In pharmacology and toxicology , a route of administration is the way by which a drug , fluid, poison, or other substance is taken into the body.
121-590: Intravenous therapy (abbreviated as IV therapy ) is a medical technique that administers fluids, medications and nutrients directly into a person's vein. The intravenous route of administration is commonly used for rehydration or to provide nutrients for those who cannot, or will not—due to reduced mental states or otherwise—consume food or water by mouth . It may also be used to administer medications or other medical therapy such as blood products or electrolytes to correct electrolyte imbalances . Attempts at providing intravenous therapy have been recorded as early as
242-431: A bolus dose, which is called an "IV push". A syringe containing the medication is connected to an access port in the primary tubing and the medication is administered through the port. A bolus may be administered rapidly (with a fast depression of the syringe plunger) or may be administered slowly, over the course of a few minutes. The exact administration technique depends on the medication and other factors. In some cases,
363-559: A central venous catheter , also known as a 'central line'. Such hypertonic saline is normally available in two strengths, the former of which is more commonly administered: Hypertonic NaCl solutions that are less commonly used are 7% (1200 mEq/L) and 23.4% (approx 4000 mEq/L), both of which are used (also via central line), often in conjunction with supplementary diuretics, in the treatment of traumatic brain injury . Other concentrations commonly used include: In medicine, common types of salines include: And in cell biology, in addition to
484-438: A xenotransfusion . He worked with Edmund King to transfuse sheep's blood into a man who was mentally ill. Lower was interested in advancing science but also believed the man could be helped, either by the infusion of fresh blood or by the removal of old blood. It was difficult to find people who would agree to be transfused, but an eccentric scholar, Arthur Coga, consented and the procedure was carried out by Lower and King before
605-445: A "bolus" dose to be administered. Alternatively, the needle may be placed and then connected to a length of tubing, allowing for an infusion to be administered. The type and location of venous access (i.e. a central line versus peripheral line, and in which vein the line is placed) can be affected by the potential for some medications to cause peripheral vasoconstriction, which limits circulation to peripheral veins. A peripheral cannula
726-467: A bolus of plain IV solution (i.e. without medication added) is administered immediately after the bolus to further force the medicine into the bloodstream. This procedure is termed an "IV flush". Certain medications, such as potassium, are not able to be administered by IV push due to the extremely rapid onset of action and high level of effects. An infusion of medication may be used when it is desirable to have
847-403: A buffering solution is sodium bicarbonate . Medications may be mixed into the fluids mentioned above, commonly normal saline, or dextrose solutions. Compared with other routes of administration , such as oral medications , the IV route is the fastest way to deliver fluids and medications throughout the body. For this reason, the IV route is commonly preferred in emergency situations or when
968-483: A complete description of blood circulation was not published until over 100 years later. The story is attributed to potential errors in translation of documents from the time, as well as potentially an intentional fabrication, whereas others still consider it to be accurate. One of the leading medical history textbooks for medical and nursing students has claimed that the entire story was an anti-semitic fabrication. In 1656 Sir Christopher Wren and Robert Boyle worked on
1089-419: A constant blood concentration of a medication over time, such as with some antibiotics including beta-lactams. Continuous infusions, where the next infusion is begun immediately following the completion of the prior, may also be used to limit variation in drug concentration in the blood (i.e. between the peak drug levels and the trough drug levels). They may also be used instead of intermittent bolus injections for
1210-518: A fast onset of action is desirable. In extremely high blood pressure (termed a hypertensive emergency), IV antihypertensives may be given to quickly decrease the blood pressure in a controlled manner to prevent organ damage. In atrial fibrillation, IV amiodarone may be administered to attempt to restore normal heart rhythm. IV medications can also be used for chronic health conditions such as cancer, for which chemotherapy drugs are commonly administered intravenously. In some cases, such as with vancomycin ,
1331-409: A line cannot be placed in an area with a cord. Infiltration occurs when a non-vesicant IV fluid or medication enters the surrounding tissue as opposed to the desired vein. It may occur when the vein itself ruptures, when the vein is damaged during insertion of the intravascular access device, or from increased vein porosity. Infiltration may also occur if the puncture of the vein by the needle becomes
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#17327805670181452-499: A loading or bolus dose of medicine is given before beginning a dosing regimen to more quickly increase the concentration of medication in the blood. The bioavailability of an IV medication is by definition 100%, unlike oral administration where medication may not be fully absorbed, or may be metabolized prior to entering the bloodstream. For some medications, there is virtually zero oral bioavailability. For this reason certain types of medications can only be given intravenously, as there
1573-430: A needle piercing the skin and entering a vein which is connected to a syringe or to external tubing. This is used to administer the desired therapy. In cases where a patient is likely to receive many such interventions in a short period (with consequent risk of trauma to the vein), normal practice is to insert a cannula which leaves one end in the vein, and subsequent therapies can be administered easily through tubing at
1694-453: A non-prescription IV solution of vitamins and minerals marketed as a hangover cure and general wellness remedy. The first "boutique IV" clinic, offering similar treatments, opened in Tokyo in 2008. These clinics, whose target market was described by Elle as "health nuts who moonlight as heavy drinkers", have been publicized in the 2010s by glamorous celebrity customers. Intravenous therapy
1815-449: A parenteral nutrition used will depend on the specific nutritional needs of the person it is being given to. If a person is only receiving nutrition intravenously, it is called total parenteral nutrition (TPN), whereas if a person is only receiving some of their nutrition intravenously it is called partial parenteral nutrition (or supplemental parenteral nutrition). Medical imaging relies on being able to clearly distinguish internal parts of
