Rules for intramuscular and subcutaneous injections. Safe injection technique. Complications of intravenous infections

Northwestern State Medical University named after I.I. Mechnikov

INJECTIONS. TYPES OF INJECTIONS.

Nursing teacher

with clinical practice

Alesheva N.V.

intradermal (or intradermal) - (intracutaneous or intradermal);

subcutaneous;

intramuscular;

intravenous;

intra-arterial;

intraosseous;

rectal injection - using enemas.

Intradermal injections

Intradermal injection is the most superficial of injections. WITH diagnostic purpose 0.1 to 1 ml of liquid is administered. The site for intradermal injection is the anterior surface of the forearm.

To carry out an intradermal injection, a needle 2-3 cm long with a small lumen is required. The palmar surface of the forearm is mainly used, and with novocaine blockades other parts of the body are used.

Before intradermal injection nurse You must wash your hands and wear rubber gloves. The site of the intended intradermal injection is treated with a cotton ball moistened with 70° alcohol. Stretch the skin at the site of intradermal injection and insert the needle into the skin with the cut side up, then move it 3-4 mm, releasing a small amount of the drug. Lumps appear on the skin, which, with further administration of the medicine, turn into a “lemon peel”. The needle is removed without pressing the intradermal injection site with cotton wool.

Subcutaneous injections

Used, for example, when administering insulin.

Subcutaneous injections are made with a needle of the smallest diameter to a depth of 1.5 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 areas for subcutaneous administration are:

outer surface of the shoulder;

subscapular space;

anterior outer surface of the thigh;

lateral surface of the abdominal wall;

lower part of the axillary region.

In these places, the skin is easily caught in the fold and the risk of damage to blood vessels, nerves and periosteum is minimal.

The skin in front of the injection site is folded, the needle is inserted into the skin at an angle of 45°, then the solution is smoothly injected into the subcutaneous fat tissue medicinal product.

Intramuscular injections

Intramuscular injection is one of the most common methods of administering small volumes medicinal substances.

Muscles have an extensive network of blood vessels and lymphatic vessels what creates good conditions for drug absorption. With intramuscular injection, a depot is created from which the drug is gradually absorbed into the bloodstream, which allows maintaining approximately the same concentration of the active substance in the blood for several hours and thereby ensuring its long-term effect.

When performing an injection into gluteal muscle the following actions are performed:

Treating the skin area at the injection site with alcohol.

With your free hand, the skin over the injection site is stretched and pierced with a needle. It is recommended to puncture with a sharp movement to reduce pain(the time of interaction of the needle tip with pain receptors, located mainly in the skin, is reduced).

Before starting to administer the drug, pull the syringe plunger back to check whether the needle has hit the large blood vessel. If blood enters the syringe, without removing the needle, change the direction and depth of immersion to bypass the damaged vessel.
The contents of the syringe are slowly injected into the muscle.

The needle is quickly removed, and a cotton ball with alcohol is pressed to the injection site.

The needle enters a blood vessel, which can lead to embolism, if oil solutions or suspensions are introduced, which should not enter directly into the bloodstream. When using similar drugs After inserting the needle into the muscle, pull the piston back and make sure that there is no blood in the syringe.
Infiltrates - painful lumps in the thickness of the muscle tissue at the injection site. They may occur on the second or third day after the injection. The reasons for their occurrence may be either non-compliance with the rules of asepsis (non-sterile syringe, poorly treated injection site), or repeated administration of drugs to the same place, or increased sensitivity human tissues to the administered drug (typical for oil solutions and some antibiotics).
Abscess- manifested by hyperemia and soreness of the skin over the infiltrate, elevated temperature bodies. Requires urgent surgical treatment and treatment with antibiotics.

Allergic reactions to the administered drug. To avoid these complications, before administering the drug, an anamnesis is collected to determine the presence of allergic reactions to any substances. For any manifestation allergic reaction(regardless of the method of previous administration), it is advisable to discontinue the drug, since repeated administration of this drug can lead to anaphylactic shock.

