Medication Administration

Administering medications occurs through multiple routes of entry. A list of some of the routes of entry include:

• by way of the mouth (swallowed, through a tube into the stomach, under the tongue, held in the cheek),
• through injection into the muscle (intramuscularly),
• into the fat layer (subcutaneously),
• rectally (suppository, enema),
• into the eye (eye drops),
• into the nose (nose drops, sprays, inhaled),
• by vein (intravenous, PEG, Porta Cath, Central lines),
• into the spinal cord, into joints,
• as ear drops, skin creams, ointments, emulsions, and even more that don’t come to mind right now. 

Routes are Unique

Medication routes each serve a unique purpose making one more effective than another in delivering medications for different purposes. I provided the information below to highlight the basic differences in routes and explain each method’s essential steps in administration. At the bottom of the page, the videos supplement the information at the top, providing a visual demonstration for your review.

Medication Administration: Oral Medicines

Giving medicine by mouth seems simple enough. We’ve all been taking oral medication since we were babies. So what more is there to know now? Maybe nothing new, but it’s best not to assume anything because doing a task for someone else is always different from doing it for yourself.

Precautions When Giving Medications to Someone Confused

Let’s go over some important points to keep in mind when dealing with someone confused.

• If a care receiver is confused, they may not trust you. Watch for signs that they are trying to hide their medication somewhere around them.
• Hiding medication under the tongue is a common trick. If you suspect your family may be hoarding medication rather than swallowing it, you might need to use a flashlight and a tongue depressor to check inside their mouth to look for pills. Use a tongue depressor or popsicle stick to move the tongue around and not your hand so you won’t get bitten.
• If you leave medicine beside the bed for them to take when you go, check later to make sure they took it. You may find it in the trash, under a pillow, or in other places.
• If they are responsible for remembering to give them their medication, use a weekly/daily dispenser as a reminder and crosscheck to help them (and you) know if they took the dose at the correct time.

Choking Risks

• If pill size presents a choking risk, try cutting the tablets in half (you can buy pill cutters) or get an order for the medication to change to a suspension form instead.
• Do not cut enteric-coated and time-released (extended released) medications. These medications need to make it to the intestine before they come apart due to irritating the stomach. If you are uncertain about cutting a medication, check with your pharmacist or look it up on the internet.
• In addition to cutting tablets in half, you can also crush them and mix them with food or beverages that your family member likes to eat or drink. However, some medications taste very bitter, and crushing them makes them difficult to tolerate.

Accurate Measurements

• When measuring a liquid medicine, pour it at eye level and read the dose at the bottom of the liquid bubble that forms on top. When finished, set the medicine cup on a solid surface to ensure the measurement is accurate when you read it.

Don’t Administer Through a Tube

• If you are giving medicine through a GI tube, don’t put anything through the tube labeled as “enteric-coated,” “time-released,” or “extended-released.”  Also, ask your doctor to change all medications to suspensions or liquids formats. Anything that does not come in that form, crust to a fine powder.
• Use a mortar and pestle type of device to ground the tables (you can order them for less than $20 if you don’t have one) or you can wrap the pills in aluminum foil and carefully tap them with a hammer or roll them with a rolling pin; whatever you have handy, as long as it crushes them well enough not to clog the tube.
• Flush the tube thoroughly with saline or water afterward to prevent clogging from any leftover powder.

How Often Do I Need To Check Tube Placement?

Check Placement

Check tube placement before giving any medications. If your family member is not receiving medication through their tube, a twice a day placement check using a saline flush works to keep it open.

Two Ways to Check Placement

Method One

Attach a large syringe to the tube’s end and pull back any contents into the tubing. If what you pull back looks like formula or clear liquids, you probably are pulling back stomach contents confirming that the tube is in the correct place.

Method Two

Measure the distance from the end of the tube to the stoma (opening going into the stomach) or nose. Is it still the same length as when first inserted? Of course, this method requires that you know the actual distance between the stoma and the farthest end. If it is the same distance as the last measurement and was in the stomach before, you’re still likely in the same place. If you don’t feel confident that you placed your tube correctly, do not give the medication or feed. Call your doctor.