1936-404: A person is likely to need long-term intravenous therapy, a medical port may be implanted to enable easier repeated access to the vein without having to pierce the vein repeatedly. A catheter can also be inserted into a central vein through the chest, which is known as a tunneled line. The specific type of catheter used and site of insertion are affected by the desired substance to be administered and
2057-438: A physiologically normal solution). Although neither of those names is technically accurate because normal saline is not exactly like blood serum , they convey the practical effect usually seen: good fluid balance with minimal hypotonicity or hypertonicity. NS is used frequently in intravenous drips (IVs) for people who cannot take fluids orally and have developed or are in danger of developing dehydration or hypovolemia . NS
2178-407: A safe osmolality while providing less sodium chloride. The amount of normal saline infused depends largely on the needs of the person (e.g. ongoing diarrhea or heart failure ). Saline is also often used for nasal washes to relieve some of the symptoms of rhinitis and the common cold . The solution exerts a softening and loosening influence on the mucus to make it easier to wash out and clear
2299-404: A set of vague symptoms such as redness or rash, fever, and others may occur; this is termed an "infusion reaction" and is prevented by decreasing the rate of administration of the medication. When vancomycin is involved, this is commonly termed "Red Man syndrome" after the rapid flushing which occurs after rapid administration. As placement of an intravenous line requires breaking the skin, there
2420-413: A therapeutic substance via IV injection was in 1492, when Pope Innocent VIII fell ill and was administered blood from healthy individuals. If this occurred, the treatment did not work and resulted in the death of the donors while not healing the pope. This story is disputed by some, who claim that the idea of blood transfusions could not have been considered by the medical professionals at the time, or that
2541-597: A therapy outside a vein, termed extravasation or infiltration, may cause other side effects. Intravenous (IV) access is used to administer medications and fluid replacement which must be distributed throughout the body, especially when rapid distribution is desired. Another use of IV administration is the avoidance of first-pass metabolism in the liver . Substances that may be infused intravenously include volume expanders , blood-based products , blood substitutes , medications and nutrition. Fluids may be administered as part of "volume expansion", or fluid replacement, through
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#17327805670182662-399: Is 1.0046 grams at 22 °C. The molecular weight of sodium chloride is approximately 58.4 grams per mole, so 58.4 grams of sodium chloride equals 1 mole. Since normal saline contains 9 grams of NaCl, the concentration is 9 grams per litre divided by 58.4 grams per mole, or 0.154 mole per litre. Since NaCl dissociates into two ions – sodium and chloride – 1 molar NaCl
2783-404: Is 2 osmolar. Thus, NS contains 154 mEq /L of Na and the same amount of Cl . This points to an osmolarity of 154 + 154 = 308, which is higher (i.e. more solute per litre) than that of blood (approximately 285). However, if the osmotic coefficient (a correction for non-ideal solutions) is taken into account, then the saline solution is much closer to isotonic. The osmotic coefficient of NaCl
2904-406: Is a central line that does not have an external connector protruding from the skin for administration of medication. Instead, a port consists of a small reservoir covered with silicone rubber which is implanted under the skin, which then covers the reservoir. Medication is administered by injecting medication through the skin and the silicone port cover into the reservoir. When the needle is withdrawn,
3025-532: Is a mixture of sodium chloride (salt) and water . It has a number of uses in medicine including cleaning wounds, removal and storage of contact lenses , and help with dry eyes . By injection into a vein , it is used to treat hypovolemia such as that from gastroenteritis and diabetic ketoacidosis . Large amounts may result in fluid overload , swelling , acidosis , and high blood sodium . In those with long-standing low blood sodium , excessive use may result in osmotic demyelination syndrome . Saline
3146-401: Is a risk of infection. Skin-dwelling organisms such as coagulase-negative staphylococcus or Candida albicans may enter through the insertion site around the catheter, or bacteria may be accidentally introduced inside the catheter from contaminated equipment. Infection of an IV access site is usually local, causing easily visible swelling, redness, and fever. However, pathogens may also enter
3267-403: Is a solid dosage form that fits for rectal administration . In hospice care , a specialized rectal catheter , designed to provide comfortable and discreet administration of ongoing medications provides a practical way to deliver and retain liquid formulations in the distal rectum, giving health practitioners a way to leverage the established benefits of rectal administration. The Murphy drip
3388-534: Is a very large cannula (used in resuscitation settings) and 24-26 is the smallest. The most common sizes are 16-gauge (midsize line used for blood donation and transfusion), 18- and 20-gauge (all-purpose line for infusions and blood draws), and 22-gauge (all-purpose pediatric line). 12- and 14-gauge peripheral lines are capable of delivering large volumes of fluid very fast, accounting for their popularity in emergency medicine . These lines are frequently called "large bores" or "trauma lines". A peripheral intravenous line
3509-403: Is about 0.93, which yields an osmolarity of 0.154 × 1000 × 2 × 0.93 = 286.44. Therefore, the osmolarity of normal saline is a close approximation to the osmolarity of blood. For medical purposes, saline is often used to flush wounds and skin abrasions . However, research indicates that it is no more effective than potable tap water. Normal saline will not burn or sting when applied. Saline
3630-426: Is administered clandestinely in store-front clinics, poses increased risks due to improper technique and oversight. Intravenous access is also sometimes used outside of a medical setting for the self-administration of recreational drugs, such as heroin and fentanyl , cocaine, methamphetamine, DMT, and others. Intravenous therapy is also used for veterinary patient management. Some medications can be administered as
3751-449: Is affected by the amount of drug that is absorbed across the intestinal epithelium and first-pass metabolism . The oral mucosa is the mucous membrane lining the inside of the mouth . Buccally administered medication is achieved by placing the drug between gums and the inner lining of the cheek . In comparison with sublingual tissue, buccal tissue is less permeable resulting in slower absorption . Sublingual administration