Intravenous injections

Intravenous injections involve the introduction of a medicinal substance directly into the bloodstream. Most important rule At the same time, there is strict adherence to the rules of asepsis (washing and treating hands, the patient’s skin, etc.).
For intravenous injections, the veins of the cubital fossa are most often used, since they have large diameter, lie superficially and move relatively little, and also superficial veins hands, forearms, less often veins of the lower extremities.

Well contoured vein. The vein is clearly visible, clearly protrudes above the skin, and is voluminous. The side and front walls are clearly visible.

Poorly contoured vein. Only the anterior wall of the vessel is very clearly visible and palpated; the vein does not protrude above the skin.

Not contoured vein. The vein is not visible and is very poorly palpated, or the vein is not visible or palpable at all.

According to the degree of fixation of the vein in the subcutaneous tissue, the following options are distinguished:

Fixed vein- the vein moves along the plane slightly.

Sliding vein- the vein easily moves in the subcutaneous tissue along the plane; it can be moved to a distance greater than its diameter.

Based on the severity of the wall, the following types can be distinguished:

Thick-walled vein- the vein is thick, dense.

Thin-walled vein- a vein with a thin, easily vulnerable wall.

well-contoured sliding thick-walled vein - occurs in 14% of cases;

The veins of these two are most suitable for puncture clinical options. Good contours and a thick wall make it quite easy to puncture the vein.

One of the most common anatomical features veins is so-called fragility. Visually and palpably, fragile veins are no different from ordinary ones. A hematoma very quickly appears at the puncture site. The following happens: in some cases, the puncture of the vein wall corresponds to the diameter of the needle, while in others, due to anatomical features, a rupture occurs along the vein.
Violations in the technique of fixing the needle in the vein can also lead to complications. A loosely fixed needle causes additional trauma to the vessel. This complication occurs almost exclusively in elderly people.
Enough a common complication there is an arrival infusion solution V subcutaneous tissue. Most often, after puncture of a vein, the needle is not fixed firmly enough in the elbow; when the patient moves his hand, the needle comes out of the vein and the solution enters under the skin. It is recommended to fix the needle in the elbow bend at at least two points, and in restless patients, fix the vein throughout the limb, excluding the joint area.
Another reason for fluid entering under the skin is a through puncture of a vein; this often happens when using disposable needles, which are sharper than reusable ones; in this case, the solution enters partially into the vein and partially under the skin.
In case of disturbance of the central and peripheral circulation, the veins collapse. Puncture of such a vein is extremely difficult. In this case, the patient is asked to clench and unclench his fingers more vigorously and at the same time pat the skin, looking through the vein in the puncture area.

The medicine is drawn into the syringe, and the absence of air in the syringe is checked. The cap is put back on the needle.

The patient extends the arm at the elbow joint as much as possible.

A rubber tourniquet is applied to the middle third of the patient's shoulder (over clothing or a napkin), the pulse is radial artery it should not change.

The patient is asked to clench and unclench his fist (to better pump blood into the vein).

The skin in the elbow area is treated with two or three cotton balls with alcohol in the direction from the periphery to the center.

With your free hand, fix the skin in the puncture area, stretching it in the area of the elbow and slightly shifting it to the periphery.

Holding the needle almost parallel to the vein, pierce the skin and carefully insert the needle 1/3 of the length with the cut upward (with the patient's fist clenched).

Continuing to fix the vein, slightly change the direction of the needle and carefully puncture the vein until it feels like “entering a void.”

To confirm that the needle has entered the vein, it is recommended to pull the syringe plunger towards you - blood should appear in the syringe.

By pulling one of the free ends, the tourniquet is untied, and the patient is asked to unclench the hand.

Slowly inject the medicinal solution without changing the position of the syringe.

A cotton ball with alcohol is pressed to the injection site and the needle is removed from the vein.

The patient bends his arm at the elbow, the ball with alcohol remains in place, the patient fixes the arm in this position for 5 minutes to prevent bleeding.

Intra-arterial injection.

