Why intravenous injection

Only two out of the nine children receiving SC epinephrine achieved C max by 5 minutes, while six out of the eight children receiving IM epinephrine achieved C max by 5 minutes. Fatal anaphylaxis is associated with delayed epinephrine administration. Therefore, the IM route of injection is preferable during an episode of systemic anaphylaxis.

A retrospective review in a military hospital showed that epinephrine was given largely by the SC route and no IM epinephrine was administered. Greater educational efforts and collaboration are needed between the allergy community and other providers regarding the importance of administering epinephrine intramuscularly. The advantage of IM administration over SC administration is challenged by the anatomical site of injection.

Simons et al conducted a prospective, randomized, blinded, placebo-controlled, six-way cross-over study of IM versus SC injection of epinephrine 0. An identical dose of epinephrine injected IM into the deltoid did not result in significant elevation of C max in comparison with endogenous epinephrine concentrations measured after saline solution injections.

Therefore, IM injection of epinephrine into the thigh was recommended as the preferred route and site of injection of epinephrine in the initial treatment of anaphylaxis; otherwise, the advantage of IM epinephrine versus SC epinephrine will disappear. The SC group exhibited faster and more pronounced effects in decreasing new cortical lesions development and cortical atrophy progression compared with IM group.

For the treatment of rheumatic diseases, the antimetabolite drug methotrexate MTX can be administered weekly by different routes: oral, SC, or IM. Studies compared the serum concentrations and the pharmacokinetics of low-dose MTX after both IM and SC injections in patients with rheumatoid arthritis. SC administration may be a more convenient and less painful way of administering low-dose MTX.

Although serum MTX levels were not significantly affected by the route of administration, seven out of eight preferred self-administration by the SC route at home. Self-administration was associated with reduced hospital visits and improved patient satisfaction; therefore, parenteral MTX should be prescribed by the SC route instead of the IM route.

The total smaller volume of administered drug and the improved usability of a pre-attached needle in combination with a smaller prefilled syringe resulted in preference of the patients of HC over MC. Human chorionic gonadotropin hCG is used to induce final oocyte maturation and to provide luteal phase support during in vitro fertilization treatment.

SC administration achieves a significantly higher hCG level in serum SC hCG obtains the desired clinical effects with less patient inconvenience. Hahner et al evaluated the pharmacokinetics and safety of hydrocortisone after SC and IM injection mg and after SC administration of sodium chloride 0.

Both IM and SC injections increased serum cortisol rapidly and were well tolerated. Regarding the administration route of hydrocortisone, eleven SC administration of mg hydrocortisone shows excellent pharmacokinetics for emergency use with a good safety profile and is preferred by patients over IM injection. A prospective randomized double-blind cross-over study compared intermittent IM and SC morphine boluses for postoperative analgesia. Patients received 0. The majority of patients indicated a strong preference for the SC route despite no significant differences in pain scores, respiratory rate, arterial oxygen saturation, heart rate, mean arterial pressure, sedation, or nausea scores between IM and SC administration of morphine.

Postoperative analgesia by SC morphine bolus injection is as effective as IM injection with a similar side-effect profile but with greater patient acceptance and less risk.

Significantly shorter mean T max and greater mean C max were achieved following SC dosing of morphine with rHuPH20 than without rHuPH20, although the extent of exposure of morphine was similar.

Some medications have been observed with the existence of optimal injection route Table 1. Obviously, it is inappropriate to simply say that one injection route is overwhelmingly better than another route. With respect to insulin and ketamine, there seems to be conflict over whether IV is superior to SC. This can also partly be explained by the fact that the ketamine dose was different between two studies 0.

The belief that insulin delivered by the IV route should act more rapidly and decrease blood glucose levels faster than the SC route has become questionable because continuous SC insulin infusion using an insulin pump seemed to control the glycemia better compared to IV insulin infusion in medical intensive care unit patients. Bodur et al explained that continuous SC insulin infusion could avoid extra problems brought by IV insulin infusions including fold dilution 50 IU in 50 mL which may bring slight variations in the preparation of the final syringe and change the concentration of insulin considerably, adsorption of insulin to the surface of the syringe and the lines, and sharing the lumens of central catheters where other treatments are streamed with the potential for interference with infusion rates.

