The most common types of drug injections include intradermal, subcutaneous, and intramuscular. More than one lesson at a medical school is devoted to how to give an injection correctly; students practice it over and over again. correct technique. But there are situations when professional help It is not possible to get an injection, and then you will have to master this science yourself.
Rules for drug injections
Every person should be able to give injections. Of course, we are not talking about such complex manipulations as intravenous injections or placing a drip, but ordinary intramuscular or subcutaneous administration of drugs in some situations can save lives.
Currently, for all injection methods, disposable syringes are used, which are sterilized at the factory. Their packaging is opened immediately before use, and after injection the syringes are disposed of. The same applies to needles.
So, how to give injections correctly so as not to harm the patient? Immediately before the injection, you must thoroughly wash your hands and wear sterile disposable gloves. This allows you not only to comply with the rules of asepsis, but also protects against possible infection blood-borne diseases (such as HIV).
The syringe packaging is torn apart while wearing gloves. The needle is carefully placed on the syringe, and it can only be held by the coupling.
Injectable medications come in two main forms: liquid solution in ampoules and soluble powder in vials.
Before making injections, you need to open the ampoule, and before that, its neck needs to be treated with a cotton swab dipped in alcohol. Then the glass is filed with a special file, and the tip of the ampoule is broken off. To avoid injury, it is necessary to grasp the tip of the ampoule only with a cotton swab.
The drug is drawn into a syringe, after which the air is removed from it. To do this, holding the syringe with the needle up, carefully squeeze out the air from the needle until a few drops of the drug appear.
According to the rules for injections, the powder is dissolved in distilled water for injection before use, saline solution or glucose solution (depending on the drug and type of injection).
Most bottles with soluble drugs They have a rubber stopper that can be easily pierced by a syringe needle. The required solvent is pre-drawn into the syringe. The rubber stopper of the bottle with the drug is treated with alcohol and then pierced with a syringe needle. The solvent is released into the bottle. If necessary, shake the contents of the bottle. After dissolving the drug, the resulting solution is drawn into the syringe. The needle is not removed from the bottle, but removed from the syringe. The injection is carried out with another sterile needle.
Technique for performing intradermal and subcutaneous injections
Intradermal injections. To perform an intradermal injection, take a small-volume syringe with a short (2-3 cm) thin needle. The most convenient place for injection is inner surface forearms.
The skin is pre-treated thoroughly with alcohol. According to the intradermal injection technique, the needle is inserted almost parallel to the surface of the skin with the cut upward, and the solution is released. At correct introduction a lump or “lemon peel” remains on the skin, and no blood comes out of the wound.
Subcutaneous injections. Most comfortable places For subcutaneous injections: outer surface of the shoulder, area under the shoulder blade, anterior and lateral surface abdominal wall, outer surface of the thigh. Here the skin is quite elastic and easily folded. In addition, when performing an injection in these very places, there is no risk of damage to the surface and.
To perform subcutaneous injections, syringes with a small needle are used. The injection site is treated with alcohol, the skin is grabbed into a fold and a puncture is made at an angle of 45° to a depth of 1-2 cm. The subcutaneous injection technique is as follows: the drug solution is slowly injected into the subcutaneous tissue, after which the needle is quickly removed and the injection site is pressed with a cotton swab swab soaked in alcohol. If it is necessary to inject a large volume of the drug, you can not remove the needle, but disconnect the syringe to re-draw the solution. However, in this case, it is preferable to give another injection in a different location.
Technique for intramuscular injection
Most often, intramuscular injections are performed into the muscles of the buttocks, less often into the abdomen and thighs. The optimal volume of the syringe used is 5 or 10 ml. If necessary to perform intramuscular injection You can also use a 20 ml syringe.
The injection is made into the upper outer quadrant of the buttock. The skin is treated with alcohol, after which the needle is injected with a quick movement at a right angle to 2/3-3/4 of its length. After the injection, the syringe plunger must be pulled towards you to check whether the needle has entered the vessel. If no blood flows into the syringe, inject the drug slowly. When the needle enters the vessel and blood appears in the syringe, the needle is pulled back slightly and the drug is injected. The needle is removed in one quick movement, after which the injection site is pressed with a cotton swab. If the drug is difficult to absorb (for example, magnesium sulfate), place a warm heating pad at the injection site.
The technique for performing intramuscular injection into the thigh muscles is somewhat different: it is necessary to inject the needle at an angle, while holding the syringe like a pen. This will prevent damage to the periosteum.
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Subcutaneous injections perform therapeutic and preventive functions and are carried out according to the indications and prescription of a doctor.
A subcutaneous injection is performed deeper than an intradermal injection; the penetration depth here is fifteen millimeters.
The area under the skin was chosen for injection due to the good blood supply to the subcutaneous tissue, which facilitates rapid absorption of drugs. Maximum effect from a drug administered subcutaneously, it occurs within half an hour.
Figure: Subcutaneous injection: needle position.
Subcutaneous injections should be given in the places marked in the figure, these are the subscapular region of the back, the upper third of the outer surface of the shoulder, thigh and side of the abdominal wall. 
Figure: Subcutaneous injection area
To make an injection, you should prepare materials and equipment. You will need a clean towel, soap, mask, gloves and a skin antiseptic, which can be used as AHD-200 Spezial or Lizanin.
In addition, you must not forget about the ampoule with the prescribed medication and a nail file for opening it, a sterile tray and a tray for waste material, cotton balls and 70% alcohol. You will need an Anti-HIV first aid kit and a couple of containers with disinfectant solutions. This can be a 3% and 5% chloramine solution.
For injection, you will also need a disposable syringe with a capacity of two to five milliliters with a current needle, with a diameter of no more than half a millimeter and a length of sixteen millimeters.