Injections are made into those arteries that provide direct action medicinal solutions on painful process at its location. For example, when pathological processes in the last phalanx of the limbs, the injection is made into the lateral arteries of the metatarsus and metacarpus. The injection technique is the same as intravenous, with the difference that the needle is inserted by palpating the pulsating artery or after making a skin incision.

Intraosseous injection.

Currently, regional and especially peripheral anesthesia are increasingly used due to the increasing number of surgical operations and clinical data confirming its advantage over general anesthesia. Its use is also due to the desire to increase the turnover of beds in hospitals, since recovery period after regional anesthesia is usually shorter than after general anesthesia.1
Intravenous regional anesthesia (IRA) is particularly difficult to administer for upper and lower limbs; studies have shown that in this case, intraosseous regional anesthesia is an effective replacement for VRA. When performing intraosseous regional anesthesia, anesthetic agents penetrate into tissues in the same way as during intravenous infusion. An injection syringe gun for adults allows you to safely and effectively administer intraosseous regional anesthesia by quickly and accurately injecting fluid into the spongy substance of the epiphysis and metaphysis of the bones of the upper and lower extremities.

In ordinary life, the ability to perform subcutaneous injections is not as important as the ability to perform intramuscular injections, but the nurse must have the skills to carry out this procedure (know the algorithm for performing subcutaneous injection).
Subcutaneous injection is performed on depth 15 mm. Maximum effect from a subcutaneously administered drug is achieved on average 30 minutes after injection.

The most convenient areas for subcutaneous administration of drugs:

upper third of the outer surface of the shoulder,
subscapular space,
anterolateral surface of the thigh,
lateral surface of the abdominal wall.

In these areas, the skin is easily caught in the fold, so there is no danger of damage to blood vessels and nerves.
Do not inject medications into areas with swollen subcutaneous fat or into lumps from poorly absorbed previous injections.

Required equipment:

sterile syringe tray,
disposable syringe,
ampoule with drug solution,
70% alcohol solution,
pack with sterile material (cotton balls, swabs),
sterile tweezers,
tray for used syringes,
sterile mask,
gloves,
anti-shock kit,
container with disinfectant solution.

Procedure to complete:

The patient should take a comfortable position and free the injection site from clothing (if necessary, help the patient with this).
Wash your hands thoroughly with soap and warm running water; Without wiping with a towel, so as not to disturb the relative sterility, wipe your hands well with alcohol; put on sterile gloves and also treat them with a sterile cotton ball soaked in a 70% alcohol solution.
Prepare a syringe with medicine (see article).
Treat the injection site with two sterile cotton balls soaked in a 70% alcohol solution, widely, in one direction: first a large area, then with the second ball directly at the injection site.
Remove any remaining air bubbles from the syringe, take the syringe into right hand, index finger holding the needle sleeve, and holding the cylinder with your thumb and fingers.
Form a fold of skin at the injection site by grasping the skin with the thumb and index finger of your left hand so as to form a triangle.

Insert the needle with a quick movement at an angle of 30-45°, cut upward, into the base of the fold to a depth of 15 mm; At the same time, you need to hold the needle sleeve with your index finger.

Release the fold; make sure that the needle does not fall into the vessel by slightly pulling the piston towards you (there should be no blood in the syringe); If there is blood in the syringe, the needle should be inserted again.
Left hand transfer to the piston and, pressing on it, slowly introduce the medicinal substance.

Press the injection site with a sterile cotton ball soaked in a 70% alcohol solution and quickly remove the needle.
Place the used syringe and needles in the tray; Place used cotton balls in a container with a disinfectant solution.
Remove gloves, wash hands.
After the injection, the formation of a subcutaneous infiltrate is possible, which most often appears after the introduction of unheated oil solutions, as well as in cases where the rules of asepsis and antisepsis are not followed.

