PH 2.1 & 2.

3 / SLO Parental Dosage Forms

At the end of the session student should be able to:
1) Identify different parenteral dosage formulation
2) Can answer about equipment of injections & IV infusion set
3) Different parenteral routes
4) Carry out techniques of different parenteral injections and IV infusion
5) Different IV fluids with their properties and uses
7) Explain advantages and hazards of IV injections

Liquid parenteral dosage forms:

1. Injections: These are liquid preparations meant for parenteral administration. They must
be sterile.
a. Ampoules:
It is a glass / plastic container, which contains single dose of a drug. Once broken, it has to be
used immediately. Unused drug is to be discarded e.g. atropine ampoule.

Stem

Neck

Body

Advantages:
1) Single dose of drug is used 2) Less or no chances of contamination
Disadvantages:
1) During breaking of ampoule drug can be wasted out

b. Single or multi-dose vial (bulb):

It contains a single or multi-dose drug solution or powder form of the drug. The solution form
can be reused but sterility has to be maintained.
When drug is in powdered form, sterile water / distilled water / isotonic saline / any other
appropriate solvent is added in the recommended quantity to dissolve the drug.
All aseptic precautions should be followed before withdrawing drug from the vial.
The unused drug should be preserved according to the manufacturer's instructions.

Metal cap with rubber stopper

Neck

Body

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Advantages: 1) Multiple time drug can be taken out
Disadvantages: 1) Contamination can occur

Equipment for injection:

● Syringes:. Syringes are available in the capacity of 1 to 50 ml and have graduation marks
on the barrel. Special insulin syringe have graduation marks in “units”.
These are used to administer drug by parenteral routes.
They are made up of plastic or glass.
The glass syringe can be reused after sterilization. Plastic syringes are disposable and are
used with disposable needles.
Prefilled syringes are meant for single administration e.g. typhoid vaccine,

Plunger

Body

Nozzle
Antiimmunoglobulin etc .

Needle:

The needles are made up of metal and consist of hub which locks to the syringe tip.
They are available in different sizes as per the length and the outer diameter of the shaft
(gauge).
The diameter varies from 13 gauge (thickest) to 27 gauge (finest).The thick or large bore
needles are used for thick or oily liquids e.g. benzathine penicillin.

The commonly used parenteral routes with needles sizes and length are shown below:
Route of Gauge Length Syringe Site of injection
administration (in mm)
Intradermal 26 12 Tuberculin Anteromedial surface of forearm
syringe(c.f. 22)

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 Subcutaneous 25 12 Tuberculin or Loose Subcutaneous tissue of
Or insulin skin, e.g. outer surface of arm,
Hypodermic syringe(c.f. 21) front of thigh, umbilical region of
abdomen
Intramuscular 20 37 2-5 ml Deltoid Muscle (Upper arm
22 25 muscle)
23 25 Vastus Lateralis Muscle (Thigh):
24 16-25 best for children
Dorsogluteal Muscle (Buttocks)
Intravenous 20 25-35 Intracath Anterior cubital vein, other veins
at the elbow
Intracardiac 14-16 90 10ml Through left 4th intercostals
space half inch inside the mid-
clavicular line
Intra-articular 18-19 35 10ml Joint space
Techniques in parenteral administration of drugs (Injections):
Precautions to be taken while administering an injection:
1. Observe aseptic precautions.
2. Clean site of injection with germicidal solution.
3. Use sterile equipments.
4. Apply proper technique to minimize pain and chances of injury to the nerves and vessels.
5. Select the appropriate size of syringe and needle.
6. Always check the label including expiry date.
7. Make sure that the injection contains proper drug in proper strength.
8. Mix only compatible drugs, if necessary.
9. Never return unused drug to stock bottle.
10. Avoid needle prick injury.
11. Destroy needle and syringe safely. Do not reuse
disposable syringes and needles.
Withdrawal of drug from an ampoule:
Syringe and needle should be empty.
1. Wash hands.
2. Put needle on syringe, without touching their tips.
3. File (cut) the neck of ampoule.
4. Break it and split it off.
5. Aspirate drug from ampoule.
6. Remove air from the syringe.
7. Administer the drug.
8. Dispose syringe and needle.
9. Wash hands.

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Withdrawal of drug from a vial: (Fig. 4.2)
1. Aseptic precaution.
2. Disinfect the tip of vial.
3. Use syringe with volume twice the amount of solution required,
4. Place needle on syringe, without touching their tips.
5. Suck as much air into the syringe as the volume of solution to be injected.
6. Insert needle into the top of vial.
7. Turn it upside down.
8. Pump air into vial.
9. Withdraw appropriate amount of drug.
10. Dispose syringe and needle.
11. Wash hands.

