeding with the administration of oral medications, it is essential to evaluate whether the patient is able to swallow; if the patient does not suffer from difficulty in swallowing (in technical terms: dysphagia), it is possible to administer the therapies by mouth without danger.

For the little ones, taking the drugs often causes "little tragedies": the advice is, when it is possible to help them choose the type of formulation they like best: the powder, the syrup and so on.

Formulations for children are usually packaged with sweeteners: it is important to observe strict oral hygiene to avoid the appearance of caries. If the drug is in the form of tablets, you can chop them and add them to honey or jam.

Older people should be given medications with attention to their state of consciousness, possible neurological diseases, visual disturbances and so on.

Before proceeding with the administration it is recommended to always check the prescription, after which proceed as follows.

  • Wash your hands.
  • Check that the drug is the right one.
  • Take medicine.
  • Check the dosage.
  • If the subject has difficulty swallowing, finely chop the tablets, transfer them to a small glass and add a little water.

If the drugs to be administered are liquid, proceed as follows.

  • Shake the bottle well with the drug.
  • Place the cap on a clean surface, with the external part in contact with the surface and the internal wall facing upwards.
  • If you need to fill a measuring cup, bring the bottle to eye level and fill the measuring cup to the height corresponding to the prescription.
  • Even if they are drops, they must be poured in the same way, keeping the glass at eye level.
  • Finally, clean the edge of the package with a cloth to prevent the product from dripping onto the sides of the bottle.

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Some considerations on oral administration

  • A patient with nausea may have difficulty taking oral medications.
  • Check or ask your doctor or nurse if medications should be taken before, during or after meals; many times the drugs are taken between meals.
  • Some medicines must not be taken with particular foods (for example, it is wrong to associate milk and tetracyclines).
  • Do not take drugs that block the absorption of others: this is the case for antacids that have the ability to cancel the absorption of almost all molecules.
  • Carefully check the color of the drugs in liquid form: if they are cloudy, do not hesitate to throw them away and replace them with others that have not expired.
  • Do not leave drugs in areas accessible to children or to people with cognitive disorders (dementia).
  • If you are unsure of the dosage, ask your doctor or nurse for clarification.
  • When administering drugs to people who cannot take them on their own, the fact of performing the same routine every day can be confusing and it may happen not to remember if the drug has been administered: it would be useful and safe to divide the daily doses into a plastic container with special compartments (provided that the drug does not damage the light).
  • Not all tablets can be chopped, some formulations are designed for a controlled release over time.
  • Do not administer drugs while lying down to avoid aspiration and suffocation.
  • The cold causes desensitization of the papillae present on the tongue, so let some ice suck before giving unpleasant drugs, especially if it is a question of children; to avoid choking with ice in younger children, it is possible to suck an ice lolly with the stick, which the adult will hold out of the mouth.
  • If equivalent drugs are used, it is good not to change the pharmaceutical companies too much: each company packs them in different forms and in an elderly person this can cause uncertainties!
  • If the subject has a tendency not to want to take the medicines, it is preferable to wait until they have swallowed them and, for safety, check the oral cavity.
  • Many drugs have safety caps for children: these useful devices can create many difficulties in opening, especially in the elderly or those with muscle weakness. If there are no children in the house, it is better to replace them with simpler ones (ask at the pharmacy).
  • Never stop drug treatment without consulting a doctor about it.
  • Prepare a sheet on which to write down the drugs to be taken during the day, with large and clearly legible characters; colors can also be used to make reading easier.

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Cutaneous way

Drugs intended for cutaneous use are also called topical drugs.

Dermatological preparations such as creams, ointments, pastes, powders and sprays are applied directly to the skin and can be used in the treatment of itching, to hydrate, disinfect and soften the skin, to release drugs, to protect delicate areas and so on.

The main products available on the market are:

  • transdermal patches;
  • ointments, creams, pastes, lotions, tinctures, gels;
  • suspensions;
  • foams;
  • powders.

Each product must be applied following particular rules and indications. Transdermal patches have the ability to release drugs directly through the skin and usually contain substances for lowering pressure, nicotine, nitroglycerin, hormones or analgesics. They have a round, square or oval shape and consist of a membrane and an adhesive. Their effectiveness can range from 12 hours per week, depending on the molecule, after which they must be replaced. The areas of the body on which to apply the patch, which must be hairless (i.e. hairless) are generally the lower back, the buttocks, the back and the shoulder; areas subject to movement (for example, the forearm) and those in which inflammations, wounds or abrasions are to be avoided. To apply a transdermal patch proceed as follows.