Hacharacteristics of the methodology for performing a simple medical service

Algorithm for performing subcutaneous drug administration

I. Preparation for the procedure.

Introduce yourself to the patient, explain the process and purpose of the procedure.
Help the patient find a comfortable position: sitting or lying down. The choice of position depends on the patient's condition; of the administered drug. (if necessary, fix the injection site with the help of junior medical personnel)
Treat your hands in a hygienic way, dry, put on gloves, mask.
Prepare the syringe.

Check the expiration date and tightness of the packaging.

Draw up the medicine into the syringe.

A set of medicine into a syringe from an ampoule.

- Shake the ampoule so that all the medicine is in its wide part.

— Treat the ampoule with a ball moistened with an antiseptic.

— File the ampoule with a nail file. Use a cotton ball moistened with an antiseptic to break off the end of the ampoule.

— Take the ampoule between your index and middle fingers, turning it upside down. Insert a needle into it and draw out the required amount of medication.

Ampoules with a wide opening should not be inverted. Make sure that when drawing the medicine, the needle is always in the solution: in this case, air cannot enter the syringe.

— Make sure there is no air in the syringe.

If there are air bubbles on the walls of the cylinder, you should slightly pull back the syringe plunger and “turn” the syringe several times horizontal plane. The air should then be forced out by holding the syringe over a sink or into the ampoule. Do not push the medicinal product into the air in the room; this is hazardous to health.

- Change the needle.

If using a reusable syringe, place it and cotton balls in the tray. When using a single-use syringe, put a cap on the needle, place the syringe with the needle and cotton balls in the syringe packaging.

A set of medicine from a bottle closed with an aluminum cap.

— Use non-sterile tweezers (scissors, etc.) to bend off the part of the bottle cap covering the rubber stopper. Wipe the rubber stopper with a cotton ball moistened with an antiseptic.

— Draw a volume of air into the syringe equal to the required volume of the drug.

— Insert the needle at an angle of 90° into the bottle.

- Inject air into the bottle, turn it upside down, slightly pulling the piston, draw the required amount of the drug from the bottle into the syringe.

— Remove the needle from the bottle.

- Change the needle.

— Place the syringe with a needle in a sterile tray or package of a single-use syringe into which the drug was drawn.

Store an opened (multi-dose) bottle for no more than 6 hours.

Select and examine/palpate the area of the intended injection to avoid possible complications.

II. Executing the procedure

Treat the injection site with at least 2 balls moistened with an antiseptic.
Gather the skin into a fold with one hand triangular shape base down.
Take the syringe with your other hand, holding the needle cannula with your index finger.
Insert the needle and syringe with a quick movement at an angle of 45° to 2/3 of the length.
Pull the plunger towards you to ensure that the needle is not in the vessel.
Slowly inject the drug into the subcutaneous fat.

III. End of the procedure.

Remove the needle, press the ball with skin antiseptic to the injection site, without lifting your hand with the ball, lightly massage the injection site.
Disinfect consumables.
Remove gloves and place them in a container for disinfection.
Treat hands hygienically and dry.
Make an appropriate entry about the results of the implementation in the medical documentation.

Additional information about the features of the technique

Before injection, individual intolerance to the drug should be determined; lesions of the skin and fatty tissue of any nature at the injection site

When administering heparin subcutaneously, it is necessary to hold the needle at an angle of 90°, do not aspirate for blood, and do not massage the injection site after the injection.

When prescribing injections over a long course, 1 hour after it, apply a heating pad to the injection site or make iodine grid.

15-30 minutes after the injection, be sure to ask the patient about his well-being and his reaction to the injected medicine (identifying complications and allergic reactions).

Places for subcutaneous injection - the outer surface of the shoulder, the outer and anterior surface of the thigh in the upper and middle third, the subscapular region, the anterior abdominal wall, in newborns the middle third of the outer surface of the thigh can also be used.