Before carrying out the manipulation, you should make sure that the patient knows about the purpose of the upcoming procedure and agrees to it.
Once you are sure of this, perform hand hygiene, select and help the patient take the required position.
Be sure to check the tightness of the syringe packaging and its expiration date. Only after this the package is opened, the syringe is collected and placed in a sterile patch.
Then they check the compliance of the drug with its intended purpose, its expiration date, dosage and physical properties.
Next, take two cotton balls with sterile tweezers, moisten them in alcohol and process the ampoule. Only after this the ampoule is opened and the prescribed amount of the drug is drawn into the syringe. Then the air is released from the syringe and the syringe is placed in a sterile patch.
After this, use sterile tweezers to place three more cotton balls soaked in alcohol.
Now you can put on gloves and treat them with a ball in 70% alcohol, after which the ball should be thrown into the waste tray.
Now we treat a large area with the ball skin at the injection site using spiral or reciprocating movements. The second ball is used to directly treat the injection site. The balls are dropped into the tray and then we make sure that the alcohol has already dried.
With your left hand, at the injection site, the skin is folded into something in the shape of a triangle.
The needle is placed under the skin at the base of this skin triangle at an angle of 45° to the surface of the skin and penetrates to a depth of fifteen millimeters, the cannula is supported at this time index finger.
Then the hand fixing the fold is transferred to the piston and the drug is slowly introduced. Do not transfer the syringe from one hand to another.
Next, the needle is removed, while it must be held by the cannula, and the puncture site is held with a sterile cotton swab soaked in alcohol. The needle is placed in a special container, however, when using a disposable syringe, the needle and cannula of the syringe break. Next you should remove your gloves.
Figure: Performing a subcutaneous injection
There are special rules for the introduction of oil solutions. They are administered only subcutaneously, since their intravenous administration is prohibited.
The fact is that drops of an oil solution clog blood vessels, which is fraught with necrosis, oil emboli in the lungs, suffocation and death. Poor absorption of oil solutions can lead to the development of infiltration at the injection site. Before insertion oil solutions heated to a temperature of 380C. Before administering the drug, you need to pull the plunger towards yourself and make sure that the needle does not fall into blood vessel, that is, blood should not be absorbed. Only after this procedure is the injection slowly introduced. After the procedure, a warm compress or heating pad is applied to the injection site to prevent infiltration.
A note must be made about the injection performed.
Intramuscular injections
Intramuscular injections are most often carried out in the upper outer quadrant of the gluteal region (to determine the injection site, the buttock area is conventionally divided into four squares by two lines (Fig. 9, Appendix)) or the anterior outer surface of the thigh.
Patient position- lying on your stomach or side (this position helps relax the muscles of the gluteal region).
Execution order:
preparing a syringe with medication for injection:
Open the packaging of the disposable syringe, take the needle by the sleeve with tweezers in your right hand, and place it on the syringe;
Check the patency of the needle by passing air or a sterile solution through it, holding the sleeve with your index finger, place the prepared syringe in a sterile tray;
Before opening an ampoule or bottle, carefully read the name of the medicine to make sure it corresponds to the doctor’s prescription, check the dosage and expiration date;
Lightly tap the neck of the ampoule with your finger so that the entire solution ends up in the wide part of the ampoule;
File the ampoule in the area of its neck with a nail file and treat it with a cotton ball soaked in a 70% alcohol solution; when taking the solution from the bottle, remove the aluminum cap from it with non-sterile tweezers and wipe the rubber stopper with a sterile cotton ball moistened with a 70% alcohol solution;
Using the cotton ball used to wipe the ampoule, break off the upper (narrow) end of the ampoule;
Take the ampoule in your left hand, holding it with your thumb, index and middle fingers, and take the syringe in your right hand;
Carefully insert a needle placed on a syringe into the ampoule and, pulling back the piston, gradually draw the required amount of the contents of the ampoule into the syringe, tilting it if necessary;
When drawing a solution from a bottle, pierce the rubber stopper with a needle, put the needle with the bottle on the cone of the syringe, lift the bottle upside down and draw the required amount of the medicinal substance into the syringe;
Remove the syringe from the needle to collect the drug and put the injection needle on it;
Remove any air bubbles in the syringe; to do this, turn the syringe with the needle up and, holding it vertically at eye level, press the piston to release air and the first drop of the drug, holding the needle by the sleeve with the index finger of your left hand;
Perpendicular to the surface of the skin, with a vigorous movement at an angle of 90º, insert the needle to a depth of 3/4 of its length (the needle must be inserted so that 2-3 mm remains between the needle sleeve and the patient’s skin);
Then, slowly pressing on the syringe plunger, inject evenly medicinal substance;
The needle should be removed from the patient’s body with a sharp movement, at the same angle, without making unnecessary movements of the needle in the tissues;
Treat the injection site with a clean cotton swab soaked in 70% ethyl alcohol.
Subcutaneous injections
Due to the fact that the subcutaneous fat layer is well supplied with blood vessels, subcutaneous injections are used for faster action of the drug. Subcutaneously administered medicinal substances have an effect faster than when administered orally, because they are quickly absorbed. Subcutaneous injections are made with a needle of the smallest diameter to a depth of 15 mm and up to 2 ml of medications are injected, which are quickly absorbed into the loose subcutaneous tissue and do not have a harmful effect on it.
The most convenient sites for subcutaneous injection are:
Outer surface of the shoulder;
Subscapular space;
Anterior outer surface of the thigh;
Lateral surface of the abdominal wall;
The lower part of the axillary region.
In these places, the skin is easily caught in the fold and there is no danger of damage to blood vessels, nerves and periosteum.
In places with edematous subcutaneous fat;
In seals from poorly absorbed previous injections.
