PARENTERAL ROUTE

-intradermal, subcutaneous, intramuscular, and

intravenous
• LIPODYSTROPHY (atrophy or
hypertrophy of subcutaneous
fat tissue), abscess, necrosis,
skin sloughing, nerve injuries,
prolonged pain, and periostitis.

• Intradermal (ID) Method

- or intracutaneous injection
means that the injection is
made into the upper layers of
the skin almost parallel to the
skin surface
Subcutaneous (SC)
Method

- Small amounts of drug

in solution are given
subcutaneously (beneath
the layers of skin, yet
above the muscle),
usually by means of a 25-
gauge (or thinner) needle
and syringe.
• The angle of insertion should Disposable syringes and
usually be 45 to 60 degrees (but needles contribute to aseptic
can vary between 30 and 90 safety of the procedure but
degrees), depending on needle
also to cost and problems of
length and depth of fat pads.
Insertion should be made on the
storage and disposal.
fat pads of the abdomen, the
outer surface of the upper arm, Care should be exercised to
the anterior surface of the
avoid contamination and to
thigh, or occasionally the lower
rotate sites. SC injections are
abdominal surface (when
heparin is ordered). In these not effective in individuals with
locations there are fewer large sluggish peripheral circulation
blood vessels, and sensation is (e.g., the patient in shock)
less keen.
INTRAMUSCULAR (IM) METHOD
-Deeper injections are made into muscular tissue, through the skin and
subcutaneous tissue, when a drug is too irritating to be given
subcutaneously, although irritation may also occur with some drugs given
intramuscularly

-A drug may be given intramuscularly in an aqueous solution, an aqueous

suspension, or a solution or suspension of oil (Synthol oil, also known as
site enhancement oil (SEO) or synthol injection - injected into muscles to
increase their size)

-Criteria for selection of a safe IM injection site include distance from

large, vulnerable nerves, bones, and blood vessels and from bruised,
scarred, or swollen previous injection or infusion sites.
SITES FOR INTRAMUSCULAR
DORSOGLUTEAL SITE (the muscle underneath is the gluteus medius) by
asking the patient to lie facedown and exposing the entire area so that the
landmarks and the injection site can be clearly located. The proper site for
this injection is outlined by an imaginary diagonal line drawn from the area
of the greater trochanter of the femur to the posterior iliac spine. The
injection should be given at any point between that imaginary straight line
and below the curve of the iliac crest

VENTROGLUTEAL SITE can be made accessible with the patient lying in a

supine or side-lying position. This site is used for IM injections in either
children or adults and could be used more often. To locate it on the left
side, the technologist should palpate for the left greater trochanter with
the right palm, point the right index finger to the anterior superior iliac
spine, and extend the middle finger toward the iliac crest. The injection
should be made into the center of the V formed between the index and
middle fingers
 VASTUS LATERALIS is a muscular area in the upper outer leg. The
potential area for injection is a long rectangular area just lateral to the
frontal plane of the thigh. Its top boundary is found about one
handsbreadth below the greater trochanter, and the bottom boundary is
about one handsbreadth above the knee

MID-DELTOID AREA is the muscular area in the arm formed by the

rectangle bounded on the top by the edge of the shoulder and on the
bottom by the beginning of the axilla
- -Considerably higher blood flow than the other IM injection

- NOTE:
- For the IM injection, the needle and syringe assembly is held as if it
were a dart while the other hand stretches the skin of the injection site
taut. If the muscle mass underlying the injection site is inadequate to
Intravenous (IV) Method
-Direct injection into a vein (intravenously) is
warranted when “immediate” effects of a drug or
fluid are desired. Most emergency drugs, sterile
saline and dextrose solutions (dehydration),
chemotherapy drugs, and radiopaque contrast
media (ROCM; imaging examinations) are
introduced through the IV route

Intravenous injection sites.

