What does it mean to administer a medicine parenterally? This is a parenteral route of infection. How to administer medications correctly
The term "parenteral" means "bypassing the intestines." That is, with this method of administration, medicinal substances are not absorbed in the gastrointestinal tract, but penetrate, for example, through the skin or are injected directly into the bloodstream. Most often, parenteral administration means injection - using injections - or infusion - using droppers - penetration of the drug into the patient’s body. And few people think that when applying medicine in the form of an ointment, gel or cream to the skin, mucous membranes or instilling drops into the nasal passages, we also use them parenterally.
Advantages of parenteral administration of drugs
The main problem with taking tablets, suspensions or solutions orally enterally, that is, dissolving in the mouth, swallowing or inserting into the rectum, is the complex set of biochemical interactions to which the drug is subjected. It is obvious that a whole series of chemical reactions, the aggressive environment of the stomach and duodenum, and so on - all these factors are capable of modifying the original substance to such an extent that it loses its original healing properties, and may acquire new, completely undesirable ones. Therefore, when the drug enters directly into the bloodstream, this greatly simplifies and speeds up its delivery to the necessary systems of the body. Thanks to this, the dosage of the active ingredient can be reduced and precisely adjusted.
Do not forget that many substances can undermine the health of the digestive system. For example, change the acidity of gastric juice or damage the mucous membrane. From this point of view, the administration of many drugs parenterally can also be considered safer.
Also, this method of using drugs makes it possible to treat unconscious, weakened patients, infants, and so on. For these groups of patients, parenteral nutrition can also be used. That is, introducing the components necessary to maintain metabolism directly into the bloodstream. In this way, the patient can receive glucose, proteins, and water-salt solutions.
Disadvantages of parenteral drug administration
But any method has not only advantages. The parenteral route, when the medicine is administered by injection or infusion, can also become a way for pathogenic bacteria to enter the body. Therefore, it is so important to maintain strict sterility of solutions and instruments and, in addition, to treat the injection site in accordance with all sanitary rules.
Also, this method of administration is traumatic. The injection can result in local capillary ruptures, bruises, and hematomas. Some drugs are poorly absorbed, forming a nodule at the injection site. Often the emotional sphere of the patient also suffers, because it is difficult to find a person who is not at all afraid of injections.
Many patients also fear that air bubbles will enter the vascular bed along with the medicine, which may impede blood flow. This condition is called embolism. More often it is caused by blood clots, blood clots or detached atherosclerotic plaques. Sometimes embolism is fatal. But the correct injection or infusion technique guarantees a person from getting such dangerous air into his vessels.
Thus, it is worth recognizing the parenteral method of drug administration as extremely successful. It significantly expands the capabilities of modern medicine. If parenteral administration of drugs is recommended for a certain pathology, then you should not refuse this because of fear of injections or IVs. Since the effectiveness of such therapy will be noticeably higher.
Parenteral administration is the introduction of drugs into the body by “bypassing” the digestive tract. As a rule, it is used in cases where it is necessary to provide assistance immediately, one might even say urgently. Most often, the term parenteral administration refers to administration in various ways:
Intravenous - ensures the fastest achievement of the expected effect (2-5 minutes). The amount of medication that needs to be administered determines how the injection will be administered. Up to 100 ml a syringe is used, more than 100 ml - a dropper.
Subcutaneous and is used when the amount of the required drug is up to 10 ml. The effect is achieved in 10-30 minutes.
Intra-arterial administration is used in cases where the drug needs to act only on a specific organ, without affecting the rest of the body. With this method, drugs break down in the body at a very high speed.
Parenteral administration also includes the application of medications to the skin in the form of creams and ointments, instillation of drops into the nose, electrophoresis, and inhalation.
advantages
The main advantages of parenteral administration of drugs are the accuracy of dosage and the speed of action of the drugs. After all, they enter directly into the blood and, importantly, unchanged, in contrast to enteral (oral) administration.
When using parenteral administration, it is possible to treat people who are unconscious or very weakened. By the way, for this type of patient or for those who have had a metabolic failure, it is also used. It is also based on the introduction of nutritional components necessary to maintain life (proteins, glucose, etc.). For many, parenteral nutrition is the so-called diet for metabolic disorders.
