ppt. Injections. Types of injections. Types of injections and rules for performing them, how to vaccinate correctly Solution for intramuscular or subcutaneous administration

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

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 Spezial)
- 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
— a 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 of ​​skin with the first ball in alcohol centrifugally (or in the direction from bottom to top), treat the puncture site directly with the second ball, 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 inject the medicine slowly, 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.

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, to avoid harm and stress on the digestive system, or if it is impossible to administer the drug in other ways (for example, orally). Any doctor would say that the simplest and most effective way to use this approach is 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.

If possible, get vaccinated in the treatment room of 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 in special cases (anesthesia, patients with high degrees of 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 of only the first three types of injections - the rest should be done only by qualified medical personnel, and the need to do them arises extremely rarely.

The most important principle of any medical procedure, including vaccinations, is sterility. Neglect or poor sanitation can often result in pathogens being introduced into, or even along with, the injection site. 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 of the medicine, as well as the consumables used for treatment.

All types of injections have many small nuances and their own technique of execution. Unfortunately, even in hospitals, patients' comfort and health are often neglected by not following proper procedures or using the wrong needles. Below are small reminders that minimize pain 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. It is unlikely that you will be able to maintain sterility and all the conditions for a high-quality intravenous injection alone, so it is 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 the medicine to the temperature of the human body in your hands or warm water - this will reduce the discomfort from the vaccination.

We take the syringe in our hand closer to the front edge, so that the tip of the needle is at the bottom and the cut is facing 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

A much simpler technique for administering vaccinations, here you won’t need to get 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. It will take 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);
• means of disinfection;

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 clothing. Next, follow the standard procedure to treat the injection site and hands, open the disposable syringe and draw the required amount of medicine and proceed to 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 convenient places are: the space under the shoulder blade, the outer part of the shoulder, the outer side of the thigh, the 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 surface of the skin at 1–1.5 cm, then the medicine is injected into the 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!

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 to determine:

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 a general reaction of the body, the manifestation of which is general malaise, a state of excitement or depression of the nervous system, headache, appetite disturbance, and 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, medications are used that do not irritate the subcutaneous tissue, do not cause a 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 at the injection site the skin and subcutaneous tissue are easily captured 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 area. 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, the thumb and forefinger of the left hand capture the skin and subcutaneous tissue into a fold, which is pulled up towards the tip of the needle.

With a short quick movement, the needle is injected into the skin and advanced into the subcutaneous tissue between the fingers of the left hand to a depth of 1-2 cm. After that, the syringe is intercepted, placing it between the index and middle fingers of the left hand, and the pulp of the nail phalanx of the thumb is placed on the handle of the syringe piston and squeeze out the content. At the end of the injection, the needle is removed with a quick movement. The injection site is lightly lubricated with iodine tincture. There should be no backflow of the drug 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) impossibility of introducing liquid into the body through the 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 poured liquid is placed in a special vessel - a cylindrical funnel, which is connected to the 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

Intramuscular administration is subject to those drugs that have a pronounced irritant effect on the subcutaneous tissue (mercury, sulfur, foxglove, hypertonic solutions of some salts).

Alcohol tinctures, especially strophanthus, hypertonic solutions of calcium chloride, novarsenol (neosalvarsan) are contraindicated for injection into muscles. The introduction of these drugs causes the development of tissue necrosis.

Places for performing intramuscular injections are shown in Fig. 30. Most often they are made in the muscles of the gluteal regions at a point located at the intersection of a vertical line passing in the middle of the buttock, and a horizontal one - two transverse fingers below the iliac crest, i.e., in the zone of the upper outer quadrant of the gluteal region. In extreme cases, intramuscular injections can be made into the thigh on 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 are the formation of post-injection abscesses and traumatic damage to the 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 to introduce a medicinal product into the body when it is necessary to obtain a quick therapeutic effect or when it is impossible to administer the medicinal substance 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 a rapid therapeutic effect will not be achieved, 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's rubber tourniquet 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 that the needle is in the correct position 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, subclavian vein puncture has become widely used in clinical practice. 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 occur with intravenous injections are due to the ingestion 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 flows out of a vein, a hematoma is formed in nearby tissues, which usually does not pose a danger to the patient and resolves relatively quickly. If an irritating liquid enters the tissue, burning pain occurs in the injection zone and a very painful, long-term non-absorbable infiltrate may form or tissue necrosis may occur.

The last complication often occurs when calcium chloride solution enters the tissues.

Infiltrates resolve after the application of warming compresses (you can use half-alcohol compresses OR compresses with Vishnevsky ointment). In cases where a solution of calcium chloride has entered the tissues, one should try to suck it out as much as possible by attaching an empty syringe to the needle, and then, without removing the needle and without moving it, inject 10 ml of a 25% solution of sodium sulfate. If there is no solution of sodium sulfate, 20-30 ml of a 0.25% solution of novocaine is injected into the tissues.