Steps for Giving Medicine Through G or J Tube

1. Gather supplies
2. Insert Extension Tubing
3. Clamp Tubing
4. Draw up Medication
5. Unclamp Tubing
6. Inject Medicine
7. Clamp Tubing
8. Draw Up Water for Flush and attach it to port
9. Unclamp Tube
10. Inject Flush
11. Clamp Tubing and Disconnect Extension Tube

Steps to Giving Sublingual (Under the Tongue)

Nitroglycerin

Nitroglycerin given under the tongue for someone having chest pain may relieve their symptoms and prevent a heart attack.

1. Place the tablet or spray the medicine under their tongue.
2. Do not let them eat or drink anything after taking medicine.
3. Monitor blood pressure and chest pain while waiting.
4. If the chest pain has not stopped, you may repeat the dose in five minutes and call the doctor.
5. Repeat the dose a third time in five minutes if the pain continues.
6. Keep the doctor informed throughout of your family member’s response.

YouTube Video Demonstrations of Medication Administration Techniques

How to Split A Pill in Half    

This video presents information on how to split a medicine into equal parts.

Crushing Medications for a Tube Feeding or to Give Orally 

This video demonstrates grinding medication and then mixing them for delivery.

Do Not Crush Medication Mnemonic 

The nurse who produced the video developed a mnemonic to remember when not to crush pills. The mnemonic is “Seniors Erroneously Crush Enteric-Coated Laxatives.” The mnemonic goes as follows:  Seniors (Sustained Released), Erroneously (Extended Released), Crush (Controlled Released), Enteric-Coated (Enteric-Coasted), Laxatives (Long-Acting).

How to Take Eye Drops

This video shows the proper way to take drops and gives two simple methods for people who can’t bring themselves to put anything into their own eyes.

Giving a Nebulizer Treatment

Nebulizers deliver medications that help you to breathe. A nebulizer is a motor that pumps air through a tube and comes up through the medicine to form a mist. The mist is breathed in through a mouthpiece, mask, or tee adapter. Following each treatment, clean the supplies with soap and water to prevent infection. The video provides additional information regarding infection control and troubleshooting equipment issues.

How to Apply and Remove a Transdermal Patch

This video reviews the impact and cautions associated with Fentanyl use. Caution must be applied whenever you work with transdermal patches (i.e., patches impregnated with medication). You take precautions because the drug affects whoever touches it the same way. Therefore, you must be particularly careful when placing it on the patient. Even when removing it, you need to carefully remove it using gloves.

Giving Medicines through a G-Tube or J-Tube

Children’s Hospital of Wisconsin’s Gastroenterology, Liver, and Nutrition Program staff show and discuss how to give medicines through a G-tube.

Important Reminders:

1. If you are giving more than one medication at a time, use about 10 ml of water between each medicine to flush the line clear to help prevent clotting.
2. Always finish up with a flush to clear the line to prevent help prevent clotting.
3. If you have difficulty getting the medication to flow with gravity, you may try milking the tubing gently with your fingers by squeezing the tube downward.

How Often Do I need to Check Tube Placement?

Guidelines on checking placement on a nasogastric tube before starting a tube feeding.

Withdrawing Medications from an Ampule

Medications occasionally come in ampules. First, open the ampule by snapping it in half after wiping the neck with alcohol and wrapping it in gauze. Then, withdraw the medicine from the ampule using a filter needle to prevent any shards of glass from cutting anyone.

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Steps to Opening an Ampule

1. Inspect the bottle for any cracks, chips, or breaks
2. Clean the neck of the bottle with alcohol
3. Wrap gauze around the neck and break off the top of the ampule
4. Attach the filter straw to the syringe
5. Draw up the medication

How to Read a Syringe

This video explains how to read measurements on the side of syringes to accurately give the correct medication dose.

How to Give a Subcutaneous Injection Using a Prefilled Syringe

Many medications now come pre-filled. You need to remove them from the refrigerator and attach a needle before giving them.

1. Before giving an injection, plan to take the medication out of the refrigerator about 30 minutes before giving it to prevent the person from feeling the cold medicine as much.