Execution order:
Wash your hands thoroughly with soap and running warm water; without wiping with a towel, so as not to disturb the relative sterility, wipe them with alcohol; wear sterile gloves;
Preparing a syringe with medication (see IM injection);
Treat the injection site sequentially with two cotton balls with alcohol: first a large area, then the injection site itself;
Place the third ball of alcohol under the 5th finger of your left hand;
Take the syringe in your right hand (hold the needle cannula with the 2nd finger of your right hand, hold the syringe piston with the 5th finger, hold the cylinder from the bottom with the 3rd-4th fingers, and the top with the 1st finger);
With your left hand, gather the skin into a triangular fold, base down;
Insert the needle at an angle of 45° into the base of the skin fold to a depth of 1-2 cm (2/3 of the needle length), hold the needle cannula with your index finger;
Place your left hand on the plunger and inject the medicine (without transferring the syringe from one hand to the other).
Remove the needle, holding it by the cannula;
Press the injection site with a cotton ball and alcohol;
Give a light massage to the injection site without removing the cotton wool from the skin.
Intravenous injections
To perform intravenous injections, it is necessary to prepare on a sterile tray: a syringe (10.0 - 20.0 ml) with a drug and a 40 - 60 mm needle, cotton balls; tourniquet, roller, gloves; 70% ethyl alcohol; tray for used ampoules, vials; container with a disinfectant solution for used cotton balls.
Execution order:
Wash your hands thoroughly with soap and running warm water; without wiping with a towel, so as not to disturb the relative sterility, wipe them with alcohol; wear sterile gloves;
Draw the medicine from the ampoule into a disposable syringe;
Help the patient take a comfortable position - lying on his back or sitting;
Give the limb into which the injection will be made the required position: the arm is extended, palm up;
Place an oilcloth pad under your elbow (for maximum extension of the limb in elbow joint);
Place a rubber band (on a shirt or napkin) on the middle third of the shoulder so that its free ends are directed up, the loop is down, the pulse is at radial artery however, it should not change;
Ask the patient to work with his fist (to better pump blood into the vein);
Find a suitable vein for puncture;
Treat the skin in the area of the elbow bend with the first cotton ball soaked in 70% ethyl alcohol, in the direction from the periphery to the center, discard it (pre-treatment of the skin);
Take the syringe in your right hand: fix the needle cannula with your index finger, and use the rest to cover the cylinder from above;
Check that there is no air in the syringe; if there are a lot of bubbles in the syringe, you need to shake it, and the small bubbles will merge into one large one, which can be easily pushed out through the needle into the tray;
Again, with your left hand, treat the venipuncture site with a second cotton ball with alcohol, discard it;
Fix the skin in the puncture area with your left hand, stretching the skin in the area of the elbow with your left hand and slightly shifting it to the periphery;
Holding the needle with the bevel upward at an angle of 45°, insert it under the skin, then reducing the angle of inclination and holding the needle almost parallel to the surface of the skin, move it along the vein and carefully insert the needle 1/3 of its length (with the patient’s clenched fist);
Continuing to fix the vein with your left hand, slightly change the direction of the needle and carefully puncture the vein until you feel “entering the void”;
Pull the plunger towards you - blood should appear in the syringe (confirmation that the needle has entered a vein);
Untie the tourniquet with your left hand, pulling one of the free ends, ask the patient to unclench his hand;
Without changing the position of the syringe, press the plunger with your left hand and slowly inject the medicinal solution, leaving 0.5 ml in the syringe (if it was not possible to completely remove air from the syringe);
Apply a cotton ball with alcohol to the injection site and carefully remove the needle from the vein (hematoma prevention);
Bend the patient’s arm at the elbow joint, leave the ball of alcohol in place, ask the patient to fix the arm in this position for 5 minutes (to prevent bleeding);
Dump the syringe into disinfectant solution or cover the needle with a cap;
After 5-7 minutes, take the cotton ball from the patient and throw it into a disinfectant solution or into a bag from a disposable syringe;
Remove gloves and place them in a disinfectant solution;
Wash the hands.
Preparing the intravenous transfusion system
(Fig. 10, appendix)
1. Put on a mask, wash your hands thoroughly with soap and running warm water, without wiping with a towel, so as not to disturb the relative sterility, wipe them with 70% ethyl alcohol, put on sterile gloves.
2. Check the expiration date and tightness of the packaging with the system by squeezing it on both sides.
3. Prepare a sterile tray with napkins and cotton balls.
4. Take a bottle with a medicinal substance, check the expiration date, appearance, check with medical prescriptions.
5. Remove the central part of the metal cap from the bottle with tweezers and treat the bottle stopper twice with cotton balls soaked in 70% ethyl alcohol.
6. Open the package and remove the system.
7. Close the clamp on the system.
8. Remove the cap from the polymer needle and insert it into the bottle until it stops.
9. Turn the bottle upside down and secure it on a tripod.
10.Open the air duct plug on the system.
11.Fill the dropper to half the control container, periodically pressing on its body.
12.Open the clamp and release air from the tube system.
13.Close the clamp and fix the system on the tripod.
14. Perform venipuncture.
15.Use the clamp to adjust the required infusion rate.
16. After the manipulation, the used system must be disinfected (before soaking the system in the solution, it must be cut with scissors).
Types of injections
Intradermal injections
The introduction of a medicinal substance in a strong dilution into the thickness of the skin is called an intradermal (intracutaneous) injection. Most often, intradermal administration of drugs is used to obtain local superficial anesthesia of the skin and to determine the local and general immunity of the body to the drug (intradermal reactions).
Local anesthesia occurs from the effect of an anesthetic substance injected intradermally on the endings of the thinnest branches of the sensory nerves.