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3872-493: Is also used for aseptic purpose. NS is typically the first fluid used when hypovolemia is severe enough to threaten the adequacy of blood circulation, and has long been believed to be the safest fluid to give quickly in large volumes. However, it is now known that rapid infusion of NS can cause metabolic acidosis . The solution is 9 grams of sodium chloride (NaCl) dissolved in water, to a total volume of 1000 ml (weight per unit volume). The mass of 1 millilitre of normal saline
3993-420: Is also used in I.V. therapy , intravenously supplying extra water to rehydrate people or supplying the daily water and salt needs ("maintenance" needs) of a person who is unable to take them by mouth. Because infusing a solution of low osmolality can cause problems such as hemolysis , intravenous solutions with reduced saline concentrations (less than 0.9%) typically have dextrose ( glucose ) added to maintain
4114-508: Is also used in people with acute ethanol toxicity to correct electrolyte and vitamin deficiencies which arise from alcohol consumption. In some countries, non-prescription intravenous glucose is used to improve a person's energy, but is not a part of routine medical care in countries such as the United States where glucose solutions are prescription drugs. Improperly administered intravenous glucose (called "ringer" ), such as that which
4235-447: Is an example of rectal infusion. The parenteral route is any route that is not enteral ( par- + enteral ). Parenteral administration can be performed by injection , that is, using a needle (usually a hypodermic needle ) and a syringe , or by the insertion of an indwelling catheter . Locations of application of parenteral administration include: The definition of the topical route of administration sometimes states that both
4356-425: Is an increased risk of side effects if the drug is administered too rapidly. Inhaled medications can be absorbed quickly and act both locally and systemically. Proper technique with inhaler devices is necessary to achieve the correct dose. Some medications can have an unpleasant taste or irritate the mouth. In general, only 20–50% of the pulmonary-delivered dose rendered in powdery particles will be deposited in
4477-422: Is being used), mask urine test results (by dilution) or by administering prohibited substances in a way that will more quickly be cleared from the body in order to beat an anti-doping test". Players suspended after attending "boutique IV clinics" which offer this sort of treatment include footballer Samir Nasri in 2017 and swimmer Ryan Lochte in 2018. In the 1960s, John Myers developed the " Myers' cocktail ",
4598-411: Is considered a colloid. The most commonly used crystalloid fluid is normal saline , a solution of sodium chloride at 0.9% concentration, which is isotonic with blood. Lactated Ringer's (also known as Ringer's lactate ) and the closely related Ringer's acetate , are mildly hypotonic solutions often used in those who have significant burns . Colloids preserve a high colloid osmotic pressure in
4719-587: Is currently recommended by the Cystic Fibrosis Foundation as a primary part of a cystic fibrosis treatment regimen. An 11% solution of xylitol with 0.65% saline stimulates the washing of the nasopharynx and has an effect on the nasal pathogenic bacteria. This has been used in complementary and alternative medicine. Hypertonic saline may be used in perioperative fluid management protocols to reduce excessive intravenous fluid infusions and lessen pulmonary complications. Hypertonic saline
4840-433: Is fulfilled by placing the drug between the tongue and the lower surface of the mouth. The sublingual mucosa is highly permeable and thereby provides access to the underlying expansive network composed of capillaries, leading to rapid drug absorption. Drug administration via the nasal cavity yields rapid drug absorption and therapeutic effects. This is because drug absorption through the nasal passages does not go through
4961-411: Is fully administered without allowing the access line to run dry. Pumps are primarily utilized when a constant flow rate is important, or where changes in rate of administration would have consequences. To reduce pain associated with the procedure, medical staff may apply a topical local anaesthetic (such as EMLA or Ametop ) to the skin of the chosen venipuncture area about 45 minutes beforehand. If
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5082-470: Is generally referred to as "y-site compatibility", named after the shape of the tubing which has a port for bolus administration. Incompatibility of two fluids or medications can arise due to issues of molecular stability, changes in solubility, or degradation of one of the medications. The simplest form of intravenous access is by passing a hollow needle through the skin directly into a vein. A syringe can be connected directly to this needle, which allows for
5203-524: Is in the crystalloid family of medications. It is most commonly used as a sterile 9 g of salt per litre (0.9%) solution, known as normal saline . Higher and lower concentrations may also occasionally be used. Saline is acidic, with a pH of 5.5 (due mainly to dissolved carbon dioxide). The medical use of saline began around 1831. It is on the World Health Organization's List of Essential Medicines . In 2022, sodium salts
5324-421: Is inserted in peripheral veins , such as the veins in the arms, hands, legs and feet. Medication administered in this way travels through the veins to the heart, from where it is distributed to the rest of the body through the circulatory system. The size of the peripheral vein limits the amount and rate of medication which can be administered safely. A peripheral line consists of a short catheter inserted through
5445-449: Is insufficient uptake by other routes of administration , such is the case of severe dehydration where the patient is required to be treated via IV therapy for a quick recovery. The unpredictability of oral bioavailability in different people is also a reason for a medication to be administered IV, as with furosemide . Oral medications also may be less desirable if a person is nauseous or vomiting, or has severe diarrhea, as these may prevent
5566-447: Is not recommended to change a peripheral IV line more frequently than every 72–96 hours. Phlebitis is particularly common in intravenous drug users, and those undergoing chemotherapy, whose veins can become sclerotic and difficult to access over time, sometimes forming a hard, painful "venous cord". The presence of a cord is a cause of discomfort and pain associated with IV therapy, and makes it more difficult for an IV line to be placed as