Flaws
But despite its many disadvantages, at the moment parenteral administration is the most reliable and effective method of getting drugs into the human body. Therefore, if you are given a choice - to take pills or give injections, then you can safely choose the second, since its effectiveness is much higher. And you shouldn’t be afraid of injections or IVs at all, because sometimes only their use can save a person’s life.
Many doctors believe that when administered parenterally, NSAIDs have a more powerful analgesic effect compared to the use of standard tablet forms. Of course, there is no doubt that intravenous administration of NSAIDs, which ensures that the peak concentration of the drug in the blood plasma is achieved in the first minutes, has the fastest possible therapeutic effect. But doctors of therapeutic specialties resort to this method of using NSAIDs quite rarely. In addition, only a few representatives of the NSAID group, available on the Belarusian pharmacological market in the form of solutions for parenteral use, are approved for intravenous administration. But the widespread practice in our country is the prescription of NSAIDs in the form of intramuscular injections, often in courses that significantly exceed the time limits for using such a dosage form prescribed by the manufacturing companies. The justification for this practice is the idea of not only greater effectiveness, but also better tolerability of these drugs when administered parenterally (“does not irritate the stomach”).
However, this idea does not stand up to serious criticism. The severity of the effect of any drug depends on its concentration in the blood plasma, regardless of the pharmacological route through which it entered the human body. The high (almost 100%) bioavailability of modern oral forms of NSAIDs ensures a stable therapeutic concentration of the active substance in plasma, which is determined, accordingly, only by the prescribed dose. Therefore, if the patient receives NSAIDs regularly for several days and taking into account the half-life of the drug (i.e., observing the prescribed frequency of administration), its effectiveness will be identical when using any pharmacological forms.
Thus, if the patient receives NSAIDs regularly for more than one day, then it makes sense to limit himself to only 1-2 intramuscular injections, the advantage of which, in comparison with tablets and capsules, can only be determined by the faster onset of the analgesic effect.
Although this point also raises serious doubts. Modern tablet forms of NSAIDs provide not only maximum bioavailability, but also minimal absorption time of the active substance. Thus, celecoxib 200–400 mg after oral administration is found in plasma within 30 minutes at a concentration of 25–50% of the maximum and begins to have an analgesic effect. These data were obtained not only from experimental work, but also from serious experience in using this drug to relieve acute pain - in particular, in dental practice.
There are many studies that have compared the effectiveness of NSAIDs when administered orally and intramuscularly. Thus, in a study conducted on volunteers, lornoxicam in the form of instant tablets showed Tmax and Cmax values similar to intramuscular administration of this drug. The speed of action of rapid tablet forms, quite comparable with intramuscular administration, has been shown for ibuprofen, diclofenac potassium and ketorolac.
The lack of real benefits of intramuscular administration of NSAIDs is very clearly demonstrated by the work of Neighbor M. and Puntillo K. (1998). The authors compared the analgesic potential of ketorolac 60 mg intramuscularly and ibuprofen 800 mg orally in 119 patients with acute pain admitted to the emergency department. To comply with the standard of a “double-blind study,” patients receiving NSAID injections were given a placebo capsule per os, and those receiving NSAIDs orally were given a placebo injection (saline solution). The level of pain relief was assessed at 15, 30, 45, 60, 90 and 120 minutes. According to the results obtained, no significant difference was found either in the speed of onset of the analgesic effect or in the severity of pain relief between the study groups.
A separate issue is the use of NSAIDs in the form of rectal suppositories. There is evidence that this route of administration of NSAIDs gives the same rapid analgesic effect as intramuscular administration. Theoretically, rectal (as well as parenteral) administration of NSAIDs avoids the initial decrease in drug concentration in the blood due to the elimination of a significant amount of it by the liver (the “first pass” phenomenon). However, clear evidence regarding the advantage of rectal suppositories in terms of the speed of onset and severity of the therapeutic effect in comparison with oral forms has not yet been obtained.