- a method of administering drugs, in which the drug enters the body by introducing an injection solution through a syringe into the subcutaneous tissue. When performing a subcutaneous injection, the drug enters the bloodstream by absorption of the drug into the vessels of the subcutaneous tissue. Typically, most drugs in the form of solutions are well absorbed in the subcutaneous tissue and provide relatively rapid (within 15-20 minutes) absorption into the subcutaneous tissue. big circle blood circulation Typically, the effect of the drug when administered subcutaneously begins more slowly than with intramuscular and intravenous administration, but faster than with oral administration. Most often, drugs are administered subcutaneously that do not have a local irritant effect and are well absorbed in the subcutaneous fatty tissue. Heparin and its derivatives are administered exclusively subcutaneously or intravenously (due to the formation of hematomas at the injection site). Subcutaneous injection is used when it is necessary to introduce into the muscle both an aqueous and an oily solution of drugs, or a suspension, in a volume of no more than 10 ml (preferably no more than 5 ml). Subcutaneous vaccinations against infectious diseases by introducing a vaccine into the body.

Application

Subcutaneous injection is a fairly common type of parenteral administration of drugs due to the good vascularization of the subcutaneous tissue and promotes rapid absorption of drugs; and also due to the simplicity of the administration technique, which allows this method of administration to be used by persons without special medical training after mastering the relevant skills. Most often, patients independently administer subcutaneous insulin injections at home (often using a syringe pen); subcutaneous injections of growth hormone can also be performed. Subcutaneous administration can also be used to administer oil solutions or suspensions of medicinal substances (provided that the oil solution does not enter the bloodstream). Usually, drugs are administered subcutaneously when there is no need to obtain an immediate effect from the drug administration (absorption of the drug during subcutaneous injection occurs within 20-30 minutes after administration), or when it is necessary to create a kind of drug depot in the subcutaneous tissue to maintain the concentration of the drug in the blood at constant level long time. Solutions of heparin and its derivatives are also administered subcutaneously due to the formation of hematomas at the injection site during intramuscular injections. Drugs may also be administered subcutaneously to local anesthesia. When administered subcutaneously, it is recommended to administer drugs in a volume of no more than 5 ml to avoid tissue overstretching and the formation of infiltrate. Do not administer subcutaneously drugs that have local irritant effect and can cause necrosis and abscesses at the injection site. To carry out the injection, you must have sterile medical equipment - a syringe, and a sterile form of the drug. Intramuscular drugs can be administered both in a medical institution (inpatient and outpatient departments) and at home, by inviting medical worker home, and in case of emergency medical care- and in the ambulance.

Execution technique

Subcutaneous injection is most often performed in the outer surface of the shoulder, the anterior surface of the thigh, the subscapular area, the lateral surface of the anterior abdominal wall and the area around the navel. Before a subcutaneous injection, the drug (especially in the form of an oil solution) must be heated to a temperature of 30-37 ° C. Before starting the injection, the medical worker treats his hands with a disinfectant solution and puts on rubber gloves. Before administering the drug, the injection site is treated antiseptic solution(more often - ethyl alcohol). Before the injection, the skin at the puncture site is folded, and after that the needle is installed at an acute angle to the skin surface (for adults - up to 90 °, for children and people with a weak subcutaneous fat layer, insertion at an angle of 45 °). After puncturing the skin, the syringe needle is inserted into the subcutaneous tissue approximately 2/3 of the length (at least 1-2 cm); to prevent needle breakage, it is recommended to leave at least 0.5 cm of the needle above the skin surface. After puncturing the skin, before injecting the drug, it is necessary to pull the syringe plunger back to check that the needle has entered the vessel. After checking that the needle is located correctly, the drug is injected under the skin in full. After completing the administration of the drug, the injection site is re-treated with an antiseptic.

Advantages and disadvantages of subcutaneous use of drugs

The advantages of subcutaneous administration of drugs are that active ingredients when introduced into the body, they do not change at the site of contact with tissues, so drugs that are destroyed by enzymes can be used subcutaneously digestive system. In most cases, subcutaneous administration provides a rapid onset of action of the drug. If prolonged action is necessary, drugs are usually administered subcutaneously in the form of oil solutions or suspensions; they cannot be administered intravenously. Some medications (in particular, heparin and its derivatives) cannot be administered intramuscularly, but only intravenously or subcutaneously. The rate of absorption of the drug is not affected by food intake and is much less influenced by the characteristics of the biochemical reactions of the body of a particular person, the use of other drugs, and the state of the enzymatic activity of the body. Subcutaneous injection is relatively simple to perform, which makes it possible for even a non-specialist to carry out this manipulation if necessary.

