Intravenous and Intramuscular Medications (Nursing)

00:01 So, that was looking at oral route.

00:04 Now let's look at IV.

00:06 Remember we talked about if I was in pain, would I want an oral med or an IV med? No, this is what I would want, and let me tell you why.

00:14 Because the rate of time to the bloodstream is…instantaneous, okay? It's immediate, because you put the drug into the bloodstream.

00:22 That's why it's called IV or intravenous.

00:24 Now, what's the impact of the first pass effect? Now I see that it says "none" there, but pause the video for just a second and see if you can think through why there isn't an impact of first pass effect with an IV medication.

00:41 Okay.

00:42 Hopefully, you were able to think through that the reason there's no impact of first pass effect is because it doesn't go through the GI tract, right? Only oral medications go through the GI tract.

00:52 We're talking about IV meds are directly right into the blood vessels.

00:57 Time of onset, very fast.

00:59 Remember, oral is the slowest of the routes, but this one is very fast.

01:05 Now, the amount of fluid volume.

01:06 Sometimes, you have a high volume of fluid.

01:09 Now, this is good for drugs that need large volumes of water.

01:13 So, if I have a medication that needs to be in a large volume of fluid, I want to give it IV versus IM or subQ.

01:21 Your body can't handle that much medication given intramuscularly or subQ.

01:27 So if it needs a lot of fluid volume for the drug to be diluted where it doesn't cause harm to the patient, IV fluid is a great route.

01:35 Irritant drugs are really good to be given IV because the body's normal blood flow will help dilute that and minimize tissue damage.

01:44 Disadvantages.

01:45 Well, this is usually pretty costly, and it's not super convenient, right? You have to have an IV started.

01:51 We can do those some at home, but predominately, that's done in the hospital setting.

01:55 Now, safety factors are different for IV than it is for oral because you do have a risk for infection, because you have to break the skin.

02:04 Anytime you break the skin, you have risk for infection.

02:08 Also, fluid volume overload can be a real problem.

02:10 If we have a patient who is…their heart's not doing well or their kidneys aren't doing well, or they're really prone to a very sensitive fluid volume balance, if we have to give something IV that might also be a problem.

02:22 Now we talked about reversibility with oral meds.

02:25 Remember, that was one of the positives of oral medications.

02:28 But with IV medications, there is no turning back.

02:31 Once you give the drug, it goes right into the bloodstream, so we have a very short period of time to try and reverse that medication.

02:39 Okay, so we've looked at oral, we've looked at intravenous.

02:43 Now we're going to look at IM; nobody's favorite.

02:47 Nurses don't like to give this type of medications and patients don't like to receive it, but if you do it well, it shouldn't be as painful for your patients.

02:55 So you really want to pay attention to the techniques that they'll teach you in your clinical labs.

03:00 So, intramuscular goes in the interstitial space of the muscle tissues.

03:04 So, rate of time to the bloodstream, yeah, here's another one that's variable.

03:09 Remember IV, immediate.

03:10 Oral, really variable.

03:12 Also IM is variable, it just depends on the drug solubility.

03:16 Is it water soluble? Then it'll go faster.

03:19 Is there good blood flow to the site? Then they'll make it faster.

03:23 Does it have to pass through capillary walls versus cell membranes to get into the bloodstream? That will also impact the time.

03:29 So the takeaway point for IM medications is the rate of time to the bloodstream… it's variable.

03:35 So it just depends on lots of things that have to do with solubility.

03:39 Okay, let's talk about amount of fluid volume.

03:42 Remember with IV medications, you can actually use larger volumes of fluid.

03:48 For IM medications it's good for drugs that don't dissolve well in water.

03:53 They're not good IV candidates, but you can't put them in very much volume.

03:57 Time of onset is actually relatively fast, usually 10 to 30 minutes.

04:02 Now, we can also use what we call depot IM and it can last for hours or weeks.

04:07 And that's where you inject it into the muscle, and it's intended to last over a long period of time.

04:13 But most drugs are given just straight IM.

04:15 It's relatively fast within 10 to 30 minutes.

04:18 So what's the disadvantages? Well, it's not as expensive as IV, but it's not necessarily as convenient.

04:24 Now, a patient can take a pill a lot easier, but it doesn't require as much equipment to use an IM medication as it would an IV medication.

04:33 Now safety risk, once again, you're breaking the skin, so there's risk for infection or bleeding.

04:38 And if someone's taking an anticoagulant, something that's like a blood thinner, then they're going to bleed longer after you give the IM medication.

04:48 Okay.

04:48 So the rate of time to bloodstream.

04:51 Now we take subQ, it's just subcutaneous.

04:54 It means that we're not giving it deep into the muscle.

04:56 We're giving it right in the tissue.

04:58 So the rate of time in the bloodstream is, again, variable.

05:01 So when you're looking at the different routes, really, the only one that was consistent was IV, right? You had oral, is variable; IM is variable.

05:11 IV was the only one that was super consistent because we put it right into the bloodstream.

05:16 But the rate of time for subQ is variable.

05:19 Again, it's back to drug solubility, just like we talked about with the other routes of medication.

05:24 As far as the amount of fluid, this is also good for drugs that don't dissolve well in water, so they wouldn't be great as IVs, just like we talked about with the IM.

05:35 Time of onset, look, this should look familiar to you, relatively fast; 10 to 30 minutes or slow, just like it was for the IM depot.

05:44 Disadvantages? Similar to IM, cost and convenience.

05:49 You're also…you can teach patients to give themselves subQ medication, but that does require a lot of patient education and not a lot of people are comfortable with sticking themselves.

05:58 So that does require some extra time with them to help them feel comfortable for it.

06:02 Anytime you break the skin, you have risk for infection or bleeding.

06:06 And if you've got someone on anticoagulant therapy, you want to keep pressure on that for an extended period of time.