Safety, efficacy, patient preference, and pharmacoeconomics are four principles governing the choice of injection route Figure 2. Safety and efficacy must be the preferred principles to be considered. Firstly, clinicians should know whether there is a contraindicational route in some cases. Prescribing information for some medications has described the IV, SC, or IM route-related contraindication information.

For example, calcium gluconate injection is only for IV use. SC or IM injection may cause severe necrosis and sloughing, and thus, they are contraindicational routes.

SC promethazine is contraindicated as it may result in tissue necrosis. Norepinephrine bitartrate injection must be diluted in dextrose-containing solutions prior to infusion. Use of IM and SC is contraindicated because of poor absorption and potential local necrosis due to the vasoconstrictive action of the drug.

Chlorpromazine hydrochloride injection is intended for deep IM use. The SC route is contraindicated for chlorpromazine administration to avoid causing skin irritation, while IV route is only for severe hiccups, surgery, and tetanus. Potassium chloride injection must be diluted and infused over a certain period of time. Second, literature, rather than prescribing information, has provided good suggestions regarding safety and efficacy issue in the choice of injection route.

For example, epinephrine should be given intramuscularly during an episode of systemic anaphylaxis, IM morphine should not be given for pain management, and IM redback spider antivenom should not be recommended in the treatment of redback spider bite. Besides the four principles, the following detailed factors are related with the choice of injection route:.

Sex SC-IG for lifelong treatment of primary antibody deficiencies Anatomical site of injection SC bortezomib, IM epinephrine 24 , Dose SC versus IV rituximab regarding bioavailability Administration time SC versus IV: insulin during pre-, intra-, and postoperative periods Indication SC versus IV ketamine for different purposes [postoperative analgesia and dissociative conscious sedation] 57 , Flexibility in the route of administration eg, among prescribing patterns of morphine including IV-to-oral, IV-to-SC, IV-only, SC-only and mixed mode, the mixed mode achieves the best clinical outcomes Further studies are needed.

First, it is necessary to conduct prospective intervention studies with multiple outcome measures following a switch to a more appropriate injection route.

Second, both retrospective and prospective pharmacoeconomic studies should be encouraged. Third, patient preference is important in medical decision making when choosing treatment methods because it has implications for adherence and quality of life.

Therefore, future drug efficacy and safety studies should include contemporaneous, actual patient preference where possible, utilizing appropriate measures.

Fourth, it is interesting to evaluate the association of potential determinants with the choice of injection route. For example, the effect of dosing frequency on the choice of injection route for bortezomib remains to be investigated.

In patients with multiple myeloma, once-weekly IV or twice-weekly SC bortezomib has been proven to offer non-inferior efficacy and improved safety profile compared with standard twice-weekly IV administration. We did not focus on one point in the form of a Cochrane-style systematic review or meta-analysis because controversial conclusions derived from comparative studies of injection routes are currently rare and our objective is to enrich the knowledge of optimally selecting administration route following a panorama investigation.

Second, we did not include the comparative studies of injection routes without any difference in efficacy, safety, cost, or patient preference, and such exclusion criteria would restrict the vision of advantages brought by SC administration. For example, even though insignificant difference in safety and efficacy has not been observed when comparing SC route and IV route, SC administration may still be preferred because it is usually more time efficient for the patient and institution.

However, a new horizon might be opened up by this updated review with plenty of new findings. In this updated review, we summarized the findings of comparative studies of different injection routes, which will enrich the knowledge of safe, efficacious, economic, and patient preference-oriented medication administration as well as catching research opportunities in clinical nursing practice.

Patients are complex because of biological, medical, socioeconomic, and cultural factors. Personalized therapeutics would go deep into routine practice and improve patient-specific outcomes if clinical practitioners perform comprehensive interventions, such as optimally choosing administration route, dosage and administration consultation services provided by pharmacy, prospective review of the appropriateness of physician orders by pharmacists, and phar-macotherapeutic monitoring following injection therapy.

