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Other routes: inhaled, topical, eye, ear, rectal and vaginal

  • Procedure

Each route has its own technique: where the drop goes, how to breathe with an inhaler, or how the patient should lie afterwards.

Updated

What it is

Besides the oral and parenteral routes, many drugs are given into the eyes, ears, nose, lungs, skin, rectum or vagina. Some aim at a local effect; others, such as the rectal route or patches, at a systemic effect that bypasses the gut. The rights apply exactly as for any other route. What changes is the technique: where the drug is placed, the patient's position and how long they should stay that way.

Indications

  • A local effect in the eye, ear, nose, skin, airway, rectum or vagina.
  • A systemic effect when the oral route is not possible (rectal, transdermal patch).
  • Inhaled treatment in asthma and obstructive lung disease.

Contraindications and precautions

  • Rectal: assess for diarrhoea or active rectal bleeding; the route may not suit some heart conditions (vagal stimulation).
  • Eye and ear: do not touch the eye or ear with the dropper tip.
  • Ear: a ruptured eardrum generally rules out drops unless sterile technique is ordered.
  • Patches: remove the old one, do not apply to broken or irritated skin, rotate sites and never apply heat over certain patches.

Equipment

  • The drug in its form (drops, ointment, inhaler, suppository, pessary, cream or patch) and the medical order.
  • Clean gloves.
  • Gauze or tissues; water-soluble lubricant for the rectal and vaginal routes.
  • A spacer if the patient uses one.
  • Vaginal applicator.

Step by step (and why)

  1. Apply the rights and identify the patient — «minor» routes have errors too.
  2. Explain the procedure and protect privacy — helps cooperation, especially for rectal and vaginal routes.
  3. Eye: pull down the lower lid, instil into the sac and press the inner corner — reduces systemic absorption.
  4. Ear: pull the pinna up and back in adults (down and back under 3 years) — straightens the canal.
  5. Inhaler: shake, have the patient breathe out and press as a slow breath in starts; hold the breath — the drug reaches the airways.
  6. Rectal: left Sims position, lubricate and insert past the sphincter — so it is not expelled.
  7. Vaginal: on the back with knees bent; applicator its full length, or suppository along the back wall — helps retention.
  8. Keep the position a few minutes, remove gloves and document — ensures absorption and traceability.

Complications

  • Systemic effects of eye drops if the inner corner of the eye is not pressed.
  • Dizziness or nausea after ear drops.
  • Oral thrush with inhaled corticosteroids if the mouth is not rinsed.
  • Vasovagal reaction during rectal insertion: dizziness, sweating, slow pulse or low blood pressure.

Next step: when to call for help

  • Breathlessness that worsens after the inhaler: report at once.
  • Severe eye pain, loss of vision or increasing redness: report.
  • Dizziness, pallor or a slow pulse during rectal insertion: stop, lay the patient flat and report.
  • If the patient cannot master the inhaler technique, report so a spacer or another device can be considered.

Test yourself

Think of the answer, then tap the question to see it.

Where is an eye drop instilled?

Into the lower conjunctival sac, without touching the eye with the bottle.

Which way is the pinna pulled to instil ear drops in an adult?

Up and back; in a child under 3, down and back.

Why is the mouth rinsed after an inhaled corticosteroid?

To remove drug left in the mouth and prevent oral thrush.

In what position is a rectal suppository given?

In the left Sims position, with the upper leg bent.

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Connections

← All of nursing

Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: Nursing Skills (Open RN), 16.2 Basic Concepts (Administration of Medications Via Other Routes) (Open RN, Chippewa Valley Technical College (LibreTexts), 2022); Nursing Skills (Open RN), 16.3 Checklist for Transdermal, Eye, Ear, Inhalation, and Vaginal Routes Medication Administration (Open RN, Chippewa Valley Technical College (LibreTexts), 2022); Nursing Skills (Open RN), 15.2 Basic Concepts of Administering Medications (Open RN, Chippewa Valley Technical College (LibreTexts), 2022); Nursing Skills (Open RN), 15.5 Checklist for Rectal Medication Administration (Open RN, Chippewa Valley Technical College (LibreTexts), 2022).

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