5687-422: Is simply hung above the height of the person and the solution is pulled via gravity through a tube attached to a needle inserted into a vein. Without extra equipment, it is not possible to precisely control the rate of administration. For this reason, a setup may also incorporate a clamp to regulate flow. Some IV lines may be placed with " Y-sites ", devices which enable a secondary solution to be administered through
5808-436: Is sometimes considered when choosing appropriate antibiotic therapy for use in a hospital setting, as a person is unlikely to be discharged if they still require IV therapy. Some medications, such as aprepitant , are chemically modified to be better suited for IV administration, forming a prodrug such as fosaprepitant . This can be for pharmacokinetic reasons or to delay the effect of the drug until it can be metabolized into
5929-991: Is tentative evidence that saline nasal irrigation may help with long term cases of rhinosinusitis . Evidence for use in cases of rhinosinusitis of short duration is unclear. Saline is used in scleral tattooing , coloring the white part of the human eye. Saline is used to lighten tattoos (including microblading tattoos) through the process of osmosis . Concentrations lower and higher than normal also exist. High concentrations are used rarely in medicine but frequently in molecular biology . Hypertonic saline—7% NaCl solutions are considered mucoactive agents and thus are used to hydrate thick secretions ( mucus ) in order to make it easier to cough up and out ( expectorate ). 3% hypertonic saline solutions are also used in critical care settings, acutely increased intracranial pressure , or severe hyponatremia . Inhalation of hypertonic saline has also been shown to help in other respiratory problems, specifically bronchiolitis . Hypertonic saline
6050-428: Is termed "red man syndrome". Any additional medication to be administered intravenously at the same time as an infusion may be connected to the primary tubing; this is termed a secondary IV, or IV piggyback. This prevents the need for multiple IV access lines on the same person. When administering a secondary IV medication, the primary bag is held lower than the secondary bag so that the secondary medication can flow into
6171-476: Is the most common intravenous access method utilized in hospitals , pre-hospital care, and outpatient medicine. This may be placed in the arm, commonly either the wrist or the median cubital vein at the elbow. A tourniquet may be used to restrict the venous drainage of the limb and make the vein bulge, making it easier to locate and place a line in a vein. When used, a tourniquet should be removed before injecting medication to prevent extravasation . The part of
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#17327805670186292-485: Is the most reliable route, as in acutely ill patients the absorption of substances from the tissues and from the digestive tract can often be unpredictable due to altered blood flow or bowel motility. Enteral routes are generally the most convenient for the patient, as no punctures or sterile procedures are necessary. Enteral medications are therefore often preferred in the treatment of chronic disease. However, some drugs can not be used enterally because their absorption in
6413-472: Is therefore different from that after parenteral administration. This can be illustrated by the action of naloxone (Narcan), an antagonist of opiates such as morphine . Naloxone counteracts opiate action in the central nervous system when given intravenously and is therefore used in the treatment of opiate overdose. The same drug, when swallowed, acts exclusively on the bowels; it is here used to treat constipation under opiate pain therapy and does not affect
6534-719: Is used in treating hyponatremia and cerebral edema . Rapid correction of hyponatremia via hypertonic saline, or via any saline infusion > 40 mmol/L (Na+ having a valence of 1, 40 mmol/L = 40 mEq/L) greatly increases risk of central pontine myelinolysis (CPM), and so requires constant monitoring of the person's response. Water privation combined with diuretic block does not produce as much risk of CPM as saline administration does; however, it does not correct hyponatremia as rapidly as administration of hypertonic saline does. Due to hypertonicity, administration may result in phlebitis and tissue necrosis . As such, concentrations greater than 3% NaCl should normally be administered via
6655-401: Is used to verify that the end of the cannula is in the right place if fluoroscopy was not used during the insertion. An EKG can also be used in some cases to determine if the end of the cannula is in the correct location. A tunneled line is a type of central access which is inserted under the skin, and then travels a significant distance through surrounding tissue before reaching and penetrating
6776-412: Is usually not preferred. This includes the treatment of mild or moderate dehydration with oral rehydration therapy which is an option, as opposed to parenteral rehydration through an IV line. Children in emergency departments being treated for dehydration have better outcomes with oral treatment than intravenous therapy due to the pain and complications of an intravenous line. Cold spray may decrease
6897-446: Is usually rather a matter of pharmacodynamics (concerning, for example, the physiological effects of drugs ). An exception is topical administration , which generally means that both the application location and the effect thereof is local. Topical administration is sometimes defined as both a local application location and local pharmacodynamic effect, and sometimes merely as a local application location regardless of location of
7018-711: The Royal Society on 23 November 1667. Transfusion gathered some popularity in France and Italy, but medical and theological debates arose, resulting in transfusion being prohibited in France. There was virtually no recorded success with any attempts at injection therapy until the 1800s, when in 1831 Thomas Latta studied the use of IV fluid replacements for cholera treatment. The first solutions which saw widespread use for IV injections were simple "saline-like solutions", which were followed by experiments with various other liquids, including milk, sugar, honey, and egg yolk. In
7139-449: The end of life . The walls of the rectum absorb many medications quickly and effectively. Medications delivered to the distal one-third of the rectum at least partially avoid the " first pass effect " through the liver, which allows for greater bio-availability of many medications than that of the oral route. Rectal mucosa is highly vascularized tissue that allows for rapid and effective absorption of medications. A suppository
7260-416: The eye . Depending on the condition being treated, they may contain steroids , antihistamines , sympathomimetics , beta receptor blockers , parasympathomimetics , parasympatholytics , prostaglandins , non-steroidal anti-inflammatory drugs (NSAIDs), antibiotics or topical anesthetics . Eye drops sometimes do not have medications in them and are only lubricating and tear -replacing solutions. There