Intradermal reactions (tests) are characterized by high sensitivity and are widely used in medical practice for determining:
a) general nonspecific reactivity of the body;
b) increased sensitivity of the body to various substances (allergens) in allergic conditions of a constitutional or acquired type;
c) the allergic condition of the body with Tuberculosis, glanders, brucellosis, echinococcosis, actinomycosis, fungal diseases, syphilis, typhoid diseases and others and for the diagnosis of these diseases;
d) the state of antitoxic immunity, characterizing the degree of immunity to certain infections (diphtheria - Schick reaction, scarlet fever - Dick reaction).
Intradermal administration of killed bacteria or waste products of pathogenic microbes, as well as medicinal substances to which the patient has increased sensitivity, causes a local reaction in the skin from tissue elements - mesenchyme and capillary endothelium. This reaction is expressed by a sharp expansion of the capillaries and redness of the skin around the injection site. At the same time, since the injected substance enters the general circulation, intradermal injection also causes general reaction the body, the manifestation of which is general malaise, a state of excitement or depression of the nervous system, headache, appetite disorder, fever.
The intradermal injection technique involves inserting a very thin needle at an acute angle to a slight depth so that its hole penetrates only under the stratum corneum of the skin. By gently pressing on the syringe plunger, 1-2 drops of solution are injected into the skin. If the needle point is installed correctly, a whitish elevation forms in the skin in the form of a spherical blister up to 2-4 mm in diameter.
When performing an intradermal test, the injection of the drug is done only once.
The site for intradermal injection is the outer surface of the shoulder or the anterior surface of the forearm. If there is hair on the skin at the site of the intended injection, it must be shaved off. The leather is treated with alcohol and ether. Do not use iodine tincture.
Subcutaneous injections and infusions
Due to the strong development of intertissue gaps and lymphatic vessels in the subcutaneous tissue, many of the medicinal substances introduced into it quickly enter the general circulation and have a therapeutic effect on the entire body much faster and stronger than when administered through the digestive tract.
For subcutaneous (parenteral) administration, the following are used: medications, which do not irritate the subcutaneous tissue, do not cause pain reaction and are well absorbed. Depending on the volume of medicinal solution injected into the subcutaneous tissue, one should distinguish between subcutaneous injections (up to 10 cm3 of solution are injected) and infusions (up to 1.5-2 liters of solution are injected).
Subcutaneous injections are used for:
1-general effect of a medicinal substance on the body, when: a) it is necessary to cause a rapid effect of the drug; b) the patient is unconscious; c) the medicinal substance irritates the mucous membrane of the gastrointestinal tract or significantly decomposes in the digestive canal and loses its therapeutic effect; d) there is a disorder in the act of swallowing, obstruction of the esophagus and stomach occurs; e) there is persistent vomiting;
2-local exposure to: a) cause local anesthesia during surgery; b) neutralize the injected toxic substance on site.
Technical accessories - syringes 1-2 cm3 for aqueous solutions of potent agents and 5-10 cm3 for other aqueous and oily solutions; thin needles that cause less pain at the time of injection.
The injection site should be easily accessible. It is necessary that the skin and subcutaneous tissue easily caught in the fold. At the same time, it must be in an area that is safe for injury to subcutaneous vessels and nerve trunks. The most convenient is the outer side of the shoulder or the radial edge of the forearm closer to the elbow, as well as the suprascapular region. In some cases, the subcutaneous tissue of the abdomen may be chosen as the injection site. The skin is treated with alcohol or iodine tincture.
The injection technique is as follows. Holding the syringe with the thumb and three middle fingers of the right hand in the direction of the lymph flow, with the thumb and index fingers of the left hand, grab the skin and subcutaneous tissue into a fold, which is pulled upward towards the needle tip.
With a short, quick movement, the needle is inserted into the skin and advanced into the subcutaneous tissue between the fingers of the left hand to a depth of 1-2 cm. After this, the syringe is intercepted, placing it between the index and middle fingers of the left hand, and the pulp of the nail phalanx thumb Place it on the syringe plunger handle and squeeze out the contents. At the end of the injection, quickly remove the needle. The injection site is lightly lubricated with iodine tincture. There should be no backflow of the medicinal solution from the injection site.
Subcutaneous infusions (infusions). They are performed with the aim of introducing into the body, bypassing the digestive canal, a liquid that can quickly be absorbed from the subcutaneous tissue without harming the tissues and without changing the osmotic tension of the blood.
Indications. Subcutaneous infusions are performed when:
1) the impossibility of introducing fluid into the body through digestive tract(obstruction of the esophagus, stomach, persistent vomiting);
2) severe dehydration of the patient after prolonged diarrhea and uncontrollable vomiting.
For infusion use a physiological solution of table salt (0.85-0.9%), Ringer's solution (sodium chloride 9.0 g; potassium chloride 0.42 g; calcium chloride 0.24 g; sodium bicarbonate 0.3 g; distilled water 1 l), Ringer-Locke solution (sodium chloride 9.0 g; calcium chloride 0.24 g; potassium chloride 0.42 g; sodium bicarbonate 0.15 g; glucose 1.0 g;
water up to 1 l).
Technique. The infused liquid is placed in a special vessel - a cylindrical funnel, which is connected to a needle through a rubber tube. The speed of blood flow is controlled by Morr clamps located on the tube.
The injection site is the subcutaneous tissue of the thigh or anterior abdominal wall.
Intramuscular injections
Those drugs that have a pronounced irritating effect on the subcutaneous tissue (mercury, sulfur, digitalis, hypertonic solutions of certain salts) are subject to intramuscular administration.
Alcohol tinctures, especially strophanthus, and hypertonic solutions are contraindicated for injection into muscles. calcium chloride, novarsenol (neosalvarsan). The administration of these drugs causes the development of tissue necrosis.