The opinion that rectal suppositories are better tolerated and less likely to cause side effects from the upper gastrointestinal tract is only partly justified and concerns a slightly lower incidence of dyspepsia. Serious complications, such as the development of ulcers or gastrointestinal bleeding, occur no less often when using NSAIDs in the form of rectal suppositories than when taking them orally. According to Karateev A.E. et al. (2009), the frequency of ulcers and multiple erosions in patients taking NSAIDs in the form of suppositories (n=343) was 22.7%, while in patients (n=3574) taking NSAIDs orally - 18.1% ( p<0,05). Причина этого совершенно очевидна – поражение верхних отделов ЖКТ связано с системным влиянием НПВС на слизистую оболочку ЖКТ, развивающимся после попадания этих препаратов в плазму крови, и вследствие этого абсолютно не зависит от фармакологического пути.
On the other hand, rectal administration of NSAIDs can in some cases lead to severe local complications from the distal parts of the intestinal tube - clinically pronounced proctitis, ulceration of the rectal mucosa and rectal bleeding.
Therefore, the main indication for the use of NSAIDs in the form of rectal suppositories is the inability to take these drugs orally and the presence of a special addiction of patients to this pharmacological form.
Nowadays, technologies have appeared in medicine that can only be called fantastic. It would seem that against the general background of the triumph of a medical genius, the death of a patient due to non-compliance with sanitary standards in a medical institution should be long forgotten. Why is the artificial route of infection gaining momentum in our prosperous times? Why are staphylococcus, hepatitis, and HIV still “walking” in hospitals and maternity hospitals? Dry statistics say that the frequency of only purulent-septic infections in hospitals has increased by 20% in recent years, and their share in intensive care units is 22%, in surgery up to 22%, in urology over 32%, in gynecology 12%, in maternity hospitals ( 33%).
Let us clarify that the artificial route of transmission of infection is the so-called artificial infection of humans in medical institutions, mainly during invasive procedures. How does it happen that people admitted to the hospital for treatment of one disease also develop other diseases there?
Natural infection
With all the variety of opportunities to catch an infection, there are only two mechanisms for transmitting microbes from a sick person to a healthy one:
1. Natural, depending on the person’s compliance with the norms and rules of hygiene.
2. Artificial or medically artificial route of transmission of infection. This is a mechanism that is almost entirely dependent on medical staff complying with their duties.
In the natural way, the introduction of pathogenic microorganisms can occur when a person comes into contact with a pathogenic environment. Routes of infection:
Airborne, that is, when sneezing, coughing, talking (flu, tuberculosis);
Fecal-oral, that is, through dirty hands, water and food (infectious diseases of the gastrointestinal tract);
Contact household (a very wide range of infections, including sexually transmitted infections, skin infections, helminthiasis, typhus, diphtheria and dozens of others).
Incredibly, this is how you can catch any illness by entering a hospital for treatment.
Artificial infection
In medical institutions, there are two main ways of infecting patients, which are characterized as the official route of transmission. This:
1. Parenteral, that is, associated with a violation of the patient’s skin. 
2. Enteral, possible during certain types of examination of patients, as well as during certain therapeutic procedures.
In addition, the same natural mechanism of infection transmission is thriving in hospitals, repeatedly aggravating the condition of patients. It turns out that you can catch the infection during the medical procedures of doctors and nurses, as well as simply while staying in the hospital.
Causes of infection of patients in medical institutions
Where do conditions arise in hospitals for patients to become infected naturally, and how does it affect the artificial mechanism of transmission of the infection. The reasons are:
1.There are always many infected people in hospitals. In addition, about 38% of the population, including healthcare workers, are carriers of various pathogens, but people are not aware that they are carriers.
2. An increase in the number of patients (old people, children) who have a significantly reduced threshold of their body’s resistance.
3. Consolidation of highly specialized hospitals into large complexes, where, willingly or unwillingly, a specific ecological environment is created.
In some cases, the patient is artificially infected during dressing changes if the nurse, who is the carrier, does not perform her work wearing a protective mask and gloves. Conversely, a patient can infect a healthcare worker if he performs medical procedures (blood sampling, dental treatment, etc.) without a protective mask, gloves, or special glasses. 
