Patient Care · Pharmacology and contrast2 min read5-question check
Medications and Routes
Know the route, check the six rights, and recognize the crash cart drugs. Give drugs only on order and within policy.
The routes
A route is the path a drug takes into the body. Enteral routes use the digestive tract: oral, sublingual (under the tongue), buccal (in the cheek), and rectal. A drug given through a nasogastric tube is also enteral. Parenteral means outside the digestive tract and usually refers to injection. Topical drugs go on the skin or mucous membranes. Inhaled drugs reach the lungs as a gas or mist.
Injection depth
The four injection routes differ by depth and needle angle. Intradermal goes just under the top layer of skin at about 10 to 15 degrees, as in a TB skin test. Subcutaneous goes into the fatty layer at about 45 degrees, as with insulin or heparin. Intramuscular goes into muscle at 90 degrees. Intravenous goes straight into a vein and acts fastest. That is why contrast and most emergency drugs are given IV.
The numbers
Before any drug is given, check the six rights: right patient, drug, dose, route, time, and documentation. Some facilities add more, such as right reason. Read the label three times. Worked example: an order calls for diphenhydramine 25 mg IV, and the vial holds 50 mg per mL. Divide 25 by 50 to get 0.5 mL. Know the emergency cart drugs by use: epinephrine for anaphylaxis and cardiac arrest, diphenhydramine for mild allergic reactions, atropine for a slow heart rate, naloxone to reverse opioids, nitroglycerin for chest pain, and 50% dextrose for low blood sugar.
On the job
Radiographers give contrast and certain drugs only on the order of a licensed practitioner, and only where state law and facility policy allow. Ask about allergies and current medications before injecting. Document the drug, dose, route, site, time, and the patient's response. If an order is unclear, ask before giving anything. A drug cannot be taken back once it is in a vein.
Clinical Example
A patient develops a few hives after a CT contrast injection. The radiologist orders diphenhydramine 25 mg IV. The technologist confirms the patient's name and birth date, checks the vial strength, draws up 0.5 mL, and documents the dose, time, and response.
Common Mistakes
- Calling every injection enteral; enteral means the GI tract, parenteral means outside it.
- Mixing up naloxone, which reverses opioids, with flumazenil, which reverses benzodiazepines.
- Giving diphenhydramine alone for anaphylaxis, when epinephrine is the first-line drug.
- Skipping documentation, which is one of the six rights.
Why It Matters
The registry tests routes, needle angles, the rights of administration, and matching emergency drugs to their uses. It also expects you to know the limits of technologist practice.
Key Relationships
- Enteral → GI tract; parenteral → injection
- Intradermal 10 to 15° → subcutaneous 45° → intramuscular 90°
- Anaphylaxis → epinephrine; mild hives → diphenhydramine
- Opioid overdose → naloxone; slow heart rate → atropine