The disadvantages of subcutaneous use are that often when drugs are administered intramuscularly, pain and the formation of infiltrates at the injection site are observed (less often, the formation of abscesses), and when insulin is administered, lipodystrophy can also be observed. If the blood vessels at the injection site are poorly developed, the rate of absorption of the drug may be reduced. With subcutaneous administration of drugs, as with other types of parenteral use of drugs, there is a risk of infection of the patient or health care worker with pathogens of infectious diseases transmitted through the blood. Subcutaneous administration increases the likelihood side effect drugs due to the higher speed of entry into the body and the absence of biological filters of the body - the mucous membrane - along the route of the drug gastrointestinal tract and hepatocytes (although lower than with intravenous and intramuscular use) .. For subcutaneous use, it is not recommended to administer more than 5 ml of solution at a time due to the likelihood of overstretching muscle tissue and reducing the likelihood of infiltration formation, as well as drugs that have a locally irritating effect and can cause necrosis and abscesses at the injection site.

Possible complications of subcutaneous injection

The most common complication of subcutaneous injection is the formation of infiltrates at the injection site. Typically, infiltrates are formed when the drug is injected into a site of compaction or swelling formed after previous subcutaneous injections. Infiltrates can also form when introducing oil solutions that are not heated to the optimal temperature, as well as when the maximum volume of subcutaneous injection is exceeded (no more than 5 ml at a time). When infiltrates appear, it is recommended to apply a rolling semi-alcohol compress or heparin ointment to the site of infiltrate formation, apply an iodine mesh to the affected area, and carry out physiotherapeutic procedures.

One of the complications that arise when the technique of drug administration is violated is the formation of abscesses and phlegmons. These complications most often arise against the background of improperly treated post-injection infiltrates, or when the rules of asepsis and antisepsis are violated during injection. Treatment of such abscesses or phlegmons is carried out by a surgeon. If the rules of asepsis and antisepsis are violated when performing injections, there is a risk of infection of patients or healthcare workers with pathogens of infectious diseases transmitted through the blood, as well as the occurrence of a septic reaction due to bacterial infection of the blood.

When injecting with a blunt or deformed needle, subcutaneous hemorrhages are likely to occur. If bleeding occurs during a subcutaneous injection, it is recommended to apply a cotton swab moistened with alcohol to the injection site, and later a semi-alcohol compress.

If the injection site is chosen incorrectly when administering drugs subcutaneously, damage to the nerve trunks may occur, which is most often observed as a result of chemical damage to the nerve trunk, when a drug depot is created close to the nerve. This complication can lead to the formation of paresis and paralysis. Treatment of this complication is carried out by a doctor depending on the symptoms and severity of the lesion.

When insulin is administered subcutaneously (more often with long-term administration of the drug in the same place), there may be an area of lipodystrophy (the area of resorption of subcutaneous fat tissue). Prevention of this complication is alternating insulin injection sites and administering insulin, which has room temperature, treatment consists of administering 4-8 units of insulin to areas of lipodystrophy.

In case of mistaken injection under the skin hypertonic solution(10% sodium chloride or calcium chloride solution) or other topical irritants, tissue necrosis may occur. If this complication occurs, it is recommended to inject the affected area with a solution of adrenaline, 0.9% sodium chloride solution and novocaine solution. After pricking the injection site, a dry pressure bandage and cold are applied, and later (after 2-3 days) a heating pad is applied.

If you use an injection needle with a defect, if the needle is inserted too deeply into the subcutaneous tissue, or if the technique of administering the drug is violated, the needle may break. At this complication you must try to independently obtain a fragment of the needle from the tissue, and if the attempt is unsuccessful, the fragment is removed surgically.