  • Discard the patch.
  • Choose a clean and hairless area of ​​the body.
  • Lift and remove the protective film without touching the drug.
  • Apply the patch by pressing it for 10 seconds.
  • Avoid applying hot water bags or heat sources in general to the patch, as they increase the absorption of the drug.
  • Some patches also have a patch cover: be careful not to apply only the latter.
  • It may happen that the glue causes allergies at the contact site, while a redness that occurs immediately after removal but regresses within half an hour is absolutely normal.

The administration of creams, ointments, pastes and the like is carried out, however, as described below.

  • Wash your hands.
  • Ask the subject to take a comfortable position and find out the part to be treated.
  • Use a wooden tongue depressor (to be discarded after each single use) to spread the medicine, whether it is in cream or ointment form.
  • Even the pasta must be spread with the tongue depressor. The consistency of the pastes is greater than the creams or ointments.
  • The suspensions must be applied (after careful mixing) with gauze on the part to be treated.
  • The powders are applied on the interested parts and, if necessary, the area is covered with a secondary dressing.

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Ophthalmic way

Medicines for ophthalmic use are generally packaged in drops or in ointment. The packs are small and, once opened, must be consumed within a pre-established period of time, generally within a few days.

The instillation of eye drops is not a painful maneuver, while the ointments can slightly disturb the vision (fogging).

Young children need to have another person hold their hands to prevent injury from attempting to remove the operator's hands. Use gloves if the patient has an infectious conjunctivitis. The application procedure proceeds as follows.

  • Place the person in a comfortable position, which can be lying down or semi-sitting.
  • Before applying the drops, clean the eye with a sterile gauze soaked in saline, from the inner corner to the outer corner.
  • Check the accuracy of the drug and the dose, and ask the patient to fix a spot on the ceiling.
  • Pull the lower eyelid down by placing your hand on the bone just below the eye.
  • Instill the drops on the outside of the eye.
  • Do not touch the eye with the dropper.

After application, it is necessary that the subject, or whoever provides assistance, keep the inner part of the eye (nasolacrimal duct) pressed for about 30 seconds with gauze to prevent the solution from escaping.

If, on the other hand, the drug to be applied is an ointment, proceed as follows.

  • Lower the lower eyelid.
  • Apply the ointment from the inside out.
  • Ask the person to gently close their eye.

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Otological pathway

The administration of drugs inside the ear is carried out for several purposes: to dissolve a plug of earwax, to treat otitis or inflammation.

The ear canal has an "S" shape and, in order to correctly instill the drugs, it is necessary to perform a maneuver that allows the canal to become temporarily straight.

  • Wash your hands.
  • Ask the patient to stand on his side, helping him in this, if he cannot do it alone.
  • Wear gloves if an infection is suspected.
  • Take some cotton paper sticks and clean the ear externally: do not go deep, especially if the patient is unable to communicate the pain or if he is agitated.
  • The drops are usually contained in small packs: warm the jar in your hands before applying the drug.
  • Pull the auricle back and up to straighten the canal.
  • Pour in the necessary number of drops.
  • Allow the patient to remain on his side for a few minutes so that the drug can penetrate well.
  • Apply a cotton ball in the ear, but only in the most external part of the ear canal, without pushing it deeply.

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Considerations for otological administration

  • When administering a drug to a child under three years of age, the pavilion must be pulled down and back because the canal is facing up.
  • After applying the drops, squeeze the area under the ear for a few seconds near the lower lobe: this maneuver allows a better diffusion of the drug.

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Nasal way

Some medications are prescribed to treat particular areas called nasal sinuses. The nasal sinuses are four pairs and include: frontal sinuses, maxillary sinuses, sphenoid sinuses and ethmoid sinuses.

They can be reached quite easily by making the patient assume the supine position with the head tilted backwards, which then must be adequately positioned according to the pair of breasts to be reached.

For the treatment of the frontal and maxillary sinuses, proceed as follows.