Work of junior medical staff
What in this case determines the artificial route of transmission of infection? This is primarily full or insufficient compliance with sanitary standards. Random checks have shown that in many hospitals, orderlies clean wards, manipulation rooms, and even operating rooms poorly. Namely, all surfaces are treated with one cloth, disinfectant solutions for cleaning premises are prepared in lower concentrations than required by standards, wards and offices are not treated with quartz lamps, even if they are available and in good condition.
The situation is especially sad in maternity hospitals. Artificial infection of the fetus or woman in labor, for example, with purulent-septic infections, can occur due to violation of antiseptic rules when treating the umbilical cord, during obstetrics and further care. The reason may be the simple absence of a mask on the face of a nurse or orderly, who is a carrier of pathogenic microbes, not to mention poorly sterilized instruments, diapers, and so on. 
Antibiotics
As noted above, people are often admitted to the hospital with an unclear diagnosis. The patient is prescribed laboratory examinations, as well as modern diagnostic methods, in which the enteral route of introduction (through the mouth) of the corresponding equipment into the body cavity is used. While test results are being prepared, the practice has been to prescribe broad-spectrum antibiotics. This in a small part causes positive dynamics, and in a large part leads to the creation of pathogen strains inside the hospital that do not respond to influences directed against them (disinfection, quartz treatment, drug therapy). Natural pathways allow these strains to spread throughout the hospital. Unjustified prescription of antibiotics was observed in 72% of patients. In 42% of cases this was in vain. In the country as a whole, due to unjustified antibiotic treatment, the infection rate in hospitals reached 13%.
Diagnosis and treatment
It would seem that new diagnostic methods should help quickly and accurately identify all ailments. This is all true, but to prevent artificial infection of patients, diagnostic equipment must be handled correctly. For example, a bronchoscope must be disinfected for ¾ hours after each patient. Checks have shown that this is rarely observed, because doctors must examine not 5-8 patients according to the norm, but 10-15 according to the list. It is clear that they do not have enough time to process the equipment. The same applies to gastroscopy, colonoscopy, installation of catheters, puncture, instrumental examination, and inhalations. 
But the enteral route of drug administration reduces the level of infection. Here, only the duodenal method poses a threat, when the medicine is administered using a probe directly into the duodenum. But oral (taking medicines and tablets by mouth, with or without water), sublingual (under the tongue) and buccal (sticking special pharmaceutical films to the mucous membranes of the gums and cheeks) are practically safe.
Parenteral route of transmission of infection
This transmission mechanism is the leader in the spread of AIDS and hepatitis. It means the peranteral route - infection through the blood and when the integrity of the mucous membranes and skin is violated. In a hospital setting this is possible in the following cases:
Blood/plasma transfusion;
Infection through a syringe during injections;
Surgical intervention;
Carrying out medical procedures.
Artificial infection often occurs in dental clinics and when visiting a gynecologist due to the fact that doctors use improperly processed instruments to examine the mucous membranes of their patients, as well as because doctors work in unsterile gloves. 
Injections
This type of therapy has been used for a long time. When the syringes were reusable, they were subject to mandatory sterilization before use. In practice, unfortunately, it was they that led to the infection of patients with dangerous diseases, including AIDS, due to the flagrant negligence of doctors. Nowadays, only disposable syringes are used for treatment (intravenous and intramuscular injections) and for drawing blood for tests, so the risk of artificial infection is minimized here. Before the procedure, healthcare workers are required to check the tightness of the syringe packaging and under no circumstances reuse it or the needle for further manipulations. The situation is different with instruments for endoscopes (needles, biopsy syringes, etc.), which in practice are not processed at all. At best, they are simply immersed in disinfectant solutions.