7381-406: The stomach , and as such gastrointestinal (along the gastrointestinal tract ) may be a more fitting term for this route of administration. Furthermore, some application locations often classified as enteral , such as sublingual (under the tongue) and sublabial or buccal (between the cheek and gums/ gingiva ), are taken up in the proximal part of the gastrointestinal tract without reaching
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#17327805670187502-461: The transitional zones of the lung by sedimentation. An inhaled powdery particle that is <3 μm in diameter is structurally predisposed to depositing primarily in the respiratory regions of the peripheral lung via diffusion. Particles that deposit in the upper and central airways are generally absorbed systemically to great extent because they are only partially removed by mucociliary clearance, which results in orally mediated absorption when
7623-406: The 1400s, but the practice did not become widespread until the 1900s after the development of techniques for safe, effective use. The intravenous route is the fastest way to deliver medications and fluid replacement throughout the body as they are introduced directly into the circulatory system and thus quickly distributed. For this reason, the intravenous route of administration is also used for
7744-436: The 1830s, James Blundell , an English obstetrician, used intravenous administration of blood to treat women bleeding profusely during or after delivery. This predated the understanding of blood type , leading to unpredictable results. Intravenous therapy was expanded by Italian physician Guido Baccelli in the late 1890s and further developed in the 1930s by Samuel Hirschfeld, Harold T. Hyman and Justine Johnstone Wanger but
7865-513: The above the following are used: Saline was believed to have originated during the Indian Blue cholera pandemic that swept across Europe in 1831. William Brooke O'Shaughnessy , a recent graduate of Edinburgh Medical School , proposed in an article to medical journal The Lancet to inject people infected with cholera with highly oxygenated salts to treat the "universal stagnation of the venous system and rapid cessation of arterialisation of
7986-435: The access must find a new access site proximal to the "blown" area to prevent extravasation of medications through the damaged vein. For this reason it is advisable to site the first cannula at the most distal appropriate vein. Placement of an intravenous line inherently causes pain when the skin is broken and is considered medically invasive . For this reason, when other forms of administration may suffice, intravenous therapy
8107-511: The active form. A blood product (or blood-based product ) is any component of blood which is collected from a donor for use in a blood transfusion . Blood transfusions can be used in massive blood loss due to trauma , or can be used to replace blood lost during surgery . Blood transfusions may also be used to treat a severe anaemia or thrombocytopenia caused by a blood disease . Early blood transfusions consisted of whole blood , but modern medical practice commonly uses only components of
8228-412: The active substance takes from application location to the location where it has its target effect is usually rather a matter of pharmacokinetics (concerning the processes of uptake, distribution, and elimination of drugs). Exceptions include the transdermal or transmucosal routes, which are still commonly referred to as routes of administration . The location of the target effect of active substances
8349-431: The amount of substance swallowed. The rate of inhalation will usually determine the amount of the substance which enters the lungs. Faster inhalation results in more rapid absorption because more substance finds the lungs. Substances in a form that resists absorption in the lung will likely resist absorption in the nasal passage, and the oral cavity, and are often even more resistant to absorption after they fail absorption in
8470-484: The application location and the pharmacodynamic effect thereof is local. In other cases, topical is defined as applied to a localized area of the body or to the surface of a body part regardless of the location of the effect. By this definition, topical administration also includes transdermal application, where the substance is administered onto the skin but is absorbed into the body to attain systemic distribution. If defined strictly as having local effect,
8591-426: The area can be used to speed the dispersal of the fluid/drug. Infiltration is one of the most common adverse effects of IV therapy and is usually not serious unless the infiltrated fluid is a medication damaging to the surrounding tissue, most commonly a vesicant or chemotherapeutic agent . In such cases, the infiltration is termed extravasation , and may cause necrosis . If the solutions administered are colder than
8712-529: The blood" seen in people with severely dehydrated cholera. He found his treatment harmless in dogs, and his proposal was soon adopted by the physician Thomas Latta in treating people with cholera to beneficial effect. In the following decades, variations and alternatives to Latta's solution were tested and used in treating people with cholera. These solutions contained a range of concentrations of sodium, chloride, potassium, carbonate, phosphate, and hydroxide. The breakthrough in achieving physiological concentrations
8833-478: The blood, such as packed red blood cells , fresh frozen plasma or cryoprecipitate . Parenteral nutrition is the act of providing required nutrients to a person through an intravenous line. This is used in people who are unable to get nutrients normally, by eating and digesting food. A person receiving parenteral nutrition will be given an intravenous solution which may contain salts , dextrose , amino acids , lipids and vitamins . The exact formulation of
8954-460: The blood, while, on the other hand, this parameter is decreased by crystalloids due to hemodilution. Crystalloids generally are much cheaper than colloids. Buffer solutions which are used to correct acidosis or alkalosis are also administered through intravenous access. Lactated Ringer's solution used as a fluid expander or base solution to which medications are added also has some buffering effect. Another solution administered intravenously as
9075-409: The bloodstream, causing sepsis , which can be sudden and life-threatening. A central IV line poses a higher risk of sepsis, as it can deliver bacteria directly into the central circulation. A line which has been in place for a longer period of time also increases the risk of infection. Inflammation of the vein may also occur, called thrombophlebitis or simply phlebitis. This may be caused by infection,