  • The patient must be in a supine position and recline the head so that it is lower than the shoulders. This is the so-called Proetz position.
  • Turn the head towards the side to be treated, which thus assumes the so-called Parkinson position.
  • Prepare the drug.
  • Apply the prescribed number of drops without touching the nostrils; pour the drug on the lateral portion of the nostril.
  • Have the person hold the position for about five minutes.
  • If necessary, repeat the application in the other nostril, keeping the position.

For the treatment of ethmoid and sphenoid sinuses, proceed as follows.

  • The patient must be in a supine position and recline the head so that it is lower than the shoulders.
  • Prepare the drug.
  • Apply the required amount of medication without touching the nostrils; pour the drops on the lateral portion of the nostril.
  • Hold for about five minutes.
  • If it is necessary to repeat the application in the other nostril, keeping the position.

There are also commercially available nasal sprays with or without propellants. The former come out thanks to the gases, while the latter have a manual delivery system. They are administered by inserting a special spout in the nostril, taking care to keep the head straight, and then inhaling deeply while the liquid comes out. Administration is repeated in both nostrils.

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Rectal way

The administration of rectal drugs is a very common practice, both for the application of suppositories and for the drug-based microclisters. The rectal route is often preferred to avoid interfering with the gastric mucosa or when it is impossible to use the oral route.

The distribution of drugs by this route is good, as there are many capillaries in the rectum which effectively transport drugs; naturally, it is necessary that there are no feces present in the last part of the intestine, which would disturb the good diffusion of the medicinal principles.

The application of suppositories is easily carried out as follows.

  • Wash your hands.
  • Wear disposable gloves.
  • Place the patient in a left lateral position with the right leg flexed.
  • Before applying the suppository, lubricate the tip with petroleum jelly or with appropriate ointments based on glycerin and anesthetic.
  • Also lubricate the index.
  • Ask the subject to breathe with his mouth open in order to reduce the tension of the last part of the intestine (anal sphincter).
  • The suppository must be inserted gradually by inserting the rounded part first.
  • Insert the gloved finger for a few centimeters and then gently pull it out.
  • Keep the buttocks closed for a few seconds to prevent accidental suppository leakage.
  • Have the patient hold the lateral position for about 5 minutes.
  • Remove the glove and discard it in a plastic bag.

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Intramuscular route

The administration of drugs intramuscularly has always been the task of nurses, even if in past years this practice was carried out by many more or less trained people.

This method, although relatively simple, still requires a minimum of knowledge and a little practice: whenever possible, intramuscular injection must be performed by a nurse or doctor, but you can also find yourself in the conditions in which neither neither are available and therefore it is necessary to know how to move independently.

To perform a puncture in a muscle you need:

  • syringe;
  • disinfectant;
  • cotton wool;
  • drug;
  • container for disposal.

On the market there are syringes for subcutaneous or intramuscular administration also available in the disposable packaged version, with or without a needle.

The syringe used for the intramuscular route in general has a variable capacity, from 2.5 to 5 cc, and is composed of a cylinder, a plunger and the tip where the needle is inserted.

The needles are very important, which must be chosen according to the use to be made of them. The diameter of a needle is calculated in gauge: the smaller the number and the larger the diameter (18-28 Ø). The choice of the needle is fundamental and must be examined whenever drugs with different consistencies are to be administered: a drug that tends to crystallize or an oily solution will require a larger diameter than a more aqueous and liquid solution.

In principle, 20-22 gauge needles are used to perform an intramuscular puncture.

The administration of intramuscular drugs can also be a source of danger for those who give the injection. Accidental punctures with needles already used are a very important problem in the hospital setting, but even at home it is possible to inadvertently prick yourself with the needle previously used. Therefore, it is good to be careful even if you administer a drug to a person you know, a relative, husband or wife.

Some pharmacological preparations are found ready for use in pre-filled syringes, while other drugs are packaged in ampoules in liquid form or with the powder to be combined with a solvent.

The vial is made of glass, with a cylindrical body and a more restricted area which makes it possible to open it. They are used only once, as they are disposable.

In correspondence with the restricted part, the vials have a dot on which to apply pressure to proceed with opening. They can contain from 1 to 10 ml of pharmacological substance or water for injections.