National Center for Biotechnology Information , U. Journal List Patient Prefer Adherence v. Patient Prefer Adherence. Published online Jul 2. Author information Copyright and License information Disclaimer. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

This article has been cited by other articles in PMC. Abstract Background Intravenous IV , intramuscular IM , and subcutaneous SC are the three most frequently used injection routes in medication administration. Conclusion This updated review of findings of comparative studies of different injection routes will enrich the knowledge of safe, efficacious, economic, and patient preference-oriented medication administration as well as catching research opportunities in clinical nursing practice.

Keywords: administration route, dosage and administration, efficacy, medication safety, patient preference, pharmacoeconomic. Introduction Injections are among the most common health care procedures throughout the world, with at least 16 billion administered in developing and transitional countries each year. Open in a separate window. Figure 1. Results SC versus IV Trastuzumab Trastuzumab is a key agent for human epidermal growth factor receptor 2 HER2 -positive breast cancer in both the early and metastatic settings.

Antitumor necrosis factor medications Antitumor necrosis factor anti-TNF medications are indicated for the treatment of chronic inflammatory conditions such as rheumatoid arthritis, inflammatory bowel disease, and psoriasis.

Bortezomib Bortezomib is indicated for treating relapsed multiple myeloma and mantle cell lymphoma. Amifostine Amifostine is a cytoprotective agent. Recombinant human granulocyte-macrophage colony-stimulating factor Recombinant human granulocyte-macrophage colony-stimulating factor rhGM-CSF can stimulate the production of white blood cells and thus prevent neutropenia following chemotherapy.

Granulocyte colony-stimulating factor Granulocyte colony-stimulating factor G-CSF can stimulate the bone marrow to produce granulocytes and stem cells. Recombinant interleukin-2 Recombinant human interleukin-2 rIL-2 has demonstrated survival benefits over chemotherapy for the majority of patients with metastatic renal cell carcinoma mRCC.

Insulin Bodur et al compared continuous SC insulin infusion via an insulin pump with the traditional continuous IV infusion method for tight glycemic control among patients in medical intensive care unit. Ketamine Ketamine can suppress hyperalgesia and allodynia. Opioids Daoust et al assessed the impact of age, sex, and route of administration on the incidence of adverse events due to opioid administration in the emergency department.

IM versus IV Epinephrine Epinephrine has a pivotal role as first-line treatment for acute anaphylaxis. Pegaspargase Pegaspargase, a modified version of L-asparaginase that is covalently conjugated to monomethoxypolyethylene glycol, is important for treatment of acute lymphoblastic leukemia. Antibiotics Generally, antibiotics available for IM injection should be considered as an economically efficient alternative to IV injections in appropriate patients.

Morphine IV morphine has a more rapid and extensive initial effect compared with IM, which is supported by the findings of the pharmacokinetic study by Dale et al. IM versus SC Epinephrine A prospective, randomized, blinded, parallel-group study in 17 children with a history of anaphylaxis compared two injection methods SC injection of 0. Methotrexate For the treatment of rheumatic diseases, the antimetabolite drug methotrexate MTX can be administered weekly by different routes: oral, SC, or IM.

Human chorionic gonadotropin Human chorionic gonadotropin hCG is used to induce final oocyte maturation and to provide luteal phase support during in vitro fertilization treatment. Hydrocortisone Hahner et al evaluated the pharmacokinetics and safety of hydrocortisone after SC and IM injection mg and after SC administration of sodium chloride 0. Morphine A prospective randomized double-blind cross-over study compared intermittent IM and SC morphine boluses for postoperative analgesia.

Discussion Principles and detailed factors determining the choice of injection route Some medications have been observed with the existence of optimal injection route Table 1. Table 1 Medications that have been observed with advantages of one route over the other route. Figure 2. Principles and affecting factors associated with the choice of injection route.

Abbreviation: BMI, body mass index. Further research opportunities Further studies are needed. Conclusion In this updated review, we summarized the findings of comparative studies of different injection routes, which will enrich the knowledge of safe, efficacious, economic, and patient preference-oriented medication administration as well as catching research opportunities in clinical nursing practice.

Footnotes Disclosure The authors report no conflicts of interest in this work. References 1. Pharmaceutical drug use principle issued. Correct recognition and management of anaphylaxis: not much change over a decade.