Intravenous infusions are used to introduce a large amount 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 to carry it out through a special catheter inserted into the vein with a puncture needle or installed during venesection.

The catheter must be fixed to the skin either with adhesive tape or, more securely, by suturing 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 sister processes the cork 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 fluid will flow into the vein. The vessel is turned upside down, a clamp is applied to the tube near the vessel, and the glass dropper filter located on the tube system is located at the level of the middle of the vessel height. After removing the clamp from the tube, fill half of the dropper filter with transfusion fluid and re-attach the clamp to the tube. Then the vessel is placed on a special stand, the tube system together with the dropper filter is lowered below the vessel, and the clamp is again removed from the tube. In this case, the liquid begins to intensively flow out of the vessel and filter-dropper into the corresponding knees of the system, after filling them, it flows out through the cannula at its end. Once the tubing system is filled with liquid, a clamp is applied to the lower tubing. The system is ready to be connected to a catheter or needle 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, vaporous or gaseous state is carried away with the inhaled air into the cavity of the nose, 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 oral cavity and pharynx into the digestive tract and thus act on the entire body.

Indications. Inhalation is used for: 1) inflammation of the mucous membranes of the nose, throat 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 the bronchial tree, for the introduction of balsamic and deodorizing agents into them.

Technique. Inhalation is performed in various ways. The simplest method of inhalation is that the patient inhales the steam of boiling water in which the drug is dissolved (1 tablespoon of sodium bicarbonate per 1 liter of boiling water).

In order for most of the vapor to enter the respiratory tract, the patient's head is placed over a pot of water, and covered with a blanket on top. A teapot can be used for the same purpose. After the water boils, it is put on a light fire, a tube is put on the spout from a folded sheet of paper and steam is breathed 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 the glass mouthpiece, which the patient takes into his mouth. The mouthpiece must be boiled after each use. Medicines to be administered to the body are placed in a special test 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 l 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. Receiving clean water from the stomach without any 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 withdrawal of the contents of the large intestine in a natural way - defecation - is a complex reflex act that occurs with the participation of the central nervous system. The liquid content from the small intestine passes into the large intestine, where it lingers for 10-12 hours, and sometimes more. When passing through the large intestine, the contents gradually thicken due to the vigorous absorption of water and turn into feces. In the intervals between bowel movements, feces move in the distal direction 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. The accumulation of feces in the sigmoid colon is not felt as an “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 rectal wall receptors and especially by stretching of the intestinal ampulla. During defecation, the anal sphincters (outer - from transverse muscles, internal - from 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 the contraction of the diaphragm and abdominal muscles during 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.

In the colon, the absorption of the injected fluid occurs, and it depends on various conditions. In this case, the composition of the liquid and the degree of mechanical and thermal irritation provided, as well as the state of the intestine itself, are of the greatest importance.

In everyday life, the ability to perform subcutaneous injections is not as important as the ability to make intramuscular injections, but the nurse must have the skills to perform this procedure (know the algorithm for subcutaneous injection).
Subcutaneous injection is performed on depth 15 mm. The maximum effect of the 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.
It is impossible to inject drugs into places with edematous subcutaneous fatty tissue or into seals 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 the remaining air bubbles from the syringe, take the syringe in your right hand, holding the needle sleeve with your index finger, and the cylinder with your thumb and other 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.
Place your left hand on 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.

Knowing how to give injections correctly is very useful, because it is not always possible to call a nurse or go to the clinic. There is nothing difficult about doing injections professionally at home. Thanks to this article, you will be able to do them for yourself or your loved ones if necessary.

Don't be afraid of injections. After all, the injection method of administering medications is in many cases better than the oral one. With the injection, more of the active substance enters the blood without causing a negative effect on the gastrointestinal tract.

Most drugs are administered intramuscularly. Some drugs, for example, insulin or growth hormone, are administered subcutaneously, that is, the drug goes directly into the subcutaneous fat tissue. Let us consider in detail these methods of administration. You should immediately talk about possible complications. If you do not follow the injection algorithms, then the following are likely: inflammation, suppuration of soft tissues (abscess), blood poisoning (sepsis), damage to nerve trunks and soft tissues. Using one syringe to inject several patients contributes to the spread of HIV infection and some hepatitis (for example, B, C, etc.). Therefore, in preventing infection, it is of great importance to follow the rules of asepsis and carry out injections according to established algorithms, including disposal of used syringes, needles, cotton balls, etc.

What is needed for intramuscular injection

Syringe 2-5 ml
Injection needle up to 3.7 cm long, gauge 22–25
Needle for withdrawing medication from a bottle up to 3.7 cm long, 21 gauge
Tampon pre-treated in an antiseptic solution (alcohol, chlorhexidine, miramistin)
Raw cotton ball
Strip of adhesive plaster

What is needed for a subcutaneous injection

Assembled (with needle) insulin syringe (0.5-1ml caliber 27-30)
Cotton ball treated with alcohol
Dry cotton ball
Band-Aid

If possible, it is necessary to place the syringe in its packaging in the refrigerator an hour before administering the solution, which will help avoid deformation of the needle during the injection process.

