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Routes of administration of drugs



The choice of the route of administration of drugs depends on the severity of the patient’s condition, the necessary duration of their continuous administration, the nature of the disease, the age of the patient and the manual capabilities of medical personnel.

According to the speed of reaching a peak concentration of drugs in the bloodstream, the following routes of drug administration are distinguished:

¦ intraarterial;

¦ intravenous;

¦ intratracheal;

¦ sublingual (in the muscles of the oral cavity);

¦ intraosseous;

¦ rectal;

¦ intramuscular;

¦ intranasal;

¦ subcutaneous.

The intra-arterial route of administration is used mainly to urgently compensate for the loss of bcc, but because of the complexity of its implementation, as a rule, it is not used at the prehospital stage.

The subcutaneous route of drug administration does not meet the requirement for urgent delivery of drugs to the bloodstream in an emergency.

The intravenous route of administration is most preferable in those situations when, due to the nature of the disease and (or) the severity of the patient's condition, an emergency effect of the drug on any functions of the patient's body is required. If it is necessary to repeatedly administer drugs, carry out infusion therapy, or transport during which therapy will be carried out, the method of choice is peripheral vein (vein) catheterization. If catheterization is not possible, venipuncture is performed. The most affordable veins for staging a peripheral catheter and venipuncture are:

¦ ulnar fold veins (v. Cephalica, v. Basilica, v. Mediana cubiti);

¦ veins of the back of the hand (v. Cephalica, vv. Metacarpeae dorsales);

¦ Vienna located anterior to the inner ankle (v. Saphena magna).

In children in the first six months of life, venipuncture can be used veins located anterior and upward from the auricle (vv. Tem-Poraks supeificiales).

If it is not possible to access the venous channel, unsuccessful attempts for 5 minutes and, if necessary, emergency administration of drugs, intratracheal administration is carried out: into the endotracheal tube (if intubation was performed) through the ligamentum conica or through the trachea ring with an intramuscular injection needle.
The dose of the drug is doubled and diluted in 1-2 ml of physiological saline. The total number of injected drugs can reach 20-30 ml once. in case of emergency, before intravenous administration, you can resort to the sublingual route of administration (into the muscles of the oral cavity), which allows for the urgent delivery of the drug to the blood in a small dose in the absence of time for venipuncture. In this case, the rule of “three twos” is used: stepping back 2 cm from the edge of the chin, with a needle for intramuscular injection to a depth of 2 cm, the drug is injected into the muscles of the bottom of the mouth towards the crown, the total amount of which does not exceed 2 ml (1 ml for children under 3 years). The dose of drugs is standard, without dilution.

If attempts to access the vein are unsuccessful for 5 minutes and urgent infusion therapy is required than bolus administration of drugs, an intraosseous route of drug administration is an exception. The tibia is trembled 2 cm below the tuberosity and a catheter is placed. The flow rate of this route of administration is 200 ml / hour.

A rectal route of administration can be used in cases where there is no possibility of access to the venous channel and attempts to access the vein were unsuccessful for 5 minutes, but bolus administration of drugs is required in order to reach the peak concentration of the drug in the bloodstream faster than with intramuscular injection. The drugs are administered in microclysters, diluted with warm (37-40 ° C) saline solution 3-5 ml, with the addition of 0.5-1.0 ml of 70% ethanol, if this does not cause inactivation of the drug. The possible dose of the drug is 1-10 ml.

The intramuscular route of administration is used in cases where a medium-term (within 15-20 minutes) exposure to drugs is required. Standard injection sites: the upper lateral quadrant of the buttock (i.e. gluteus maximus), the anterolateral portion of the thigh (i.e. rectus _ femoris), the lateral portion of the shoulder (i.e. triceps brachii).

The intranasal route of administration is advisable in situations where it is desirable to combine the urgency of the drug with its simultaneous effect on the epithelium of the upper respiratory tract. The dose of the drug is not more than 1 ml in the form for intranasal administration.

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