Fig. 4.2
Dissolving a drug in a medium: (Fig 4.2)
1. Aseptic precaution.
2. Disinfect the tip of vial.
3. Insert needle with syringe containing medium into vial.
4. Hold it in upright position.
5. Inject fluid into vial.
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6. Shake the vial well.
7. Dissolve the drug.
Technique for subcutaneous injection:
1. Wash hands.
2. Reassure the patient and explain the procedure.
3. Hold the syringe in one hand like pencil or a dart
4. Grasp the skin at the site of injection between the
thumb and index finger with your other hand and
pinch up. Aspirate briefly; if blood appears:
withdraw needle, replace it with new one, if
possible and start again from point 4
5. Inject slowly (0.5-2 minutes)
6. Withdraw needle quickly.
7. Press sterile cotton onto the opening. Fix with
adhesive tape.

Technique for Intramuscular injection: (Fig. 4.4)

1. Wash hands.
2. Reassure the patient and explain the
procedure.
3. Uncover the area to be injected and disinfect
4. Ask patient to relax the muscle
5. Insert needle at an angle of 90 degree
6. Aspirate briefly, if no blood, give injection
slowly
7. Withdraw needle swiftly.
8. Press sterile cotton onto the opening.
9. Fix with adhesive tape.

Technique for intravenous injection: (Fig. 4.5)

1. Wash hands.
2. Reassure the patient and explain the
procedure.
3. Uncover the arm completely
4. Have the patient relax and support his arm
below the vein to be used.
5. Hold the syringe and needle steady.
6. Aspirate briefly; if blood appears, hold the syringe steady, you are in the vein. If it does
not come, try again.
7. Loosen tourniquet.
8. Inject very slowly. Check for pain, swelling, hematoma; if in doubt whether you are still in
the vein, aspirate again.
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 9. Withdraw needle swiftly. Press sterile cotton onto the opening. Fix with adhesive tape.

2. Intravenous fluids:
These are most commonly used for IV infusion. They are available in glass or plastic containers
in 100ml, 500ml or 1000ml capacity. IV fluids can be divided into three groups.
1. Maintenance fluids- they replace fluid lost from lungs, skin, urine and faeces that are
poor in salt, e.g. 5% dextrose.
2. Replacement fluids- they are formulated to correct fluid deficit caused by vomiting,
diarrhoea, oozing from trauma, burns etc. e.g. isotonic saline, ringer lactate.
3. Special fluids- they are used for indications like hypoglycaemia, hypokalemia and
metabolic acidosis. e.g. 25% dextrose, potassium chloride.

IV fluid Contents Pharmacological basis Indications Contraindications

5% Glucose Corrects intracellular Dehydration due to Diabetes mellitus
Dextrose 5gms/ 100 ml dehydration and supplies inadequate water intake Hypovolemic shock
energy (170kcal/litre) as or excessive water loss, Hyponatremia
is hypotonic to plasma. IV administration of
drugs
Isotonic NaCl Provides extracellular Dehydration due to Hypertension and
saline(0.9%) 0.9 gm/100ml electrolytes and water and salt depletion congestive cardiac
NaCl 100ml increases the like diarrhoea, vomiting failure,
intravascular volume. excessive perspiration, Edema due to renal
Hypovolemic shock disease and cirrhosis
Ringer Sodium The most physiological Rapid correction of Conditions with
lactate lactate 320 solution, rapidly expands severe hypovolemia impaired lactate
mg, NaCl 600 the intravascular volume. Dehydration associated metabolism (liver
mg, KC1 40 Sodium lactate present is with metabolic acidosis disease, severe
mg and CaCl2 metabolized into like diarrhea hypoxia)
27 mg/ 100ml bicarbonate in liver.

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 Equipments for administering an intravenous infusion:
An i.v. set (Fig. 4.6) consists of
1. Insertion spike (Plunger) to be fixed in the pint.
2. Plastic tube for passage of fluids.
3. Drip chamber (Murphy's chamber) with filter (for blood
transfusion) or without filter to fix the drop rate
4. Control clamp or roller clamp (regulator) to control rate
of flow.
5. Latex tube for injecting additional drugs
6. Needle adapter to be introduced inside the needle hub.
7. Intravenous cannula

Hazards of parenteral administration:

1. Pyrogenic reaction due to old solution.
2. Pulmonary embolism.
3. Pulmonary edema in case of rapid infusion.
4. Thrombophlebitis due to injury to the vein.
5. Circulatory overload that may lead to CHF.
6. Contamination of fluid by bacteria and fungi.
Method of administration of parenteral infusions: (Fig. 4.7)
1. Wash hands.
2. Reassure and explain.
3. Select a proper vein and make it prominent by applying a tourniqu

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4. Disinfect the skin with spirit.
5. Pull the skin in longitudinal direction of vein.
6. Insert intravenous cannula at an angle of 35 degree.
7. Puncture the skin, move the needle horizontally in vein.
8. Confirm the cannula is inside the vein, then fix it.
9. Loosen the tourniquet.
10. Check for pain, swelling and haematoma.
11. Adjust the flow rate as required.
12. After injection, remove needle, press cotton, dispose the waste safely.
13. Secure with adhesive tape.
Method of administration of intravenous infusion:

Fig. 4.7