Postgrad Med J. Gabriel J. Intravenous versus subcutaneous access for palliative care patients. Br J Nurs. Intravenous versus subcutaneous drug administration. Switching from intravenous to subcutaneous formulation of abatacept: a single-center Italian experience on efficacy and safety.

J Rheumatol. Subcutaneous drug delivery: a route to increased safety, patient satisfaction, and reduced costs. J Infus Nurs. Sanford M. Subcutaneous trastuzumab: a review of its use in HER2-positive breast cancer. Target Oncol.

Ann Oncol. PrefHer Study Group Preference for subcutaneous or intravenous administration of trastuzumab in patients with HER2-positive early breast cancer PrefHer : an open-label randomised study. Lancet Oncol. Comparison of subcutaneous versus intravenous administration of rituximab as maintenance treatment for follicular lymphoma: results from a two-stage, phase IB study.

J Clin Oncol. Subcutaneous vs intravenous rituximab in patients with non-Hodgkin lymphoma: a time and motion study in the United Kingdom. J Med Econ. Subcutaneous absorption of monoclonal antibodies: role of dose, site of injection, and injection volume on rituximab pharmacokinetics in rats.

Pharm Res. Effects of subcutaneous and intravenous golimumab on inflammatory biomarkers in patients with rheumatoid arthritis: results of a phase 1, randomized, open-label trial. Rheumatology Oxford ; 52 — Considering patient preferences when selecting anti-tumor necrosis factor therapeutic options. Am Health Drug Benefits. Subcutaneous versus intravenous administration of bortezomib in patients with relapsed multiple myeloma: a randomised, phase 3, non-inferiority study.

Pharmacokinetic, pharmacodynamic and covariate analysis of subcutaneous versus intravenous administration of bortezomib in patients with relapsed multiple myeloma. Clin Pharmacokinet. Updated survival analysis of a randomized phase III study of subcutaneous versus intravenous bortezomib in patients with relapsed multiple myeloma.

Subcutaneous versus intravenous bortezomib: efficiency practice variables and patient preferences. Ann Pharmacother. High incidence and severity of injection site reactions in the first cycle compared with subsequent cycles of subcutaneous bortezomib. Other risks include infection at the site where the IV needle is inserted. The needle could also become dislodged, causing the solution to enter the surrounding tissues.

Entrusting your IV therapy to a registered medical professional will lower these risks. At Infusion Associates, we provide medically-prescribed infusion therapy for patients in a welcoming and friendly environment. Our team of healthcare professionals is fully committed to making the experience as comfortable as possible for you or your patients.

We always inform patients of any potential side effects and answer all their questions before starting treatment. In addition, we have a Registered Pharmacist on-site to make the process as seamless as possible. If you would like to refer a patient to us or want to inquire about the treatments we offer, you can contact us by calling us at or filling out this form. Skip to content.

Lower MI Plymouth, MN How an IV Works In medical terms, intravenous — or IV, for short — refers to the administration of substances into the body through a vein or veins.

There are two primary methods of IV therapy: 1. Injection Injection works by using a syringe to force a liquid into the body. In addition to being given intravenously, Injections can also be given through different routes, such as: Intradermal injections are given directly into the dermis the middle layer of the skin. This has the slowest absorption rate of the injection types, and is generally reserved for things like sensitivity tests. Intramuscular IM injections are given deep into a muscle and absorbed rapidly by blood vessels.

These injections, such as flu shots and epi-pens, are often given in the thigh, shoulder, or butt. Spread the skin taut below the planned injection site using a thumb or fingers of one hand.

Alternatively ask the patient to open and close their fist several times. Clean and disinfect the planned injection site using a single-use alcohol swab or single-use cotton swab with disinfectant solution. Start over the planned injection site and work outwards. Allow the disinfectant to dry completely.

When blood is seen in the syringe, release the tourniquet and inject the drug this is usually done slowly , then withdraw the needle. Compress the injection site with a sterile gauze immediately after the needle is removed to stop bleeding, then protect it with a small adhesive dressing. Dispose of all sharps securely in a sharps container. Do not recap needles to avoid needle-stick injuries. Remove gloves and perform hand hygiene.

Intravenous Injections. McMaster Textbook of Internal Medicine. Accessed November 11, Last Updated: March 2,