- -The most common IV injection sites are the
basilic or cephalic veins on the back of the
hand, the basilic vein on the medial, anterior
forearm and elbow or the cephalic vein on the
lateral, anterior forearm and elbow
- -The anterior recess of the elbow where these
veins are located is often referred to as the
antecubital space.
Intravenous equipment. The
winged-tip or butterfly set is
the most common IV needle
used by imaging technologists
for the introduction of contrast.
These needles vary from 1⁄4 to
11⁄4 inches in length and 18 to
27 gauge in diameter. Most
have 6 to 12 inches of tubing
attached, extending from the
needle to the syringe hub.
 NOTE: THE
SMALLER THE
NUMBER OF
NEEDLE , THE
BIGGER THE
BEVELED TIP
The following sequence should be used when performing VENIPUNCTURE:
1. Wash your hands thoroughly.

2. Introduce yourself and thoroughly check the patient’s identification.

3. Explain the procedure. Make sure the patient understands. Obtain feedback

4. Prepare the drug and all required supplies for administration.

5. Put on disposable gloves.

6. Determine the most appropriate site for venipuncture, and cleanse it with an
alcohol swab using a circular motion while moving from the injection site outward.
Cleansing a second time may be warranted.
7. Apply a tourniquet 3 to 4 inches above the site of injection. The patient
may open and clench the fist to make the veins more identifiable.

8. To stabilize the vein and to keep it from rolling, place your thumb
directly below the injection site and gently pull the skin toward the fingers
of the patient

9. Hold the needle with the bevel facing upward. If using a butterfly set,
pinching the wings together assists in stability.

10. Insert the needle at a 15- to 20-degree angle through the skin. Gently
advance it into the vein. You will feel a subtle “pop” as the needle enters
the vein, and you should see a backflow of blood into the tubing.
11. Release the tourniquet and inject the drug. Taping the
needle in place during injection will keep it from dislodging.

12. Remove the needle quickly, and apply gentle pressure to

the injection site with an alcohol swab.

13. Dispose of the syringe and needle in a labeled “sharps”

container.

14. Chart all pertinent information.

NOTE : During and after venipuncture, it is important to
watch carefully for drug and blood leakage into the
tissues surrounding the vein. This infiltration or
extravasation can be very painful and is often quite
serious for the patient.

NOTE: If extravasation does occur, remove the needle

immediately, apply pressure to the injection site, and
apply a warm, moist cloth to relieve
the pain. Important: Do not continue to inject
the drug!
 CHEST TUBES AND LINES
Medical imaging technologists may often come in
contact with patients who have endotracheal tubes,
central venous lines, or pulmonary arterial lines.
Endotracheal Tubes (Intubation)
Endotracheal (ET) tubes are used primarily to assist the patient through
number of respiratory problems. Indications for use of ET tubes include
the following:
● Mechanical ventilation and oxygen delivery necessitated by oxygen
debt (e.g., airway obstruction, shock, poor gas exchange in lungs)
● Concerns about aspiration of stomach contents
● Upper airway obstruction
● Administration of epinephrine during advanced cardiac life support
(ACLS)

The inhaled air must be adequately humidified because the nor- mal
humidifying function of the upper respiratory tract is bypassed.

Inhaled air must also be protected from contamination as much as

possible. Suctioning of secretions through the tube is required because
Central Venous Lines
Central venous (CV) lines, also known as central venous
catheters and venous access devices, are catheters inserted
into a large vein to administer drugs, manage fluid volume,
transfuse and analyze blood, and monitor pressures within the
heart.

CV catheters vary in size and composition and are used in both

short-term and long-term patient care. They are available as
percutaneous catheters (subclavian insertion), totally implanted
access ports (Infusa Port, Port-a-Cath, Mediport), peripherally
inserted central catheters (PICC lines), and externally tunneled
Regardless of the style used, the goal is to position the catheter tip in
a central vein, usually the superior vena cava, 2 to 3 cm above the
right atrial junction. Because of its size, the superior vena cava reacts
less to infusions of caustic IV fluids.

The most common insertion site for CV catheters is the subclavian

vein. Other common sites include the internal jugular and femoral
veins.
Pulmonary Arterial Lines
Pulmonary arterial (PA) lines are commonly called
Swan-Ganz catheters, after their inventors. PA lines are
actually specialized CV lines that incorporate a small
electrode at the distal end used to monitor pulmonary
arterial pressures. PA lines are used to estimate left
ventricular end-diastolic pressure (LVEDP).
Complications and Patient Care

Examples of complications include catheter

dislodgment and occlusions resulting from the
accumulation of blood clots or drug residue.