Very severe complication subcutaneous injection is a drug embolism. This complication occurs rarely, and is associated with a violation of the injection technique, and occurs in cases where a health care worker, when performing a subcutaneous injection of an oil solution of a drug or suspension, does not check the position of the needle and the possibility of this drug getting into the vessel. This complication can manifest itself as attacks of shortness of breath, the appearance of cyanosis, and often ends in the death of patients. Treatment in such cases is symptomatic.

Subcutaneous injection technique:
Purpose: therapeutic, preventive
Indications: determined by the doctor
Subcutaneous injection is deeper than intradermal and is performed to a depth of 15 mm.

Rice. Subcutaneous injection: needle position.

Subcutaneous tissue has a good blood supply, so medications are absorbed and act faster. The maximum effect of a subcutaneously administered drug usually occurs after 30 minutes.

Injection sites for subcutaneous injection: upper third of the outer surface of the shoulder, back (subscapular region), anterolateral surface of the thigh, lateral surface of the abdominal wall.

Prepare equipment:
- soap, personal towel, gloves, mask, skin antiseptic (for example: Lizanin, AHD-200 Special)
- an ampoule with a medicinal product, a nail file for opening the ampoule
- sterile tray, waste material tray
- disposable syringe with a volume of 2 - 5 ml, (a needle with a diameter of 0.5 mm and a length of 16 mm is recommended)
- cotton balls in 70% alcohol
- first aid kit “Anti-HIV”, as well as containers with disinfectant. solutions (3% chloramine solution, 5% chloramine solution), rags

Preparation for manipulation:
1. Explain to the patient the purpose and course of the upcoming manipulation, obtain the patient’s consent to perform the manipulation.
2. Treat your hands at a hygienic level.
3.Help the patient into the desired position.

Algorithm for performing subcutaneous injection:
1. Check the expiration date and tightness of the syringe packaging. Open the package, assemble the syringe and place it in a sterile patch.
2. Check the expiration date, name, physical properties and dosage of the drug. Check with the assignment sheet.
3. Take 2 cotton balls with alcohol with sterile tweezers, process and open the ampoule.
4. Fill the syringe with the required amount of the drug, release the air and place the syringe in a sterile patch.
5. Use sterile tweezers to place 3 cotton balls.
6. Put on gloves and treat the ball with 70% alcohol, throw the balls into a waste tray.
7. Treat a large area with the first ball in alcohol centrifugally (or in the direction from bottom to top) skin, apply the second ball directly to the puncture site, wait until the skin dries from the alcohol.
8. Throw the balls into the waste tray.
9. With your left hand, grasp the skin at the injection site in the warehouse.
10. Place the needle under the skin at the base of the skin fold at an angle of 45 degrees to the surface of the skin with a cut to a depth of 15 mm or 2/3 of the length of the needle (depending on the length of the needle, the indicator may vary); index finger; Hold the needle cannula with your index finger.
11. Move the hand fixing the fold to the piston and insert slowly medicine, try not to transfer the syringe from hand to hand.
12. Remove the needle, continuing to hold it by the cannula; hold the puncture site with a sterile cotton swab moistened with alcohol. Place the needle in a special container; if a disposable syringe is used, break the needle and cannula of the syringe; take off your gloves.
13. Make sure that the patient feels comfortable, take the 3rd ball from him and escort the patient.

Rules for introducing oil solutions. Oil solutions often administered subcutaneously; intravenous administration forbidden.

Drops of the oil solution entering the vessel are clogged with it. The nutrition of surrounding tissues is disrupted, and their necrosis develops. With the blood flow, oil emboli can enter the vessels of the lungs and cause their blockage, which is accompanied by severe suffocation and can cause the death of the patient. Oil solutions are poorly absorbed, so an infiltrate may develop at the injection site. Before administration, warm oil solutions to a temperature of 38 "C; before administering the medicine, pull the plunger towards you and make sure that blood does not enter the syringe, that is, you do not get into a blood vessel. Only after this, slowly inject the solution. Apply it to the injection site a heating pad or a warm compress: this will help prevent infiltration.