The room in which the injection will be performed should have good lighting. The necessary equipment should be placed on a clean table surface.

Wash your hands well with soap.

Make sure that the disposable packaging of the equipment is sealed, as well as the expiration date of the medicine. Avoid reusing disposable needles.

Treat the bottle cap with a cotton swab moistened with an antiseptic. Wait until the alcohol has completely evaporated (the lid will become dry).

Attention! Do not use syringes and other accessories that were not packaged or if their integrity was damaged. Do not use the bottle if it has been opened before you. It is forbidden to drive a drug that has passed its expiration date.

A set of the drug from a bottle into a syringe

#1 . Remove the syringe and attach to it a needle intended for drawing up the solution.

#2 . Fill the syringe with as much air as you need to administer the medication. This action makes it easier to draw the medicine from the bottle.

#3 . If the solution is produced in an ampoule, then it must be opened and placed on the table surface.

#4 . You can open the ampoule using a paper towel, this way you can avoid cuts. When collecting the solution, do not poke the needle into the bottom of the ampoule, otherwise the needle will become dull. When there is little solution left, tilt the ampoule and collect the solution from the wall of the ampoule.

#5 . When using a reusable bottle, you need to pierce the rubber cap with a needle at a right angle. Then turn the bottle over and introduce into it the air that was drawn in before.

#6 . Fill the syringe with the required volume of solution, remove the needle and put the cap on it.

#7 . Change needles using the one you will use to inject. This recommendation must be followed if the solution is drawn from a reusable bottle, since the needle becomes blunt when piercing the rubber cap, although this is not visually noticeable. Remove any air bubbles in the syringe by squeezing them out and prepare to inject the solution into the tissue.

#8 . Place the syringe with the needle cap on a non-contaminated surface. If the solution is oily, it can be warmed to body temperature. To do this, you can hold the ampoule or bottle under your arm for about 5 minutes. Do not stand under running hot water or in any other way, because in this case it is easy to overheat. A warm oil solution is much easier to inject into the muscle.

Intramuscular injections

#1 . Treat the injection site with a swab soaked in antiseptic. It is best to inject the solution into the upper outer part of the buttocks or the outer thigh. After treatment with a swab, you should wait until the antiseptic dries.

#2 . Remove the cap from the needle, stretch the skin of the intended injection site with two fingers.

#3 . With a confident movement, insert the needle almost its entire length at a right angle.

#4 . Slowly inject the solution. At the same time, try not to move the syringe back and forth, otherwise the needle will cause unnecessary microtrauma to the muscle fibers.

When performing an intramuscular injection, it is correct to inject the solution into the area of ​​the upper outer quadrant of the buttock.

The middle part of the upper arm is also suitable for injection.

In addition, you can inject the solution into the area of ​​the lateral thigh. (Colored in the figure.)

#5 . Remove the needle. The skin will close, closing the wound channel, which will prevent the medicine from flowing back out.

#6 . Dry the injection site with a cotton ball and, if necessary, cover with a strip of adhesive tape.

Attention! You cannot insert a needle into the skin if there are mechanical injuries, pain is felt, a change in color is observed, etc. The maximum volume of solution that can be injected at a time should be no more than 3 ml. It is recommended to change the injection site to avoid getting the solution in one place more than every 14 days. If you have weekly injections, use both buttocks and thighs. When you inject in the second circle, try to move a couple of centimeters from the previous injection site. Touch with your finger, perhaps you will feel where the last injection was and inject a little to the side.

Subcutaneous injections

Treat the injection site with an antiseptic. The lower abdomen around the navel is the best place for injection. Wait for the alcohol to dry completely.

The area of ​​the abdomen that is best suited for subcutaneous administration of the drug is indicated by shading.

#1 . Remove the cap. Gather the skin into a fold to separate the subcutaneous fat layer from the muscles.

#2 . Using confident movements, insert the needle at a 45-degree angle. Make sure the needle is located under the skin and not in the muscle layer.

#3 . Enter the solution. There is no need to make sure that they do not fall into the vessel.

#4 . Remove the needle and release the skin fold.

The skin should be gathered into a fold, which facilitates the introduction of the solution into the subcutaneous fat layer.

Treat the injection field with an antiseptic. If necessary, after administering the medicine, the puncture site can be sealed with a strip of adhesive tape.

Attention! You cannot insert a needle into the skin if there are mechanical injuries, pain, a change in color, etc. It is not recommended to inject more than 1 ml of solution at a time. Each injection must be given to a different area of ​​the body. The distance between them should be at least 2 cm.