Overview of Medication Routes of Administration
Medicines can be given in different ways, and the method used is often determined by where the medicine will be administered in the body. Some examples are swallowing a pill (oral) or receiving a shot (intravenous). The choice isn’t just about what is easiest or what the patient is comfortable with, it’s also about how the medicine acts in the body and how fast it works.
It’s very important for healthcare professionals to understand the different ways medicines can be given, and the things to consider with each method. There are many different people involved in giving medicines to patients, including doctors, nurses, and pharmacists, among others.
Anatomy and Physiology of Medication Routes of Administration
Taking medicine by mouth is a common, cost-effective, and convenient method. Usually, your body absorbs the medication in the small intestine. How much of the drug is absorbed across the tiny cells that line your gut affects how much of the medicine makes it into your bloodstream. This process can vary because some drugs are mostly absorbed in the liver before they get to the rest of the body, a phenomenon known as the “first-pass effect”.
A different form of taking medication orally involves placing the drug either directly under the tongue (sublingual) or on the inside of your cheek (buccal). This approach allows the drug to enter your bloodstream via the veins in your mouth, skipping the “first-pass effect” in the liver. The drug gets absorbed quicker when put under the tongue compared to being placed on the cheek because the underneath tissue of the tongue is more permeable.
The rectal route, where you take medication through your rectum, provides another relatively quick and effective way for your body to absorb medications. Like the sublingual and buccal methods, this route also bypasses the first-pass of the liver to an extent, with around half of the drug going directly to the liver after absorption from the rectum.
Another way to take medication is by intravenous injection, which is a common method that lets the drug bypass first digestion by the liver as well. It’s usually easier to inject into veins closer to the skin surface, often in your arms. Less commonly, veins in the lower body, such as on the top part of the foot, are used for injections.
There’s also the option of injecting the drug into your muscles, like your arms or thighs. While the upper area of your buttock was traditionally a common site for injections, injecting in your hip muscle is now recommended owing to fewer risks of injuring arteries and nerves located in the buttock.
Subcutaneous injections, another method, are done in the layer of skin below the outer layer and just above the muscle tissue. These injections have a slower absorption rate because of fewer blood vessels in that area. Common injection sites include your upper arm, stomach, thigh, upper back, or upper buttock area.
Another less common way to take medication is through the arteries which is usually done for certain treatments like angiography, chemotherapy, or treating some types of brain tumors.
Medicine can also be taken through the nasal route by breathing it in, allowing the drug to be absorbed across the lining of your respiratory system and directly into your bloodstream. This method, like the others, bypasses first digestion in the liver.
Medicine can also be delivered through the vagina, a less commonly used route that also bypasses first digestion by the liver and can be an effective method for local and systemic therapy. Drugs can also be delivered through the skin, via methods like ointments, gels, and patches.
For newborns or in some emergency situations, the intraosseous route (into the bone marrow) can be used to administer fluids and medication if other methods are not possible. Currently, there are studies exploring how this method can be used in cases of cardiac arrest occurring outside of the hospital. This route is also used sometimes to administer preventative antibiotics for certain regional surgeries.
Why do People Need Medication Routes of Administration
There are several ways medicines can enter the body, and the path they take can depend on various factors. Each route has pros and cons that your healthcare provider will consider when prescribing your medication.
The oral route is the most common. If you can tolerate this method, you would swallow a pill or liquid. This method is good because it’s easy and most patients don’t mind it. However, some medications might get broken down too soon or not be absorbed well when taken this way. Certain drugs can also irritate the lining of your digestive tract, but special coatings can help with this.
The sublingual and buccal routes involve placing a pill or other form of medication under your tongue or inside your cheek. These methods are used for drugs, like nitroglycerin, that are quickly removed by the liver if swallowed. The medicine is quickly absorbed into your bloodstream through the tissues in your mouth, and this method avoids the first passage through the liver. But, to work, you mustn’t swallow or chew the medicine. Some people also find the taste unappealing.
The rectal route might be used if you can’t take medicine orally due to a problem with your digestive system or toward the end of life. This method can also be used in emergencies, such as seizures, when an intravenous line cannot be placed. It is also useful for infants and the elderly who may not be able to swallow a pill. However, there might be irritation or inflammation of the rectum with this method.
