3 Routes of Medication Administration

Why the route matters

The route is the path by which a medication enters the body. The ordered route matters because a medication formulated for one route may be ineffective or harmful if given another way. Routes can affect absorption, onset, and risks.

Before administration, verify the medication order and route, confirm the patient’s identity and allergies, assess whether the patient can safely receive the medication by that route, and follow the medication label and facility policy. If the ordered route is unavailable or unsafe, pause and clarify the order rather than substituting a route.

Enteral routes

Enteral medications enter the gastrointestinal tract. Their absorption and onset can vary with the drug, formulation, food, and gastrointestinal function.

• Oral (PO): Give tablets, capsules, or liquids by mouth. Assess swallowing ability, alertness, NPO status, and positioning. Sit the patient upright when possible and remain until the medication is swallowed. Measure liquids with an appropriate medication device, not a household spoon. Do not crush or open a dosage form unless the specific product is confirmed safe to do so; extended-release and enteric-coated forms generally must not be crushed.

• Sublingual (SL) and buccal: Place medication under the tongue or between the cheek and gum, respectively. Allow it to dissolve; do not chew or swallow it unless instructions say otherwise. Follow product directions about eating, drinking, or smoking while it dissolves.

• Feeding tube: Confirm the order specifies the correct tube and that the medication is appropriate for that tube. Use a suitable liquid formulation when available; never assume a tablet can be crushed or a capsule opened. Give medications separately and flush the tube as directed by facility policy and medication instructions to reduce clogging and interactions. Keep the patient positioned as directed for safe administration. Feeding tubes may include NG, gastrostomy, or jejunostomy tubes.

• Rectal (PR): Suppositories and enemas may provide local or systemic effects. Provide privacy, use gloves and lubricant as appropriate, position the patient on the side, and insert gently according to product instructions. Check for relevant contraindications such as rectal bleeding or recent surgery.

Parenteral routes

Parenteral medications are delivered by injection and bypass the gastrointestinal tract. Use aseptic technique and appropriate equipment, identify correct anatomical landmarks, and select a suitable site. Monitor for pain, bleeding, infection, or other reactions, and dispose of sharps immediately in an approved container.

• Intradermal (ID): Inject into the dermis, commonly for skin testing. Insert the needle bevel-up at a shallow angle of about 5–15°. A small raised bleb indicates appropriate placement. Do not massage the site when the test protocol says not to.

• Subcutaneous (SC/SQ): Inject into the fatty tissue beneath the dermis. Common examples include insulin and heparin. Choose an appropriate site, rotate sites as indicated, and use the angle and technique appropriate to the needle, device, and patient’s tissue depth.

• Intramuscular (IM): Inject into muscle at 90°. Select the site and needle based on the medication, patient’s age and muscle mass, and clinical guidance. The ventrogluteal site is often preferred for appropriate medications; avoid sites with infection or injury. Follow medication-specific guidance and facility policy.

• Intravenous (IV): Deliver medication into a vein for rapid systemic availability. Verify that the medication is approved for the IV route and confirm the prescribed rate and dilution. Assess line patency and compatibility, and monitor closely for adverse effects, infiltration, or extravasation. IV administration requires route-specific competency and adherence to policy.

Mucosal, respiratory, and skin routes

Use the product and device as directed for each route, and apply the relevant safety checks and technique.

• Ophthalmic (eye): Verify the correct eye. Avoid touching the dropper tip to the eye or other surfaces. Place drops in the lower conjunctival sac, not directly on the cornea; apply gentle pressure to the inner corner when indicated to limit systemic absorption. Use a separate clean technique for each eye.

• Otic (ear): Verify the correct ear and that the product is intended for otic use. Warm drops to room temperature if needed for comfort. For adults, gently pull the auricle up and back; for young children, pull it down and back. Avoid touching the dropper to the ear, and allow the patient to remain on the opposite side briefly so drops can enter the canal.

• Nasal: Clear secretions when appropriate. Aim a spray slightly outward, away from the nasal septum, and use the device as directed. Do not share nasal devices.

• Inhaled: Use the prescribed inhaler or nebulizer technique. For a metered-dose inhaler, coordinate a slow inhalation with actuation; a spacer can help when appropriate. Follow product instructions between puffs. After inhaled corticosteroids, have the patient rinse and spit to reduce oral residue. Assess the patient’s response and adverse effects.

• Topical: Apply creams, ointments, or lotions to the designated skin area, using gloves when appropriate. Check the skin, apply only the prescribed amount, and avoid unintended contact or spread.

• Transdermal: Apply the patch to clean, dry, intact skin at the designated site. Remove the old patch before applying a new one, rotate sites as directed, and document the site and time. Do not cut patches unless product instructions specifically permit it; dispose of used patches safely.

• Vaginal: Provide privacy and explain the procedure. Use gloves and an applicator if supplied; insert the medication as directed and offer a pad if leakage is expected.

Checks after administration

For every route, use the correct medication-specific technique and equipment, respect the patient’s comfort and preferences, and document administration and relevant assessments. Reassess the therapeutic response and watch for adverse effects. If administration cannot be completed safely, hold the dose and promptly clarify the plan with the appropriate clinician.

Match the route exactly to the order and formulation. Assess patient suitability, use route-specific technique and infection prevention, and monitor the patient; do not improvise when a route is unsafe or uncertain.