The bottles are small containers that have a stopper and a pierceable membrane through which to inject the liquid to reconstitute the preparation (reconstitution of the solution), or they contain only the liquid drug. Reconstitution liquids are often absolutely harmless substances, such as sterile water or physiological solution; at other times they contain anesthetic to make the sting less painful and can be dangerous if injected directly into the veins.

The technique of opening the containers and aspirating the liquids contained in them takes place as follows.

  • Wash your hands.
  • Withdraw the vial, being careful to free the tip, with small taps of the fingers, from the liquid that always settles there.
  • To avoid cutting your fingers, wrap a sterile gauze around the tip of the vial, then pulling the tip towards you.
  • If you have the appropriate sharps container, discard the tip of the vial.
  • Take the syringe and open it, remove the needle and replace it with another small one (23 G): in this way, the aspiration of glass fragments is avoided.
  • Draw up the drug with the syringe, being careful not to touch the outside of the container.
  • Discard the 23G needle and apply the required needle: the syringe is now ready.

When a drug has to be reconstituted, i.e. adding the solvent to the powder (solute), the procedure varies slightly and proceeds as described below.

  • Wash your hands.
  • Take the medicine.
  • Open the bottle and disinfect the rubber membrane with a gauze pad and soaked in a special disinfectant (chlorhexidine in alcohol, for a contact time of 30 seconds).
  • Aspirate the liquid and remove excess air.
  • Insert the needle into the bottle and inject all the liquid.
  • Remove needle and syringe and place the cap on the needle so that it is not exposed to air and does not touch any surface.
  • Take the bottle and, with circular movements, make sure that the drug has reconstituted (do not shake the bottle to avoid foaming).
  • Read on the packaging of the drug how many milliliters (cc = ml) each vial contains and draw the same quantity of air into the syringe.
  • Verify that the needle is properly inserted in the syringe.
  • Insert the needle into the bottle and introduce the air: this makes it easier to aspirate the liquid.
  • Aspirate the drug by inverting the bottle and keeping the tip of the needle below the liquid level.
  • Remove the needle and apply the cap so as not to compromise sterility.
  • Remove excess air by pushing the plunger upwards with the cap inserted; you can lightly hit the syringe barrel with your fingers to facilitate the removal of small bubbles.
  • Replace the needle with one of the appropriate size (22 G), without touching the tip of the syringe with your hands. The syringe is now ready.

Some drugs can create foam and gas inside the bottle when they are reconstituted: in this case, it is not necessary to add air to the bottle before aspirating them; usually there are indications on the packaging.

There are also filter needles on the market equipped with a system that does not allow large particles to pass from the bottle to the syringe. These are safety systems adopted in particular for the administration of intravenous drugs; however, these devices can hinder the passage of reconstituted drugs and before using them it is preferable to ask the doctor or nurse. Even a small needle avoids the passage of particles.

Finally, there are oily drugs that are fatigue-aspirated and injected with equal difficulty: in this case needles with a larger caliber (18 G) are used.

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Considerations for intramuscular administration

  • If you have to puncture children, it is best to seek medical attention.
  • The elderly may have a reduced muscle mass: evaluate before proceeding with the puncture.
  • Some types of drugs, in particular an antibiotic drug called diaminocillin, when reconstituted produce microcrystals that can clog the needle and, if introduced into the vein, produce serious damage (embolisms): before proceeding, ask for advice.
  • On the market there are drugs packaged with two needles: one for reconstitution and the other for puncture (read the data sheet carefully).
  • If scars of previous operations on the bones are found near the muscle (for example, hip prosthesis), do not inject at that location: any infection caused by the puncture could spread deep and infect the prosthesis.

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Intramuscular injection technique

Performing an intramuscular injection cannot disregard some basic rules. First you need to choose:

  • the appropriate location;
  • the type of syringe;
  • the needle.

For an adult person, the amount of drug to be injected into a large muscle (buttock) should not exceed 5 ml. The choice of the needle must be calibrated according to the type of muscle to be treated and the size of the muscle masses. As already mentioned, 2.5 and 5 cc syringes are almost always used.

The needle to be used is almost always standard in pre-packaged syringes (20-21 G, length 40 mm).

There are numerous sites where intramuscular puncture can be performed, but only two will be considered: the deltoid and gluteal areas. The deltoid area (i.e. the shoulder site) requires the use of smaller needles (23-25 ​​G, length 25 mm); the gluteal area (i.e. the seat of the buttocks) requires the use of standard needles.