The intravenous route allows the medicine to get directly into your bloodstream. This may be used when a quick response is needed, when precise control of the medication level is needed, or when oral medications aren’t an option. But, it can also cause pain and increases the chance of infection.
The intramuscular route involves injecting medication into a muscle. This can be useful for certain medications that work better this way or if you cannot take the medication orally. However, it can cause some pain, and there is a small chance of complications like bleeding or nerve damage.
The subcutaneous route involves injecting medication beneath your skin. This can work for medications that need to be absorbed quickly or aren’t effectively absorbed in the digestive tract. There might be some pain or irritation at the injection site, and the injection sites must be routinely changed to prevent injury to the tissues.
The intranasal route involves inhaling medicine through your nose. This is used for nasal conditions such as allergies or colds, but also for certain conditions like diabetes insipidus or osteoporosis. The speed at which the drug works can depend on many factors such as how much mucus is in your nose, the condition of your nose’s lining, and your personal blood flow.
When a Person Should Avoid Medication Routes of Administration
Each way we can give medication has its own set of rules about when it shouldn’t be used. The healthcare team has to know these rules. For example, if a patient cannot take oral medication – perhaps they’re confused, or they’re feeling nauseous or vomiting, making it unsafe to swallow medication – then they should not be given medicine by mouth.
Similarly, medicine cannot be delivered rectally (via the anus) to patients who show signs of active rectal bleeding or diarrhea or if they’ve recently had rectal or bowel surgery. The rectal method can exacerbate these issues.
Intramuscular medication, i.e., given through a muscle, should not be used if there’s an ongoing infection or inflammation where the drug would be administered. If the patient has diseases affecting their muscles, or conditions causing thinner-blood or clotting issues – known as thrombocytopenia or coagulopathy, an intramuscular administration can prove risky.
Subcutaneous medication, given just underneath the skin, should be avoided if the site of injection is currently infected or inflamed. If a dose needs to be larger than 1.5 mL in one go, it’s preferable not to use this method. Injections larger than 2 mL can cause side effects, like pain and leakage at the injection site.
Intranasal medication, given through the nose, should not be used in patients with nasal injuries, blockages, foreign objects in the nose, or if there’s too much mucus or bleeding. Similarly, medication that needs to be inhaled should not be used in patients with airflow blockages as it prevents the free flow of the medication.
Equipment used for Medication Routes of Administration
The type of tools we need to give you your medicine depends on how we’re going to give it to you. Giving medicine directly into your body (or parenteral administration) usually requires certain tools. We need clean bandages, a dry cotton swab, gloves that won’t cause allergic reactions, a cleaning solution made of alcohol or chlorhexidine, a band that we tighten around your arm (tourniquet), a thin tube that we insert into a vein (intravenous catheter), a syringe, a saltwater solution to clean the catheter (saline flush), and a bandage.
When we use larger tubes or when you might feel discomfort, such as kids, we may also use a numbing medicine (local anesthetic). If we have to give medicine through the rectum or vagina, we can use a smooth substance (lubricant) to lessen any discomfort or friction.
Who is needed to perform Medication Routes of Administration?
Usually, it only takes one healthcare professional to give out medicines. However, it can be helpful to have an extra pair of hands if the patient finds it tough to stay in the right position, or if the medicine is being given to a child.
Preparing for Medication Routes of Administration
When preparing to give medication, healthcare providers are taught to adhere to the “five rights”. These include: the right patient, the right drug, the right dose, the right site, and the right timing. This means they carefully make sure that the correct patient is getting the right medication, at the correct dose, administered in the proper place, and at the correct time.
Patient understanding is equally important in this process. It’s critical to inform patients about the medication they will be receiving, what it does and how it will be given to them. Also, in some cases, doctors need to get a patient’s permission to perform certain procedures such as inserting a central venous catheter. This is a tube inserted into a large vein in the neck, chest, or groin to give medication or fluids or to collect blood for medical tests.
Lastly, patients should be well prepared before they receive their medication. The area of the body where the drug is given, known as the site of application, should be suitable and indicated for each specific drug. Moreover, the identification tags on the medication are checked to ensure it’s the correct drug, dose, and method of administration which is stated on the label.