The sites for intramuscular injections are shown in Fig. 30. Most often they are made into the muscles of the gluteal region at a point located at the intersection of a vertical line running in the middle of the buttock and a horizontal line - two transverse fingers below the iliac crest, i.e. in the area of the upper outer quadrant of the gluteal region. IN extreme cases intramuscular injections can be made into the thigh along the anterior or outer surface.
Technique. When performing intramuscular injections into the gluteal region, the patient should lie on his stomach or side. Injections into the thigh area are made while lying on your back. A needle with a length of at least 5-6 cm of sufficient caliber is used. The needle is inserted into the tissue with a sharp movement of the right hand perpendicular to the skin to a depth of 5-6 cm (Fig. 31, b). This ensures minimal pain sensation and insertion of the needle into the muscle tissue. When injecting into the thigh area, the needle should be directed at an angle to the skin.
After the injection, before administering the drug, you need to slightly pull the piston outward, remove the syringe from the needle and make sure that no blood flows out of it. The presence of blood in the syringe or flowing out of the needle indicates that the needle has entered the lumen of the vessel. After making sure that the needle is positioned correctly, you can administer the drug. At the end of the injection, the needle is quickly removed from the tissue, and the injection site on the skin is treated with iodine tincture.
After injections, painful infiltrates sometimes form at the injection site, which soon resolve on their own. To speed up the resorption of these infiltrates, you can use warm heating pads applied to the area of infiltration.
Complications arise when asepsis is violated and the injection site is incorrectly chosen. Among them, the most common is the formation of post-injection abscesses and traumatic injury sciatic nerve. The literature describes such a complication as air embolism, which occurs when a needle penetrates the lumen of a large vessel.
Intravenous injections and infusions
Intravenous injections are made for introduction into the body remedy if it is necessary to obtain a quick therapeutic effect or it is impossible to administer the drug into the gastrointestinal tract subcutaneously or intramuscularly.
When performing intravenous injections, the doctor must ensure that the injected drug does not leave the vein. If this happens, then either the rapid therapeutic effect, or a pathological process associated with the irritating effect of the ingested drug will develop in the tissues surrounding the vein. In addition, you must be very careful to prevent air from entering the vein.
In order to perform an intravenous injection, it is necessary to puncture the vein - perform venipuncture. It is produced to inject a small amount of medicine or a large amount of various liquids into a vein, as well as to extract blood from a vein.
Technical accessories. To perform venipuncture, you must have: a syringe of appropriate capacity; a short needle of sufficient caliber (it is best to use a Dufault needle) with a short bevel at the end; Esmarch rubber band or a regular rubber drainage tube 20-30 cm long; hemostatic clamp.
Technique. Most often, veins located subcutaneously in the elbow area are used for puncture.
In cases where the veins of the elbow are poorly differentiated, the veins of the dorsum of the hand can be used. Veins of the lower extremities should not be used, as there is a risk of developing thrombophlebitis.
During venipuncture, the patient's position can be sitting or lying down. The first is applicable for infusing a small amount of medicinal substances into a vein or when taking blood from a vein to study its components. The second position is indicated in cases of prolonged administration of liquid solutions into a vein for therapeutic purposes. However, given that venipuncture is often accompanied by the development of a fainting state in the patient, it is best to always perform it in a supine position. It is necessary to place a towel folded several times under the elbow joint to give the limb a position of maximum extension.
To facilitate puncture, the vein must be clearly visible and filled with blood. To do this, you need to apply an Esmarch tourniquet or a rubber tube to the shoulder area. A soft pad should be placed under the tourniquet so as not to injure the skin. The degree of compression of the shoulder tissues should be such as to stop the flow of blood through the veins, but not to compress the underlying arteries. The patency of the arteries is checked by the presence of a pulse in the radial artery.
The sister's hands and the patient's skin in the elbow area are treated with alcohol. The use of iodine is not recommended, as it changes the color of the skin and does not reveal complications during puncture.
To ensure that the vein chosen for puncture does not move when the needle is inserted, it is carefully held at the site of the intended injection with the middle (or index) and thumb of the left hand.
A vein is punctured either with one needle or with a needle attached to a syringe. The direction of the needle tip should correspond to the blood flow towards the center. The needle itself should be positioned at an acute angle to the surface of the skin. The puncture is performed in two stages: first the skin is pierced, and then the vein wall. The depth of the puncture should not be large so as not to puncture the opposite wall of the vein. Having felt that the needle is in the vein, you should advance it along the course by 5-10 mm, placing it almost parallel to the course of the vein.
The fact that the needle has entered a vein is indicated by the appearance of a stream of dark venous blood from the outer end of the needle (if a syringe is connected to the needle, blood is detected in the lumen of the syringe). If blood does not flow out of the vein, you should slightly pull the needle outward and repeat the stage of piercing the vein wall again.
When injecting a drug into a vein that causes tissue irritation, venipuncture should be performed with a needle without a syringe. The syringe is attached only when there is complete confidence that the needle is positioned correctly in the vein. When a drug that does not irritate the tissue is injected into a vein, venipuncture can be done with a needle attached to a syringe into which the drug is drawn.
Injection technique. After performing venipuncture and making sure correct position needles in the vein, begin administering the drug. To do this, you need to remove the tourniquet that was applied to fill the vein. This should be done carefully so as not to change the position of the needle. The injection itself, even in cases where a small volume of medicinal liquid is administered, must be done very slowly. Throughout the injection, it is necessary to monitor whether the injected liquid enters the vein. If the liquid begins to flow into nearby tissues, then swelling appears in the circumference of the vein, and the syringe plunger does not move forward well. In such cases, the injection should be stopped and the needle removed from the vein. The procedure is repeated.
At the end of the injection, the needle is quickly removed from the vein in the direction of its axis, parallel to the surface of the skin, so as not to damage the vein wall. The pinhole at the needle insertion site is pressed with a cotton or gauze swab moistened with alcohol. If the injection was performed into the antecubital vein, the patient is asked to bend the arm at the elbow joint as much as possible, while holding the tampon.