The deltoid site should be used for 1 ml drugs and is usually the site of choice for the administration of vaccines. It is important to precisely locate the site to be pricked in order to avoid injuring the nerve: by placing a hand over the shoulder it is possible to identify the bone: the first finger is on the muscle attachment and the fourth in the injection site.

In this area, an imaginary triangle is created with the base facing upwards, which is the seat of the puncture. Before giving the injection, the muscle must be pulled towards you in order to make the puncture less annoying. The gluteal site is the area where the punctures are made most frequently.

The exact point where to give the injection should be identified by palpating the iliac spine and drawing an imaginary line that starts from the iliac bone and reaches the hip prominence of the hip (trochanter). This portion excludes risky parts such as the sciatic nerve.

After locating the precise point, puncture must be performed in the upper area.

The correct position to be taken by the patient is that of the stomach (prone) or sideways with the knee slightly flexed to promote muscle relaxation.

Take the drug and follow the instructions above for preparation and aspiration, then proceed as follows.

  • Wash your hands.
  • Choose the appropriate site based on the drug to be administered.
  • With palpation, locate the iliac spine or deltoid.
  • Check that locally there are no inflammatory processes, swelling, cysts or dermatitis: in this case, do not puncture at that point and prefer another area.
  • If the punctures are to be done daily, alternate the seats.
  • Disinfect the skin with a cotton swab and chlorhexidine disinfectant in alcohol, following a spiral path that goes outwards from the center.
  • Leave to dry completely (otherwise it will cause intense burning).
  • Take the syringe and remove the cap without touching the needle.

Some drugs must not come into contact with the subcutaneous tissue, as they could be harmful and / or cause pain, so it is good to use the so-called Z technique to perform the puncture. The execution of a puncture with the Z technique takes place as follows.

  • With the hand that does not perform the puncture (not dominant), stretch the skin laterally for about 2 centimeters.
  • Warning: if the muscle is small, it is preferable to squeeze it between the fingers in order to lift it and avoid touching the bone with the needle.
  • Grasp the syringe between your fingers, as if holding a large marker, pierce the skin quickly so that the needle forms a 90 ° angle with the skin.
  • The faster the needle is introduced, the less pain it will cause.
  • With the non-dominant hand, keep the syringe stationary, while with the dominant one pull the plunger back so as to perform an aspiration. This maneuver is intended to check whether the needle was accidentally introduced into a blood vessel.
  • The aspiration must last at least 5-10 seconds. If the needle tip was accidentally inserted into a capillary and blood flows, it is essential to remove everything and prepare the solution from the beginning.
  • If the drug is injected into a vein, the greatest danger may arise from the harmfulness of the medicine spread directly into the bloodstream. The anesthetic that is added to the solutions to decrease the painful reaction can trigger changes in the heart rhythm if administered directly into a vein.
  • If the aspiration maneuver is negative, the drug can be injected. The rate of administration must be constant, approximately ten seconds for each ml.
  • At the end of the injection quickly remove the needle and release the previously tightened skin: this prevents the drug from leaking out.
  • Apply a cotton swab soaked in disinfectant to the injection area.
  • Do not massage the site where the puncture was performed.
  • Properly discard the needle.

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Subcutaneous route

In the domestic environment, it often happens that you have to perform a puncture in the subcutaneous tissue: one of the most common cases is that of substances often prescribed after surgery to keep the blood more fluid (heparin).

The continuous increase in diabetic subjects has also made the administration of insulin into the subcutaneous tissue an increasingly widespread practice, which is often taught to the patients or relatives who take care of them at home.

The most frequent places to practice subcutaneous puncture are:

  • the deltoidea site;
  • the abdominal seat;
  • the femoral seat;
  • the scapular site.

Subcutaneous injection involves the administration of small quantities of the drug, between 0.5 and 1 ml maximum. The syringe is usually 2 ml and is generally of the ready-made type, with the drug inside (low molecular weight heparins). The needles are smaller in size (10-16 mm) than intramuscular and the diameter also varies (23-25 ​​G). The insertion of the needle into the subcutaneous tissue occurs at an angle of about 90 ° with respect to the skin.

Insulin syringes are created to meet specific requirements: a few years ago, each ml contained 40 units of insulin, currently the syringes are calibrated to contain 100 international units (IU) per ml.