How is Medication Routes of Administration performed
If you need to take medicine, there are several ways to do it. These include injections, pills, creams, and breathing in a mist from an inhaler. Let’s talk about the best way to do each of these:
Injections in the vein (Intravenous Route)
If your medicine needs to go directly into your blood, it will be given through a vein. Sometimes, a band is tied tightly around your arm to make the veins bigger and easier to see. This is called a tourniquet. Once the needle is in, this band is removed before the medicine is given. If a bigger needle called a central line or a PICC (peripherally inserted central catheter) line is used, your doctor might use an ultrasound machine to help guide the needle into the right spot.
Injections in the muscle (Intramuscular Route)
Some medications work best when they’re injected into a muscle. The nurse or doctor will make sure the needle goes straight in, not at an angle. They might also press down on your muscle or stretch the skin over it to make the shot less painful. If you’re getting a shot in your butt, they might pull back on the plunger a bit to make sure they didn’t accidentally hit a blood vessel.
Injections under the skin (Subcutaneous Route)
Some medications can be given to you with a small needle just under your skin. This is easy to do, and some people can even learn to do it themselves. The nurse or doctor may suggest that you change the spot where you do the injection each time to avoid any problems, like getting a hard bump under your skin from the medicine. Depending on the kind of needle used, they might put it in at an angle or straight in.
Medication through the rectum (Rectal Route)
Some medications work best when put into your rectum. You’ll probably be asked to lie on your left side with your right knee bent towards your chest. This lets the medicine flow by gravity up into your intestines. A nurse or doctor will gently put the medicine into your rectum with their finger. A lubricant can be used to make this more comfortable. If you’re getting a medicine to help you have a bowel movement, you’ll need to be near a toilet or have a bedpan nearby. You should try to stay in the same position for 5 to 10 minutes after getting the medicine unless you’re told differently.
Medicine in the vagina (Vaginal Route)
Some medications need to be inserted into the vagina. You’ll be asked to lie on your back with your knees bent and feet flat. A nurse or doctor will gently put the medicine into your vagina with their finger. They might use a lubricant to make this more comfortable. The medicine should go about 3 to 4 inches up towards the back wall of the vagina.
Breathing in (Inhaled Route)
Sometimes, medicine is given by being breathed in. If you’re using an inhaler, it’s essential to follow the instructions that came with it. You should usually shake it before using it, inhale through your mouth when you use it, and try to hold your breath for about 5 to 10 seconds after each puff. Remember to clean your inhaler regularly so it doesn’t get too clogged up. A spacer or chamber can also be used to help you take in the medicine and to make sure it doesn’t just end up in your mouth or throat instead of your lungs.
Possible Complications of Medication Routes of Administration
Medical staff need to be aware of the potential problems that can occur with different methods of giving medication. The method where the medicine is given through a needle can cause pain or discomfort, bleeding, bruising, infection, or swelling in the area where the needle went in. There’s also a common issue that can occur when medicine or fluid is given directly into a vein, where the medicine or fluid escapes into nearby tissue. This is usually not a big problem unless the leaked medicine can harm the surrounding tissues. This is called extravasation, which can sometimes cause tissue death. Although getting medicine directly into a vein can allow the medicine to act quickly, it can also cause serious heart or lung effects, so healthcare staff need to watch patients closely.
For injections into muscles, there are risks associated with specific locations. When the muscle in the shoulder is used, there’s a risk of injuring nerves in the area, which can sometimes lead to long-term issues. The usual injection site in the hip area has a higher risk of injuring a major nerve, so a slightly different hip site is preferred. Problems connected with injections just under the skin depend more on the specific medicine. For example, with insulin injections, lumps or dents can develop under the skin over time, which can affect how well the insulin is absorbed. So, using different injection locations is a good idea for patients.
For medicine given through the nose, long-term use of nasal steroids has been linked to a few patients developing holes in the nasal dividing wall. People using nasal decongestants for a long time can develop problem where their nose doesn’t respond well to the decongestant, leading to a stuffy, swollen nose. Problems with inhaled medicines also depend on the specific medicine being used. For instance, inhaled steroids can cause local issues like mouth infections or voice changes, and sometimes cough, throat irritation, and allergic reactions.
What Else Should I Know About Medication Routes of Administration?
Giving medicine is a key part of caring for patients in a variety of healthcare settings. The healthcare team needs to know the distinct features of each method of giving medicine. By knowing when not to use a certain method and potential issues that can occur, they can avoid needless risks to the patient. Also, understanding when to use each method can assist in picking the best way to deliver medicine to the patient.