Recently in clinical practice puncture of the subclavian vein became widely used. However, due to the possibility of developing serious complications during manipulation, it must be performed according to strict indications by doctors who are proficient in the technique of performing it. It is usually performed by resuscitators.
Complications that arise from intravenous injections are caused by the ingress of blood and fluid into the tissues, which is injected into the vein. The reason for this is a violation of the venipuncture and injection technique.
When blood leaks from a vein, a hematoma forms in nearby tissues, which usually does not pose a danger to the patient and resolves relatively quickly. If an irritating liquid enters the tissue, a burning pain occurs in the injection area and a very painful, long-lasting infiltrate may form or tissue necrosis may occur.
The last complication often occurs when a calcium chloride solution gets into the tissue.
Infiltrates resolve after applying warming compresses (semi-alcohol compresses OR compresses with Vishnevsky ointment can be used). In cases where a calcium chloride solution has entered the tissue, try to suck it out as much as possible by attaching an empty syringe to the needle, and then, without removing the needle or displacing it, inject 10 ml of a 25% sodium sulfate solution. If there is no sodium sulfate solution, 20-30 ml of a 0.25% novocaine solution is injected into the tissue.
Intravenous infusions are used to introduce large volumes of transfusion agents into the body. They are performed to restore the volume of circulating blood, detoxify the body, normalize metabolic processes in the body, and maintain the vital functions of organs.
Infusions can be performed both after venipuncture and after venesection. Due to the fact that the infusion lasts a long period of time (in some cases a day or more), it is best carried out through a special catheter inserted into the vein with a puncture needle or installed during venesection.
The catheter should be fixed to the skin either with adhesive tape or, more securely, by suturing it to the skin with silk thread.
The liquid intended for infusion must be in vessels of various capacities (250-500 ml) and connected through special systems to a needle or catheter inserted into a vein. The characteristics of transfusion agents and indications for their use are described in detail in the relevant manuals on transfusiology.
Complications. A great danger for the patient is the entry of air into the transfusion system, which leads to the development of air embolism. Therefore, the nurse must be able to “charge” the transfusion system without violating its sterility and creating complete tightness.
To connect the container containing the transfusion medium to the needle-catheter inserted into the vein, a special disposable tubing system is used (Fig. 34).
Technique. Preparing the system for intravenous infusion is as follows. With sterile hands, the nurse handles the stopper that closes the vessel with the transfusion fluid, and inserts a needle through it (the length of the needle must be no less than the height of the vessel). Next to this needle, a needle is inserted into the cavity of the vessel, connected to a system of tubes through which the liquid will flow into the vein. The vessel is turned upside down, a clamp is applied to the tube near the vessel, and a glass dropper filter located on the tube system is located at the mid-height of the vessel. After removing the clamp from the tube, fill half of the dropper filter with transfusion fluid and re-apply the clamp to the tube. Then the vessel is placed on a special stand, the tube system along with the dropper filter is lowered below the vessel, and the clamp is removed from the tube again. In this case, the liquid begins to flow intensively from the vessel and the dropper filter into the corresponding elbows of the system, filling them, it flows out through the cannula at its end. Once the tube system is filled with fluid, a clamp is applied to the bottom tube. The system is ready for connection to a catheter or needle located in the patient’s vein.
If the system tubes are made of transparent plastic,
mass, then determining the presence of air bubbles in it does not present much difficulty. When rubber opaque tubes are used, the presence of air bubbles is monitored by a special glass tube located between the cannula connecting the tubes to the needle in the vein and the tube.
If during the infusion there is a need to replace the bottle of liquid, then this should be done without leaving the vein. To do this, a clamp is placed on the tube near the vessel, and the needle to which the tube is connected is removed from the vessel and inserted into the plug of the vessel with the new transfusion medium. In this case, it is very important that at the time of rearranging the vessels, the tube system is filled with liquid from the previous infusion.
After the intravenous infusion of fluid is completed, a clamp is placed on the tube near the vein and the needle is removed from the vein. The vein puncture site is pressed with a cotton or gauze swab moistened with alcohol. The same is done with a catheter inserted into a vein during puncture. As a rule, active bleeding from a wound in the vein wall is not observed.
Inhalation
A method of treatment in which a drug in a finely sprayed, vapor or gaseous state is carried with inhaled air into the nasal cavity, mouth, pharynx and into the deeper respiratory tract is called inhalation. Inhaled substances are partly absorbed in the respiratory tract, and also pass from the mouth and pharynx into the digestive tract and thus affect the entire body.
Indications. Inhalation is used for: 1) inflammation of the mucous membranes of the nose, pharynx and pharynx, especially accompanied by the formation of thick mucus that is difficult to separate; 2) inflammatory processes of the respiratory tract, both medium (laryngitis, tracheitis) and deep (bronchitis); 3) the formation of inflammatory cavities in the lungs associated with bronchial tree, for introducing balsamic and deodorizing agents into them.
Technique. Inhalation is performed in various ways. The simplest way inhalation consists of the patient inhaling steam from boiling water in which the drug is dissolved (1 tablespoon of sodium bicarbonate per 1 liter of boiling water).
In order to most of the vapor enters the respiratory tract, the patient’s head is placed over a pan of water, and a blanket is covered on top. A teapot can be used for the same purpose. After the water boils, place it on low heat, put a tube made of a folded sheet of paper over the spout and breathe steam through it.
The domestic industry produces steam inhalers. The water in them is heated using a built-in electric element. Steam exits through the nozzle and enters a glass mouthpiece, which the patient takes into his mouth. The mouthpiece must be boiled after each use. Medicines to be administered into the body are placed in a special tube installed in front of the nozzle.