9196-417: The body from each other. One way this is accomplished is through the administration of a contrast agent into a vein. The specific imaging technique being employed will determine the characteristics of an appropriate contrast agent to increase visibility of blood vessels or other features. Common contrast agents are administered into a peripheral vein from which they are distributed throughout the circulation to
9317-418: The cannula is not inserted correctly, or the vein is particularly fragile and ruptures, blood may extravasate into the surrounding tissues; this situation is known as a blown vein or "tissuing". Using this cannula to administer medications causes extravasation of the drug, which can lead to edema , causing pain and tissue damage, and even necrosis depending on the medication. The person attempting to obtain
9438-544: The catheter itself, or the specific fluids or medication being given. Repeated instances of phlebitis can cause scar tissue to build up along a vein. A peripheral IV line cannot be left in the vein indefinitely out of concern for the risk of infection and phlebitis, among other potential complications. However, recent studies have found that there is no increased risk of complications in those whose IVs were replaced only when clinically indicated versus those whose IVs were replaced routinely. If placed with proper aseptic technique, it
9559-597: The catheter that remains outside the skin is called the connecting hub; it can be connected to a syringe or an intravenous infusion line, or capped with a heplock or saline lock, a needleless connection filled with a small amount of heparin or saline solution to prevent clotting, between uses of the catheter. Ported cannulae have an injection port on the top that is often used to administer medicine. The thickness and size of needles and catheters can be given in Birmingham gauge or French gauge . A Birmingham gauge of 14
9680-507: The central vein output. A peripherally inserted central catheter (also called a PICC line) is a type of central IV access which consists of a cannula inserted through a sheath into a peripheral vein and then carefully fed towards the heart, terminating at the superior vena cava or the right atrium. These lines are usually placed in peripheral veins in the arm, and may be placed using the Seldinger technique under ultrasound guidance. An X-ray
9801-546: The central vein. Using a tunneled line reduces the risk of infection as compared to other forms of access, as bacteria from the skin surface are not able to travel directly into the vein. These catheters are often made of materials that resist infection and clotting. Types of tunneled central lines include the Hickman line or Broviac catheter. A tunnelled line is an option for long term venous access necessary for hemodialysis in people with poor kidney function. An implanted port
9922-408: The consumption of some recreational drugs . Many therapies are administered as a " bolus " or one-time dose, but they may also be administered as an extended infusion or drip . The act of administering a therapy intravenously, or placing an intravenous line ("IV line") for later use, is a procedure which should only be performed by a skilled professional. The most basic intravenous access consists of
10043-399: The different particle surfaces. Inhalation by nose of a substance is almost identical to oral inhalation, except that some of the drug is absorbed intranasally instead of in the oral cavity before entering the airways. Both methods can result in varying levels of the substance to be deposited in their respective initial cavities, and the level of mucus in either of these cavities will reflect
10164-444: The digestive tract is low or unpredictable. Transdermal administration is a comfortable alternative; there are, however, only a few drug preparations that are suitable for transdermal administration. Identical drugs can produce different results depending on the route of administration. For example, some drugs are not significantly absorbed into the bloodstream from the gastrointestinal tract and their action after enteral administration
10285-412: The dosage is difficult to control. Upon contact with the skin, the drug penetrates into the dead stratum corneum and can afterwards reach the viable epidermis , the dermis , and the blood vessels . The term parenteral is from para-1 'beside' + Greek enteron 'intestine' + -al. This name is due to the fact that it encompasses a route of administration that is not intestinal. However, in common English
10406-418: The effects. Through the gastrointestinal tract is sometimes termed enteral or enteric administration (literally meaning 'through the intestines '). Enteral/enteric administration usually includes oral (through the mouth ) and rectal (into the rectum ) administration, in the sense that these are taken up by the intestines. However, uptake of drugs administered orally may also occur already in
10527-432: The former cavities and are swallowed. Neural drug delivery is the next step beyond the basic addition of growth factors to nerve guidance conduits . Drug delivery systems allow the rate of growth factor release to be regulated over time, which is critical for creating an environment more closely representative of in vivo development environments. Saline (medicine) Saline (also known as saline solution )
10648-430: The gut before entering capillaries situated at tissue cells and then systemic circulation and such absorption route allows transport of drugs into the central nervous system via the pathways of olfactory and trigeminal nerve . Intranasal absorption features low lipophilicity, enzymatic degradation within the nasal cavity, large molecular size, and rapid mucociliary clearance from the nasal passages, which explains
10769-447: The health of the veins in the desired site of insertion. Placement of an IV line may cause pain, as it necessarily involves piercing the skin. Infections and inflammation (termed phlebitis ) are also both common side effects of an IV line. Phlebitis may be more likely if the same vein is used repeatedly for intravenous access, and can eventually develop into a hard cord which is unsuitable for IV access. The unintentional administration of
10890-413: The imaging site. IV rehydration was formerly a common technique for athletes. The World Anti-Doping Agency prohibits intravenous injection of more than 100 mL per 12 hours, except under a medical exemption. The United States Anti-Doping Agency notes that, as well as the dangers inherent in IV therapy, "IVs can be used to change blood test results (such as hematocrit where EPO or blood doping
11011-511: The intestines. Strictly enteral administration (directly into the intestines) can be used for systemic administration, as well as local (sometimes termed topical ), such as in a contrast enema , whereby contrast media are infused into the intestines for imaging. However, for the purposes of classification based on location of effects, the term enteral is reserved for substances with systemic effects. Many drugs as tablets , capsules , or drops are taken orally. Administration methods directly into