Operations
A high percentage of infection occurs during surgery. It is curious that in 1941-1945, 8% of wounded infections were recorded, and in our time, postoperative rates of purulent-septic infections have increased to 15%. This happens for reasons:
Use of poorly sterilized dressings during or after surgery;
Insufficient sterilization of cutting or non-cutting instruments;
Widespread use of various implants (in orthopedics, dentistry, cardiology). Many microorganisms are able to exist inside these structures; in addition, they cover themselves with a special protective film, making them inaccessible to antibiotics. 
Disinfection should be carried out in special containers, autoclaves or chambers, which depends on the sterilization method. Now in operating rooms they are trying to use disposable sterile sheets, clothes for surgeons and patients, which should reduce the level of artificial infection. To exclude infection through implants, after surgery, patients are given enhanced antibacterial therapy.
Blood transfusion
It is believed that through blood transfusion you can only catch syphilis, AIDS and two hepatitis viruses, B and C. It is these pathogens that donated blood is tested for at collection points. But practice shows that even using only disposable syringes, hepatitis viruses D, G, TTV, toxoplasmosis, cytomegalovirus, listeriosis and other infections can be transmitted through blood transfusion. Before donating blood, doctors are required to check all donors for infection. In fact, there is often not enough time to carry out analyzes or there is simply negligence. Therefore, it is imperative to carefully check the blood taken from the donor. But this is not always done, so to this day, even in Moscow clinics, cases of infection of patients during blood transfusion occur. The second problem is that there are many mutated strains that even the latest test systems do not recognize. The same situation with infection occurs during donor organ transplantation.
There are 5 main routes of transmission, which will be listed below.
The artificial route of transmission is...
The artificial route of transmission of infection is an artificial infection in which the spread of an infectious agent occurs as a result of iatrogenic human activity. An example is infection with HIV infection or hepatitis during operations or blood plasma transfusion.
The vector-borne route of infection is...
The vector-borne route of transmission of infection is infection through insects:
flies (Botkin's disease, typhoid fever, dysentery, anthrax), lice (typhus), bedbugs (relapsing fever), fleas (plague), mosquitoes - anopheles (tropical malaria).
It is necessary to destroy these insects, prevent them from entering living quarters and prevent flies from coming into contact with water and food.
The parenteral route of transmission is...
The parenteral route of transmission of infection is a type of artificial infection mechanism in which the pathogen enters directly into the blood.
Airborne transmission of infection is...
The airborne route of transmission of infection is infection through the air into which tiny splashes and drops of saliva and nasal mucus containing pathogens - droplet infection (flu, sore throat, diphtheria, whooping cough, measles, scarlet fever, tuberculosis). When these splashes and drops dry, the pathogens remain in the dust for a long time (tuberculosis) - a dust infection. Infection occurs through inhalation of pathogens.
The contact route of transmission of infection is...
Contact transmission of infection is, as the name suggests, the spread of an infectious agent through direct contact. It can be carried out by several mechanisms:
Contact with a sick person (natural smallpox, chickenpox, measles, scarlet fever, mumps, Botkin's disease, etc.). Therefore, it is prohibited to enter an apartment where there are sick people. Infection from bacilli carriers. The causative agents of some infectious diseases (typhoid fever, diphtheria, scarlet fever) continue to live in the body of a recovered person for a long time. Bacilli carriers can also be people who have not had this infectious disease, but carry its causative agent, for example, during a diphtheria epidemic, up to 7% of healthy schoolchildren have diphtheria bacilli in their throats or noses. Bacilli carriers are distributors of pathogens.
The fecal-oral route of transmission is...
The fecal-oral route of transmission of infection is a mechanism of infection in which the pathogen enters the gastrointestinal tract. Infectious disease specialists identify three main mechanisms of infection transmission:
Through the discharge of patients: feces (typhoid fever, dysentery), urine (gonorrhea, scarlet fever, typhoid fever), saliva, nasal mucus. Infection also occurs when pathogens enter the mouth, so it is imperative to instill in children the habit of thoroughly washing their hands before eating. Contact with objects that an infectious patient has touched (linen, water, food, dishes, toys, books, furniture, room walls). Therefore, disinfection is carried out and it is recommended to use only your own dishes and things. Through unboiled water and milk, unwashed fruits and vegetables, pathogens of gastrointestinal diseases (paratyphoid fever, typhoid fever, dysentery, Botkin's disease) and tuberculosis enter the body. Water and milk must be boiled, and fruits and vegetables must be doused with boiling water or peeled.