IMPACT ON CAVITY ORGANS
GASTRIC WASHING
Gastric lavage is a technique in which its contents are removed from the stomach through the esophagus: stagnant, fermented liquid (food); poor quality food or poisons; blood; bile.
Indications. Gastric lavage is used for:
1) diseases of the stomach: atony of the stomach wall, obstruction of the antrum of the stomach or duodenum;
2) poisoning with food substances, various poisons;
3) intestinal obstruction due to paresis of its wall or mechanical obstruction.
Methodology. For gastric lavage, a simple device is used, consisting of a glass funnel with a capacity of 0.5-1.0 liters with engraved divisions of 100 cm3, connected to a thick-walled rubber tube 1-1.5 m long and about 1-1.5 cm in diameter. Washing is carried out with water at room temperature (18-20° C).
Technique. The position of the patient during gastric lavage is usually sitting. A probe connected to a funnel is inserted into the stomach. The outer end of the probe with a funnel is lowered to the patient’s knees and the funnel is filled with water to the brim. Slowly raise the funnel upward, approximately 25-30 cm above the patient’s mouth. At the same time, water begins to enter the stomach. You need to hold the funnel in your hands somewhat obliquely so that the column of air that is formed during the rotational movement of the water passing into the tube does not enter the stomach. When the water drops to the point where the funnel enters the tube, slowly move the funnel to the height of the patient’s knees, holding it with the wide opening upward. The return of fluid from the stomach is determined by the increase in its amount in the funnel. If as much liquid comes out into the funnel as it entered the stomach or
more, then it is poured into a bucket, and the funnel is filled again with water. The release of a smaller amount of fluid from the stomach, compared to what was injected, indicates that the tube in the stomach is not positioned correctly. In this case, it is necessary to change the position of the probe, either by tightening it or deepening it.
The effectiveness of lavage is assessed by the nature of the fluid flowing from the stomach. Obtained from the stomach clean water without admixture of gastric contents indicates complete lavage.
In case of acidic reaction of gastric contents, it is advisable to use salt-alkaline solutions for gastric lavage: add 10.0 soda (NaHCO3) and salt (NaCl) to 3 liters of water.
enemas and gas removal
FROM THE INTESTINE
A technical technique that involves introducing a liquid substance (water, medicine, oil, etc.) into the intestines through the rectum is called an enema.
Anatomical and physiological data on which
based on the method of using enemas
The natural release of the contents of the large intestine - defecation - is a complex reflex act that occurs with the participation of the central nervous system. Liquid contents from the small intestines pass into the large intestine, where they linger for 10-12 hours, and sometimes more. As it passes through the large intestine, the contents gradually become denser due to the vigorous absorption of water and turn into feces. In the intervals between bowel movements, feces move distally due to peristaltic contractions of the muscles of the colon, descend to the lower end of the sigmoid colon and accumulate here. Their further advancement into the rectum is prevented by the third sphincter of the rectum. Accumulation feces V sigmoid colon does not feel like a “urge to go down”. The urge to defecate occurs in a person only when feces enter the rectum and fill its cavity. It is caused by mechanical and chemical irritation of the receptors of the rectal wall and especially by stretching of the intestinal ampulla. During defecation, the anal sphincters (external - made of transverse muscles, internal - made of smooth muscles) are constantly in a state of tonic contraction. The tone of the sphincters especially increases when feces enter the rectal cavity. When the “urge to go down” appears and during defecation, the tone of the sphincters reflexively decreases and they relax. This removes the obstacle to the excretion of feces. At this time, under the influence of irritation of rectal receptors, the circular muscles of the intestinal wall and pelvic floor contract. The movement of feces from the sigmoid colon into the rectum, and from the latter outward, is facilitated by contraction of the diaphragm and muscles abdominals with held breathing. Thanks to the participation of the cerebral cortex, a person can voluntarily carry out or delay bowel movements.
The extinction of the reflex from the rectal ampulla leads to proctogenic constipation. Irritation of the rectum, especially stretching of its ampulla, reflexively affects the function of the overlying parts of the digestive apparatus, excretory organs, etc. An enema appears as such a mechanical irritant.
In addition to active peristaltic contractions of the muscles of the colon wall, there is also an antiperistaltic contraction, which contributes to the fact that even a small amount of liquid introduced into the rectum quickly passes into the overlying sections of the colon and quite soon ends up in the cecum.
Absorption of the injected liquid occurs in the colon, and it depends on various conditions. Highest value at the same time, it has the composition of the liquid and the degree of mechanical and thermal irritation provided, as well as the condition of the intestine itself.
Often, medical necessity requires the introduction of drugs into the body as quickly as possible or directly into the blood. This is necessary to achieve a faster, higher-quality effect, avoid harm and stress on digestive system or if it is not possible to administer the drug by other routes (for example, orally). The simplest and effective way With this approach, any doctor will call an injection - that is, the introduction of drugs into the body using a hollow needle. To many, this process will seem painful and barbaric; they will remember the unsuccessful experience of very painful injections. However, by following all the rules for vaccinations, you can save yourself from pain or unpleasant side effects.
Get vaccinated when possible treatment room Your clinic. If this is not possible, consult your doctor in detail about the nuances of the procedure.
People who are far from medicine or simply from going to clinics often mistakenly believe that the types of injections are limited to two: into a vein in the arm or the buttock. In fact, there are six of them, and they are classified based not at all on the place of injection:
- intravenous is the most common injection that directly introduces medicine into the blood. In addition, all types of IVs are placed intravenously, with rare exceptions;
- intramuscular is the most popular method of administering drugs, due to its simplicity. The injection and administration of the drug is carried out into the muscle tissue, where it is easiest to reach;
- subcutaneous is a slightly more complex procedure that requires minimal concentration and skill. The needle is inserted into the subcutaneous fat layer, where there are many thin blood vessels;
- intradermal - an injection that does not involve widespread distribution of the drug through the blood, for the purpose of local anesthesia or diagnostics. Not everyone can give such an injection - a very thin needle is inserted into the stratum corneum of the skin, the dosage is very strict;
- intraosseous - used only for special cases(anesthesia, patients with high degree obesity) only by qualified personnel;
- intra-arterial - an even rarer type of injection, very complex, often dangerous with complications. Performed during resuscitation efforts.
