The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [547]
For further information about the administration of rectal medication, see Chapter 6.
Vaginal administration
Definition
Medications are inserted into the vaginal canal usually for local effects such as treatment of infections (e.g. Trichomonas and Candida infections) and contraceptive purposes. They are used less commonly for systemic effects (such as oestrogens and progesterones) (Chernecky et al. 2002, Snyder 2007).
Related theory
Vaginal preparations can be delivered in a wide variety of dosage forms including pessaries, creams, aerosol foams, gels and tablets (Chernecky et al. 2002, Snyder 2007).
Evidence-based approaches
The advantages of the vaginal route include the following.
The vagina offers a large surface area for drug absorption.
A rich blood supply ensures a rapid absorption of drug.
This route can act as an alternative to drugs that cannot be delivered via the oral route (as for suppositories).
This route can be used when patients cannot take drugs via the oral route (as for suppositories).
The vaginal route can deliver drug over a controlled period of time, thus avoiding peaks and troughs which result in less toxicity and risk of ineffectiveness.
The disadvantages include the following.
The route is limited to drugs that are potent molecules and are therefore easily absorbed.
The vagina can be easily irritated by the use of devices or locally irritating drugs.
Care must be taken with the use of vaginal devices to ensure they are sterilized and not acting as a growth medium for bacteria.
The vaginal bio-availability can be affected by hormone levels and can therefore change during menstrual cycles, with age and during pregnancy.
Leakage can occur with vaginal preparations. This can be alleviated by using the preparation at night.
This route may not be acceptable to some patients.
(Hillery et al. 2001)
Preprocedural considerations
Specific patient preparations
Check patient for any allergies and also whether they have recently given birth or undergone vaginal surgery as this may alter tissue integrity and the level of discomfort. The nurse should also review the patient’s willingness and ability to self administer the medication (Chernecky et al. 2002; Snyder 2007).
Procedure guideline 13.6 Medication: vaginal administration
Essential equipment
Disposable gloves
Topical swabs
Disposable sanitary pad
Medicinal products
Pessary
Lubricating jelly
Prescription chart
Warm water
Pen torch
Preprocedure
Action Rationale
1 Explain and discuss the procedure with the patient. To ensure that the patient understands the procedure and gives her valid consent (Griffith and Jordan 2003, E; NMC 2008b, C; NMC 2008c, C).
2 Consult the patient’s prescription sheet and ascertain the following:
(a) Drug
(b) Dose
(c) Date and time of administration
(d) Route and method of administration
(e) Validity of prescription
(f) Signature of doctor
To ensure that the patient is given the correct drug in the prescribed dose and by the correct route (NMC 2008a, C).
3 Select the appropriate pessary and check it with the prescription chart. To ensure that the correct medication is given to the correct patient at the appropriate time (NMC 2008a, C).
Procedure
4 Close room door or curtains, keeping the patient covered as much as possible. To ensure patient privacy and dignity. E
5 Assist the patient into the appropriate position, either left lateral with buttocks to the edge of the bed or supine with the knees drawn up and legs parted. May require a light source, e.g. lamp or torch. To facilitate easy access to the vaginal canal, visualize the external genitalia and vaginal canal and facilitate correct insertion of the pessary (manufacturer’s instruction, C; Chernecky et al. 2002, E; Snyder 2007, E).
6 Wash hands with bactericidal soap and water or bactericidal alcohol handrub, and put on gloves. To minimize the risk of cross-infection (DH 2007, C; Fraise and Bradley