Subcutaneous and intradermal administration / Intravenous administration

      • Subcutaneous and intradermal administration
        • Give anywhere there is adequate subcutaneous tissue.
        • Common sites are the lateral aspect of the upper arm, abdomen, and anterior thigh
          • Inject volumes of less than 0.5 ml
          • Use a 1ml syringe with a 26-to-30- gauge needle
          • Insert at a 90° and 45° angle for thin children
      • Intravenous administration
        • Used for giving drugs to children who
          • Have poor absorption as a result of diarrhea, vomiting, or dehydration
          • Need a high serum concentration of a drug
          • Have resistant infections that require parental medication over an extended time
          • Need continuous pain relief
          • Require emergency treatment
        • Intravenous line placement
          • Factors to consider when preparing and administering drugs to infants and children by the IV route include the following:
            • Amount of drug to be administered
            • Minimum dilution of drug and whether child is fluid restricted
            • Type of solution in which drug can be diluted
            • Length of time over which drug can be safely administered
            • Rate limitations of child, vascular system, and infusion equipment
            • Time that this or another drug is to be administered
            • Compatibility of all drugs that child is receiving intravenously
            • Compatibility with infusion fluids
        • Peripheral intermittent infusion device
          • Use a 24-to-22- gauge catheter
          • Use for continuous and intermittent IV medication administration
          • Short-term IV therapy can be completed at home with the assistance of a home health nurse 
        • Central venous access device
          • Short term: 
            • Non-tunneled catheter or peripherally inserted central catheter (PICC) require an x-ray to verify placement prior to use
          • Long term:
            • Tunneled catheter or implanted infusion ports
          • Provide atraumatic care
            • Insert a PICC before multiple peripheral attempts
            • Use a transilluminator to assist in vein location
            • Avoid terminology (a “bee sting” or “stick”)
            • Attach an extension tubing to decrease movement of the catheter
            • Use play therapy
            • Apply lidocaine and prilocaine topical ointment to the site for 60 min prior to attempt
            • Keep equipment out of the site until procedure begins
            • Perform procedure in a treatment room
            • Use a nonpharmacologic therapies
            • Allow guardians to stay if they prefer
            • Use therapeutic holding
            • Avoid using the dominant or sucking hand
            • Cover site with a protective cover that allows visibility of the IV site
            • Swaddle infants
            • Offer nonnutritive sucking to infants before, during, and after the procedure
            • Teach guardians how to properly care for device

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