Subcutaneous Injection Sites

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Administration of Ophthalmic Medications

For instillation of ophthalmic solutions, instruct patient to lie down or tilt head back and look at ceiling. Pull down on lower lid, creating a small pocket, and instill solution into pocket. With systemically acting drugs, apply pressure to the inner canthus for 1–2 min to minimize systemic absorption. Instruct patient to gently close eye. Wait 5 min before instilling second drop or any other ophthalmic solutions.

For instillation of ophthalmic ointment, instruct patient to hold tube in hand for several minutes to warm. Squeeze a small amount of ointment (¼–½ in.) inside lower lid. Instruct patient to close eye gently and roll eyeball around in all directions with eye closed. Wait 10 min before instilling any other ophthalmic ointments.

Do not touch cap or tip of container to eye, fingers, or any surface.

Administration of Medications with Metered-Dose Inhalers

Instruct patient on the proper use of the metered-dose inhaler. There are 3 methods of using a metered-dose inhaler. Shake inhaler well. (1) Take a drink of water to moisten the throat; place the inhaler mouthpiece 2 finger-widths away from mouth; tilt head back slightly. While activating the inhaler, take a slow, deep breath for 3–5 sec; hold the breath for 10 sec; and breathe out slowly. (2) Exhale and close lips firmly around mouthpiece. Administer during second half of inhalation, and hold breath for as long as possible to ensure deep instillation of medication. (3) Use of spacer. Consult health care professional to determine method desired prior to instruction. Allow 1–2 min between inhalations. Rinse mouth with water or mouthwash after each use to minimize dry mouth and hoarseness. breath for 10 sec; and breathe out slowly. (2) Exhale and close lips firmly around mouthpiece. Administer during second half of inhalation, and hold breath for as long as possible to ensure deep instillation of medication. (3) Use of spacer. Consult health care professional to determine method desired prior to instruction. Allow 1–2 min between inhalations. Rinse mouth with water or mouthwash after each use to minimize dry mouth and hoarseness. Wash inhalation assembly at least daily in warm running water.

For use of dry powder inhalers, turn head away from inhaler and exhale (do not blow into inhaler). Do not shake. Close mouth tightly around the mouthpiece of the inhaler and inhale rapidly.

Steps for Using Your Inhaler *

1. Remove the cap and hold inhaler upright.

2. Shake the inhaler.

3. Tilt your head back slightly and breathe out slowly.

4. Position the inhaler in one of the following ways (A or B is optimal, but C is acceptable for those who have difficulty with A or B. C is required for breath-activated inhalers):

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5. Press down on the inhaler to release medication as you start to breathe in slowly.

6. Breathe in slowly (3–5 sec).

7. Hold your breath for 10 sec to allow the medicine to reach deeply into your lungs.

8. Repeat puff as directed. Waiting 1 min between puffs may permit second puff to penetrate your lungs better.

9. Spacers/holding chambers are useful for all patients. They are particularly recommended for young children and older adults and for use with inhaled corticosteroids. Avoid common inhaler mistakes. Follow these inhaler tips:.

Avoid common inhaler mistakes. Follow these inhaler tips:

• Breathe out before pressing your inhaler.
• Inhale slowly.
• Breathe in through your mouth, not your nose.
• Press down on your inhaler at the start of inhalation (or within the first sec of inhalation).
• Keep inhaling as you press down on inhaler.
• Press your inhaler only once while you are inhaling (one breath for each puff).
• Make sure you breathe in evenly and deeply.
• If you are using a short-acting bronchodilator inhaler and a corticosteroid inhaler, use the bronchodilator first, and allow 5 min to elapse before using the corticosteroid.

Other inhalers have become available in addition to the one illustrated here. Different types of inhalers may require different techniques.

Administration of Medications by Nebulizer

Administer in a location where patient can sit comfortably for 10–15 min. Plug in compressor. Mix medication as directed, or empty unit-dose vials into nebulizer. Do not mix different types of medications without checking with health care professional. Assemble mask or mouthpiece and connect tubing to port on compressor. Have patient sit in a comfortable upright position. Make sure that mask fits properly over nose and mouth and that mist does not flow into eyes, or put mouthpiece into mouth. Turn on compressor. Instruct patient to take slow deep breaths. If possible, patient should hold breath for 10 sec before slowly exhaling. Continue this process until medication chamber is empty. Wash mask in hot soapy water; rinse well and allow to air dry before next use.

Administration of Nasal Sprays

Clear nasal passages of secretions prior to use. If nasal passages are blocked, use a decongestant immediately prior to use to ensure adequate penetration of the spray. Keep head upright. Breathe in through nose during administration. Sniff hard for a few minutes after administration.

Intramuscular Injection Sites

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*Source: Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. National Asthma Education and Prevention Program, National Heart, Lung, and Blood Institute, 2007.