For diabetic patients there are also special insulin administrators, called pens, which contain a 3 ml disposable ampoule to be replaced once it is used up. The pens are:

  • multipurpose / disposable, if you replace the needle with each administration and the pens only once the drug has finished;
  • multipurpose / reusable, if the needle is replaced at each administration and the internal cartridge when it is exhausted, but the "frame" of the pen is preserved.

The pens are comfortable in that they promote autonomy, do not require aspiration of the drug (since this is already ready) and are devices that can be easily used by everyone.

The location where the drugs are administered can change their absorption: the deltoid has a different availability compared to the abdomen and when you need to supply some drugs it is good to take them into account.

If you have to administer drugs in a chronic way, it is essential to choose the rotation seats to avoid damaging the subcutaneous tissue.

The use of very short needles avoids accidentally inserting the tip into the intramuscular tissue and inadvertently piercing a blood capillary.

The procedure for giving a subcutaneous injection is carried out as described below.

  • Wash your hands.
  • Choose the appropriate site based on the drug to be administered.
  • Verify that locally there are no inflammatory processes, swellings, cysts or dermatitis; in this case, do not puncture at that point and prefer another area.
  • If punctures are to be done daily, alternate the seats.
  • Rub the skin with a cotton swab and disinfectant based on alcohol at 90 ° or chlorhexidine in alcohol, following a spiral path that gradually goes outwards from the center.
  • Leave to dry completely (otherwise it will cause intense burning).
  • Take the syringe and remove the cap without touching the needle.
  • With the non-dominant hand, pinch and lift a skin fold.
  • Pull the skin outwards to lift it (this maneuver is particularly important when the subjects are thin).
  • In case of excessive thinness, in addition to pinching the skin and pulling it outwards, it is advisable to bend the needle at 45 ° with respect to the skin.
  • With your dominant hand, quickly insert the needle.
  • Still with the dominant hand, pull back on the plunger if the syringe is equipped with it.
  • If blood does not flow, proceed slowly to administer the drug.
  • Always keep the skin fold raised throughout the operation.
  • At the end of the puncture, remove the needle and apply a swab soaked in disinfectant.
  • Do not massage: drugs subcutaneously are designed for slow absorption and if you speed up the intake you can create problems (for example, hypoglycemia in diabetics).
  • Dispose of the syringe in appropriate rigid containers.
  • Do not puncture near the navel but stay at least four fingers apart: in this area, the subcutaneous tissue is very small.

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Considerations for subcutaneous administration

  • After heparin administration, small hematomas can form on the skin near the injection site, which disappear on their own within a few days.
  • The heparin pre-filled syringes are ready for use: inside the cylinder they contain the drug and a small amount of air that must not be eliminated; the syringe should be used as it is.
  • If you are using multipurpose / disposable insulin pens, before performing the administration it is recommended to hold the pen with the needle upwards, load some units and then push the plunger in order to eliminate the air: in otherwise, air is administered instead of insulin! This rule also applies to multipurpose / reusable pens.

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Intradermal route

The administration of the drugs intradermally occurs by injecting a small amount of the drug (about 0.1 ml) into the space between the epidermis and the dermis.

This type of administration is rarely carried out at home: in principle, intradermal punctures are used to check if allergies are present or to test some toxins and read the immune response a few days later.

Almost always the preferred way for injection is the internal portion of the forearm, but sometimes it is practiced in the back, more precisely in the subscapular portion.

The technique is simple and the description is provided for informational purposes only, as at home there are hardly ever any injections in the intradermal site, unlike what happens for injections in the subcutaneous site of more frequent execution even by a relative or a non-healthcare professional.

After washing the hands, the exact location is identified and then disinfection is carried out with the specific substance (chlorhexidine in alcohol).

When the disinfectant is dry, the needle is inserted in the area previously described.

This puncture causes a "bubble" clearly visible to the naked eye which in medical jargon is called ponfo.

The syringe is introduced at an angle almost parallel to the skin and the drug is injected slowly. After the puncture, a patch is usually applied and the site is not massaged.

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Some considerations

  • After the appearance of the whelk, remember not to touch and scratch the seat.
  • Many times, after the administration of particular drugs, a hard nodule is formed with a large reddened area around the injection point.

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