The article will describe in detail the rules only the first three type of injections - the rest should only be done by qualified medical personnel, and the need to do them arises extremely rarely.
The most important principle of any medical procedure, not excluding vaccinations - sterility. Negligent attitude or unsanitary conditions can often lead to the introduction of pathogenic microorganisms into the injection site, or even along with it. This not only does not contribute to recovery, but can also lead to serious complications. Therefore, before injection, the injector’s hands should be thoroughly washed, the injection site should be treated with alcohol, and the syringe and needle should be sterile (at best, disposable).
After use, be sure to throw away the syringe, needle and ampoule from the medicine, as well as Consumables with which the processing was carried out.
All types of injections have many small nuances and their own technique of execution. Unfortunately, even in hospitals, the comfort and health of patients are often neglected by not respecting necessary rules procedures or using the wrong needles. Below are small reminders that minimize painful sensations and the risk of complications after common types of medical injections.
Everyone has seen scenes in feature films where characters inject something into their veins on their own. This is indeed possible, but is highly not recommended. Maintain sterility and all conditions for high-quality intravenous injection It’s unlikely that you can do it alone, so it’s worth enlisting someone’s support. In addition to the person and the medicine itself, you will need:
- disposable, hermetically sealed syringe of the required volume;
- sterile needle with a thickness of 0.8, 0.9 or 1.1 millimeters;
- rubber venous tourniquet;
- any antiseptic, cotton wool or clean rags;
- optional: elbow pad, rubber gloves.
Be careful! There should be no air bubbles in the syringe at the time of drug administration!
First of all, the patient should be seated or laid down - it is not uncommon for people to lose consciousness during vaccinations from fear of pain or blood. It is recommended to place a small pillow or simply a rolled-up rag under the elbow; this will ensure fuller extension of the arm and additional comfort. Apply a tourniquet just above the shoulder (preferably on top of a clean cloth rag or clothing). We ask the patient to clench and unclench his fist, during which you can fill the syringe with the medication solution, after washing and treating your hands with an antiseptic. It is important to make sure that there is no air in the syringe and needle: to do this, squeeze a few milliliters of medicine out of the syringe, pointing it with the needle up. Afterwards, we find the most convenient place for the needle to penetrate, and slightly stretch the skin at the grafting site downwards, towards the hand. Do this with the right hand free from the syringe; it also additionally fixes the patient’s limb, clenched into a fist.
Before vaccination, try to warm up medicine up to temperature human body in hands or warm water- this will reduce discomfort from vaccination.
We take the syringe in the hand closer to leading edge, so that the needle point is at the bottom, and the cut looks up. Pressing the needle with your finger, we pierce the vein and skin at the same time, inserting the needle a third of its entire length. In this case, the needle is almost parallel to the vein itself, a deviation of several degrees is allowed. A sign that the needle has entered the vein can be its slight advancement, the appearance of blood in the syringe and direct visibility (it is permissible to slightly move the inserted needle to make sure that it has hit the right place). You should take some blood into the syringe by pulling the plunger towards you. If everything is done correctly, the tourniquet must be removed, and the patient must be asked to work with his fist again. Only now can you slowly inject the medicine, pull out the syringe, holding the skin at the injection site with a cotton swab moistened with alcohol.
Intramuscular method
Much more simple technique introduction of vaccinations, here you won’t need to go anywhere and aim - muscle tissue on the human body is always easy to find, at least on the buttock. We will analyze this type of injection. You will need a little:
- A couch, a trestle bed or a comfortable straight-shaped sofa to give the patient a horizontal position;
- a syringe and a needle with a diameter of at least 1.4 mm, but no more than 1.8 (it is important to keep in mind that if there is an impressive subcutaneous fat layer, you will need a needle of a larger diameter and longer length);
- disinfectants;
First of all, the patient will need to lie on his stomach on a trestle bed or couch and clear the area for vaccinations from clothes. Followed by standard procedure treat the injection site and hands, open the disposable syringe and draw the required amount of medicine and begin the operation. The needle should be inserted into the upper right quadrant of the buttock (visually divided into four parts by a horizontal and vertical line to make four parts), strictly perpendicular to the skin. After administering the medicine, the needle can be pulled out by immediately applying alcohol-soaked cotton wool for a few minutes. It should be remembered that the drug must be warmed, and the administration must be carried out very smoothly - then the patient will receive much less painful sensations.
Subcutaneous administration
Also, a method that is not difficult for an attentive person - the drug is injected into the subcutaneous fat layer, to a depth of no more than one and a half centimeters. The most comfortable places are: the space under the shoulder blade, the outer part of the shoulder, outer side hips, axillary region. A needle with a diameter of 0.6 mm is best suited for this type of procedure. As usual, the first step is to disinfect the selected injection site. Afterwards, the skin is folded with the hand free from the syringe. The needle is inserted at an angle of 30-45° relative to the skin surface at 1–1.5 cm, then the medicine is injected into fat layer.
Any type of vaccination will be much more painless if you warm the medicine with your hands immediately before administration.
People who have no idea what vaccines, injections, needles, and so on are, often make the same mistakes. Failure to comply with the technique of performing medical vaccinations can, at best, bring very unpleasant painful sensations to the patient, and at worst, give rise to serious complications. Follow the injection rules and such troubles as abscesses, painful papules, hematomas will bypass you!
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