11132-422: The intravenous route. Volume expansion consists of the administration of fluid-based solutions or suspensions designed to target specific areas of the body which need more water. There are two main types of volume expander: crystalloids and colloids . Crystalloids are aqueous solutions of mineral salts or other water-soluble molecules. Colloids contain larger insoluble molecules, such as gelatin . Blood itself
11253-399: The line directly after the initial IV cannula insertion. A central line is an access method in which a catheter empties into a larger, more central vein (a vein within the torso), usually the superior vena cava , inferior vena cava or the right atrium of the heart. There are several types of central IV access, categorized based on the route the catheter takes from the outside of the body to
11374-417: The low risk of systemic exposure of the administered drug absorbed via intranasal. By delivering drugs almost directly to the site of action, the risk of systemic side effects is reduced. Skin absorption (dermal absorption), for example, is to directly deliver drug to the skin and, hopefully, to the systemic circulation. However, skin irritation may result, and for some forms such as creams or lotions,
11495-407: The lung upon mouth inhalation. The remainder of 50-70% undeposited aerosolized particles are cleared out of lung as soon as exhalation . An inhaled powdery particle that is >8 μm is structurally predisposed to depositing in the central and conducting airways ( conducting zone ) by inertial impaction. An inhaled powdery particle that is between 3 and 8 μm in diameter tend to largely deposit in
11616-399: The medicine from being fully absorbed from the gastrointestinal tract. In these cases, a medication may be given IV only until the patient can tolerate an oral form of the medication. The switch from IV to oral administration is usually performed as soon as viable, as there is generally cost and time savings over IV administration. Whether a medication can be potentially switched to an oral form
11737-683: The nasal passages for both babies and adults. In very rare instances, fatal infection by the amoeba Naegleria fowleri can occur if it enters the body through the nose; therefore tap water must not be used for nasal irrigation. Water is only appropriate for this purpose if it is sterile, distilled, boiled, filtered, or disinfected. Sterile isotonic saline is also used to fill breast implants for use in breast augmentation surgery, to correct congenital abnormalities such as tuberous breast deformity, and to correct breast asymmetry. Saline breast implants are also used in reconstructive surgery post-mastectomy. Eye drops are saline-containing drops used on
11858-447: The other end. In some cases, multiple medications or therapies are administered through the same IV line. IV lines are classified as "central lines" if they end in a large vein close to the heart, or as "peripheral lines" if their output is to a small vein in the periphery, such as the arm. An IV line can be threaded through a peripheral vein to end near the heart, which is termed a "peripherally inserted central catheter" or PICC line. If
11979-480: The pain of putting in an IV. Certain medications also have specific sensations of pain associated with their administration IV. This includes potassium , which when administered IV can cause a burning or painful sensation. The incidence of side effects specific to a medication can be affected by the type of access (peripheral versus central), the rate of administration, or the quantity of drug administered. When medications are administered too rapidly through an IV line,
12100-489: The pain-reducing effect of the opiate. The oral route is generally the most convenient and costs the least. However, some drugs can cause gastrointestinal tract irritation. For drugs that come in delayed release or time-release formulations, breaking the tablets or capsules can lead to more rapid delivery of the drug than intended. The oral route is limited to formulations containing small molecules only while biopharmaceuticals (usually proteins) would be digested in
12221-447: The path of least resistance—such as a cannula which has been left inserted, causing the vein to scar. It can also occur upon insertion of an IV line if a tourniquet is not promptly removed. Infiltration is characterized by coolness and pallor to the skin as well as localized swelling or edema. It is treated by removing the intravenous line and elevating the affected limb so the collected fluids drain away. Injections of hyaluronidase around
12342-413: The patient and the requirement of trained staff using aseptic techniques for administration. However, in some cases, patients are taught to self-inject, such as SC injection of insulin in patients with insulin-dependent diabetes mellitus . As the drug is delivered to the site of action extremely rapidly with IV injection, there is a risk of overdose if the dose has been calculated incorrectly, and there
12463-405: The primary tubing, rather than fluid from the primary bag flowing into the secondary tubing. The fluid from the primary bag is needed to help flush any remaining medication from the secondary IV from the tubing. If a bolus or secondary infusion is intended for administration in the same line as a primary infusion, the molecular compatibility of the solutions must be considered. Secondary compatibility
12584-401: The reservoir cover reseals itself. A port cover is designed to function for hundreds of needle sticks during its lifetime. Ports may be placed in an arm or in the chest area. Equipment used to place and administer an IV line for infusion consists of a bag, usually hanging above the height of the person, and sterile tubing through which the medicine is administered. In a basic "gravity" IV, a bag
12705-424: The same line (known as piggybacking). Some systems employ a drip chamber , which prevents air from entering the bloodstream (causing an air embolism ), and allows visual estimation of flow rate of the solution. Alternatively, an infusion pump allows precise control over the flow rate and total amount delivered. A pump is programmed based on the number and size of infusions being administered to ensure all medicine
12826-450: The same reason, such as with furosemide . Infusions can also be intermittent, in which case the medication is administered over a period of time, then stopped, and this is later repeated. Intermittent infusion may be used when there are concerns about the stability of medicine in solution for long periods of time (as is common with continuous infusions), or to enable the administration of medicines which would be incompatible if administered at