On the other hand, cold medicine can sometimes act as a numbing agent. Therefore, if you have a shot causing pain, you might try leaving it in the frig until the last minute.

1. You can use milk cartons as needle disposal units. However, since blood and body fluids may be attached to used needles disposing of them in regular trash is prohibited. Instead, place all used syringes into a hazardous waste container (obtain Hazardous Waste containers from a pharmacy). Follow the instructions in your area to be sure you know how to dispose of them correctly).

Intramuscular (IM) Injection Sites

The appropriate place for intramuscular injection for those under age two is the vastus lateralis muscle (the thigh muscle). The preferred area for persons three years of age and older is the deltoid muscle over the triceps area of the upper arm. Giving injections in the buttocks is no longer recommended. However, using the upper thigh is still an option in adults, the same as in children, and you may use the upper outer hip area. Safe injection practices minimize the risk of injuries, infections, and non-infectious adverse events for both patients and providers.

IM Injections in the Deltoid Muscle using Z Track Technique

Z track technique is now the recommended technique for all IM injections. A Z-track means that you pull the skin to the side and then inject at a 90-degree angle. When you release the skin’s surface, the track creates a zig-zag type.

When you give a Z track injection, push the medication in slowly (about 10 sec/ml at a time) and then wait another 10 seconds before withdrawing the needle. This delay allows the absorption of the medicine into the muscle so that it won’t irritate the subcutaneous tissue when withdrawing the needle. Do not massage the muscle or aspirate to check for potential vein access (per the recommendation of the Center for Disease Control).

How to Give an IM Injection in the Buttocks

IM (intramuscular) injection site (dorsogluteal muscle). Hip injection technique administration of the dorsogluteal muscle, also known as a butt muscle or hip muscle for injection. Update 2018: Due to recent research, the CDC No longer recommends the dorsogluteal site as a potential site for intramuscular injection for nurses. WHY? The site is very close to essential structures such as the sciatic nerve and blood vessels. Also, a large amount of fatty tissue resides at this site, increasing the risk of a subcutaneous injection rather than an intramuscular injection. Therefore, avoid this IM injection site.

How to Give an IM Injection in the Ventrogluteal (buttock) muscle

A video tutorial on how to give an intramuscular injection in the ventrogluteal butt muscle. (closer to the hip). Produced in 2014. In 2017 the CDC announced new guidelines stating not to aspiration before giving an injection.

The reason:

1. Aspiration causes unnecessary pain during the administration process.
2. The research did not support a need to check for blood when using the correct size needle because needles do not insert deep enough to reach blood vessels.
3. The only exception to the new guideline occurs when administering a highly toxic medication likely to cause harm if accidentally inserted into a blood vessel.

Administration of Buccal Midazolam for Seizure Control via the Cheek

Midazolam is a medication used to stop seizures. If you have an order to use this medication, remember to stay in contact with the physician if the need arises to use it.

Steps to Use Midazolam

• Open the medication
• Turn your family member on their side if you can, or at least turn their head to the side.
• Allow the medicine to drip into the inside of their mouth between the cheek and teeth one drip/second. Do not squeeze the medication into the mouth.
• Monitor breathing continuously and open the airway further if breathing becomes shallow.
• A seizure may continue for a while after giving the medicine. Notify the doctor if one dose does not stop the seizure.

Sublingual Nitroglycerin

1. Place the tablet or spray the medicine under their tongue.
2. Do not let them eat or drink anything after taking medicine.
3. Monitor blood pressure and chest pain while waiting.
4. If the chest pain has not stopped, you may repeat the dose in five minutes (remember to call the doctor).
5. Repeat the dose a third time in five minutes if the pain continues.
6. Keep the doctor informed throughout of your family member’s response.

Fear of Needles: Nursing Tips for Patients with Needle Phobia

As a caregiver, you may need to give injections to someone who has a phobia of needles. Needle phobia (called belonephobia, aichmophobia, or trypanophobia) can come in different intensity levels. This video provides some pointers in helping you approach someone who fears needles.