The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [546]
8 Apply the patch immediately, pressing firmly with the palm of the hand for up to 10 seconds, making sure the patch sticks well around the edges. To ensure adequate adhesion and prevent loss of patch which would result in reduced dose and effectiveness (Snyder 2007, E).
9 Date and initial the patch To ensure all staff know when it must be changed (Snyder 2007, E).
Postprocedure
10 Record the administration on appropriate charts. To maintain accurate records, provide a point of reference in the event of any queries and prevent any duplication of treatment (NMC 2008a, C; NMC 2009, C).
Postprocedural considerations
Ongoing care
To avoid skin irritation, the sites of transdermal patches should be rotated (Chernecky et al. 2002). After use, the patch still contains substantial quantities of active ingredients which may have harmful effects if they reach the aquatic environment. Hence, after removal, the used patch should be folded in half, adhesive side inwards so that the release membrane is not exposed, placed in the original sachet and then discarded safely out of reach of children. Any used or unused patches should be discarded according to local policy or returned to the pharmacy. Used patches should not be flushed down the toilet or placed in liquid waste disposal systems (www.medicines.org.uk).
Complications
See Topical applications.
Rectal administration
Definition
These are medications administered via the rectum which may exert a local effect on the GI mucosa such as promoting defaecation or systemic effects such as providing analgesia or relieving nausea and vomiting (Chernecky et al. 2002, Snyder 2007).
Related theory
Suppositories
Suppositories are solid preparations which may contain one or more drug. The drugs are normally ground or sieved and then dissolved or dispersed into a glyceride-type fatty acid base or a water-soluble one. These suppositories will either melt after insertion into the body or dissolve and mix with the available volume of rectal fluid (Aulton 1988).
Enemas
Enemas are solutions or dispersions of a drug in a small volume of water or oil. These preparations are presented in a small plastic container made of a bulb which contains the drug and an application tube. The bulb can be compressed when the tube has been inserted in the rectum to deliver the drug. Enemas can be difficult for patients to use by themselves compared to suppositories and therefore their use is not as widespread (Aulton 1988).
Evidence-based approaches
The advantages of rectal administration include the following.
The drug can be administered when the patient is not able to make use of the oral route, for example if the patient is vomiting or is postoperative and therefore either unconscious or unable to ingest via the oral route.
In some categories of patient it may be easier to use the rectal route than the oral one as it does not require swallowing, for example children, the elderly.
The drug may be less suited to the oral route, for example the oral route can cause severe local GI side-effects. The drug may not be stable after GI administration or it may have an unacceptable taste which makes it unpalatable via the oral route.
Rarely cause local irritation or side-effects.
(Chernecky et al. 2002, Snyder 2007)
The disadvantages of the rectal route include the following.
Strong feelings against the rectal route by some patients in some countries and also feelings of discomfort and embarrassment.
There can be slow and incomplete absorption via the rectal route.
The development of proctitis has been reported with rectal drug administration.
Contraindicated in patients who have had rectal surgery or have active rectal bleeding.
(Chernecky et al. 2002, Downie et al. 2003, Snyder 2007)
After a suppository is inserted into the rectum, body temperature melts the suppository so it can be distributed. Proper