12947-400: The same time in the same IV line, for example vancomycin. Failure to properly calculate and administer an infusion can result in adverse effects, termed infusion reactions. For this reason, many medications have a maximum recommended infusion rate, such as vancomycin and many monoclonal antibodies . These infusion reactions can be severe, such as in the case of vancomycin, where the reaction
13068-399: The skin into a peripheral vein . This is usually in the form of a cannula -over-needle device, in which a flexible plastic cannula comes mounted over a metal trocar . Once the tip of the needle and cannula are placed, the cannula is advanced inside the vein over the trocar to the appropriate position and secured. The trocar is then withdrawn and discarded. Blood samples may also be drawn from
13189-521: The stomach and thereby become ineffective. Biopharmaceuticals have to be given by injection or infusion. However, recent research found various ways to improve oral bioavailability of these drugs. In particular permeation enhancers, ionic liquids , lipid-based nanocarriers, enzyme inhibitors and microneedles have shown potential. Oral administration is often denoted "PO" from "per os", the Latin for "by mouth". The bioavailability of oral administration
13310-451: The stomach include those by gastric feeding tube or gastrostomy . Substances may also be placed into the small intestines , as with a duodenal feeding tube and enteral nutrition . Enteric coated tablets are designed to dissolve in the intestine, not the stomach, because the drug present in the tablet causes irritation in the stomach. The rectal route is an effective route of administration for many medications, especially those used at
13431-487: The subject. As stated by Wren, "I Have Injected Wine and Ale in a liveing Dog into the Mass of Blood by a Veine, in good Quantities, till I have made him extremely drunk, but soon after he Pisseth it out." The dog survived, grew fat, and was later stolen from his owner. Boyle attributed authorship to Wren. Richard Lower showed it was possible for blood to be transfused from animal to animal and from animal to man intravenously,
13552-464: The target of action is. Action may be topical (local), enteral (system-wide effect, but delivered through the gastrointestinal tract ), or parenteral (systemic action, but is delivered by routes other than the GI tract). Route of administration and dosage form are aspects of drug delivery . Routes of administration are usually classified by application location (or exposition). The route or course
13673-416: The temperature of the body, induced hypothermia can occur. If the temperature change to the heart is rapid, ventricular fibrillation may result. Furthermore, if a solution which is not balanced in concentration is administered, a person's electrolytes may become imbalanced. In hospitals, regular blood tests may be used to proactively monitor electrolyte levels. The first recorded attempt at administering
13794-842: The term has mostly been used to describe the four most well-known routes of injection. The term injection encompasses intravenous (IV), intramuscular (IM), subcutaneous (SC) and intradermal (ID) administration. Parenteral administration generally acts more rapidly than topical or enteral administration, with onset of action often occurring in 15–30 seconds for IV, 10–20 minutes for IM and 15–30 minutes for SC. They also have essentially 100% bioavailability and can be used for drugs that are poorly absorbed or ineffective when they are given orally. Some medications, such as certain antipsychotics , can be administered as long-acting intramuscular injections . Ongoing IV infusions can be used to deliver continuous medication or fluids . Disadvantages of injections include potential pain or discomfort for
13915-557: The topical route of administration can also include enteral administration of medications that are poorly absorbable by the gastrointestinal tract . One such medication is the antibiotic vancomycin , which cannot be absorbed in the gastrointestinal tract and is used orally only as a treatment for Clostridioides difficile colitis . The reason for choice of routes of drug administration are governing by various factors: In acute situations, in emergency medicine and intensive care medicine , drugs are most often given intravenously. This
14036-428: The transported mucus is swallowed, and first pass metabolism or incomplete absorption through loss at the fecal route can sometimes reduce the bioavailability. This should in no way suggest to clinicians or researchers that inhaled particles are not a greater threat than swallowed particles, it merely signifies that a combination of both methods may occur with some particles, no matter the size of or lipo/hydrophilicity of
14157-540: Was accomplished by Sydney Ringer in the early 1880s, when he determined the optimal salt concentrations to maintain the contractility of frog heart muscle tissue. Normal saline is considered a descendant of the pre-Ringer solutions, as Ringer's findings were not adopted and widely used until decades later. The term "normal saline" itself appears to have little historical basis, except for studies done in 1882–83 by Dutch physiologist Hartog Jacob Hamburger ; these in vitro studies of red cell lysis suggested incorrectly that 0.9%
14278-446: Was followed in 1975 with the introduction of intravenous fat emulsions and vitamins which were added to form "total parenteral nutrition", or that which includes protein, fat, and carbohydrates. Route of administration Routes of administration are generally classified by the location at which the substance is applied. Common examples include oral and intravenous administration. Routes can also be classified based on where
14399-509: Was not widely available until the 1950s. There was a time, roughly the 1910s–1920s, when fluid replacement that today would be done intravenously was likelier to be done with a Murphy drip , a rectal infusion; and IV therapy took years to increasingly displace that route. In the 1960s, the concept of providing a person's complete nutritional needs through an IV solution began to be seriously considered. The first parenteral nutrition supplementation consisted of hydrolyzed proteins and dextrose. This
14520-430: Was the 216th most commonly prescribed medication in the United States, with more than 1 million prescriptions. Normal saline ( NSS, NS or N/S ) is the commonly used phrase for a solution of 0.90% w/v of NaCl , 308 mOsm /L or 9.0 g per liter. Less commonly, this solution is referred to as physiological saline or isotonic saline (because it is approximately isotonic to blood serum, which makes it
14641-401: Was the concentration of salt in human blood (rather than 0.6%, the true concentration). Normal saline has become widely used in modern medicine, but due to the mismatch with real blood, other solutions have proved better. The 2018 publication of a randomized, controlled trial with 15,000 people in intensive care units showed that compared to normal saline, lactated Ringer's solution reduced
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