Parenteral- - “bypassing the gastrointestinal tract.”
Parenteral administration of drugs- these are ways of introducing drugs into the body in which they bypass the gastrointestinal tract, in contrast to oral way of using drugs.
There are other, more rare, parenteral methods of administration: transdermal, subarachnoid, intraosseous, intranasal, subconjunctival - however, these methods of drug penetration into the body are used only in special cases.
Parenteral route of transmission of infections- infection through blood or mucous membranes as a result of transfusion of infected blood or blood products or as a result of the use of contaminated needles, syringes or other instruments that damage the skin.
Almost each of us has encountered the method of parenteral administration of a medical drug into the body. Parenteral means “bypassing or bypassing the intestines.” In other words, the drug in this case does not enter the body orally and is not processed in the gastrointestinal tract and then enters the blood. Any other method can already be considered parenteral, for example, penetration of the drug through the skin or directly through the bloodstream. Most often, parenteral administration is called:
- injection, which uses conventional injections;
- infusion or using droppers.
But not every one of us realizes that by rubbing the skin or mucous membranes with gel, ointment and cream, or putting drops into the eyes or nasal passages, we are using what is called “parenteral administration.”
The advantage of parenteral administration of drugs
The great advantage of parenteral administration of drugs over enteral administration (administration through the esophagus or rectum, absorption in the mouth) is that the latter method is accompanied by a complex set of biochemical interactions that sometimes subject the drug to severe modifications. Factors such as the aggressive environment of the duodenum and stomach, a number of certain chemical reactions, and so on, can so distort the original chemical composition of the administered healing substance that it can ultimately acquire properties that do not always meet the full therapeutic purpose. In addition, the effect of the drug in this case may not give any result for up to several hours. But when we administer the medicine directly through the bloodstream, we achieve a significant acceleration and simplification of its delivery to the necessary systems of the body. In addition, the dosage of the active substance is reduced, as well as the cost of medications.
It should also be noted that many drugs (as well as food products) can harm the digestive system: damage the liver, cause stomach ulcers, damage the mucous membrane, cause heartburn and much more. Based on this factor, parenteral administration of the substance can be considered the safest.
In addition, this method significantly expands the number of patients in need of help and who find themselves practically unattainable by treatment with other methods. Such patients include infants, weakened, unconscious, and so on. In the same cases, parenteral nutrition can be used, that is, the introduction into the body through the bloodstream of components and vitamins that support metabolism and replace food intake in the usual way. Thus, the patient’s body can receive water, proteins, glucose, water-salt solutions, etc.
Disadvantages of parenteral drug administration
But, like any other method or phenomenon, parenteral administration also has some disadvantages. When we introduce a medicinal substance into the body parenterally, by infusion or injection, there is a danger that pathogenic bacteria can pass through in the same way and infections can spread (for example, life-threatening gangrene). If the patient can take the pills on his own, then only specialists or persons competent in this field need to give injections and place IVs. It is very important to maintain a number of sanitary rules for strict control over the sterility of instruments and solutions, and to treat the area of injection or infusion.
In addition, this method of administration is also traumatic. A carelessly given injection can lead to capillary ruptures, hematomas, and bruises in the injection area. The properties of some drugs do not allow them to dissolve well enough, which leads to a nodule in the injection area.
In many cases, a psychological factor or the emotional sphere of the patient is manifested. There are probably few people who are absolutely not afraid of injections. In addition, this is another factor that prevents the correct administration of the injection. But the patient’s fears may also be natural. For example, many patients are not without concern that during an injection, small air bubbles may enter the vein along with the medicine and disrupt the normal function of blood flow. This condition is called embolism. But most often it occurs due to blood clots, blood clots, and so on. Embolism can sometimes be fatal. The qualifications of the doctor and the correct technique for performing infusions and injections sufficiently guarantee to exclude the possibility of these small air bubbles entering the patient’s bloodstream.
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