home Thyroid Rules for performing various types of injections. Intradermal and subcutaneous injection: technique of execution Injections and their types

Rules for performing various types of injections. Intradermal and subcutaneous injection: technique of execution Injections and their types

The subcutaneous fat layer is well supplied with blood vessels, therefore, for faster action of the drug, subcutaneous injections (SC) are used. Drugs administered subcutaneously are absorbed more quickly than when administered orally. Subcutaneous injections are made with a needle 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.

Characteristics of needles and syringes for subcutaneous injections :

Needle length -20 mm

Section -0.4 mm

Syringe volume - 1; 2 ml Subcutaneous injection sites:

The middle third of the anterior outer surface of the shoulder;

The middle third of the anterior outer surface of the thigh;

Subscapular region;

Anterior abdominal wall.

In these places, the skin is easily caught in the fold and there is no danger of damage to blood vessels, nerves and periosteum. It is not recommended to inject: into places with edematous subcutaneous fat; in compactions from poorly absorbed previous injections.

Equipment:

Execution algorithm:

Put on a clean gown, a mask, sanitize your hands, and put on gloves.

Draw up the medicine, release the air from the syringe, and place it in the tray.

Have the patient sit or lie down, depending on the choice of injection site and drug.

Inspect and palpate the injection area.

Treat the injection site sequentially in one direction with 2 cotton balls moistened with a 70% alcohol solution: first a large area, then the second ball directly at the injection site, place it under the little finger of your left hand.

Take the syringe in your right hand (hold the needle cannula with the index finger of your right hand, hold the syringe plunger with your little finger, hold the cylinder with fingers 1, 3, 4).

With your left hand, gather the skin into a triangular fold, base down.

Insert the needle at an angle of 45° with the cut up 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 medication (do not transfer the syringe from one hand to the other).

Remove gloves and place in

Wash hands, dry.

Note. During the injection and after it, 15-30 minutes later, ask the patient about his well-being and reaction to the injected drug (identifying complications and reactions).

Fig.1.Sites for subcutaneous injections

Fig.2. SC injection technique.

Subcutaneous injection of oil solutions.

Target: medicinal.

Indications: administration of hormonal drugs, solutions of fat-soluble vitamin preparations.

Equipment:

Sterile: a tray with gauze pads or cotton balls, a syringe with a volume of 1.0 or 2.0 ml, 2 needles, 70% alcohol, drugs, gloves.

Non-sterile: scissors, couch or chair, containers for disinfecting needles, syringes, dressings.

Execution algorithm:

Explain the procedure to the patient and obtain his consent.

Put on a clean gown, mask, sanitize your hands, and put on gloves.

Before use, immerse the ampoule in a container with warm water and heat it to 38°C.

Fill the syringe with the medicine and release the air from the syringe.

Treat the injection site twice with tufikomi with 70% alcohol.

Inject with a needle, pull the plunger towards you - make sure that no blood enters the syringe - preventing drug embolism (oil embolism).

Slowly introduce the solution (temperature of the oil solution is 38°C).

Apply pressure to the injection site with a cotton ball containing 70% alcohol.

Remove the needle by holding it by the cannula.

Place the disposable syringe and needle in a container with 3% chloramine for 60 minutes.

Remove gloves, place a container with a disinfectant solution.

Wash hands, dry.

Injection is a method of introducing certain solutions into the body using special syringes and needles, or using the needle-free method (high-pressure injection).

Main types of injections:

Intravenous
Intramuscular
Subcutaneous
Intradermal
Rectal (using enemas)

Intravenous injections

This type of injection involves the introduction of the active substance directly into bloodstream through a puncture in, most often in the area of the elbow joint, since in this place the veins have the largest diameter, and these veins are also characterized by low displacement. Often the places for intravenous injections and other substances are the forearm, wrist, etc. Theoretically, any of the veins of the body can be used. For example, to gain access to the root of the tongue, it is necessary to inject the drug through the diaphragm. The main rule in this procedure is strict adherence to the rules asepsis , which consists of washing and treating skin and hands.

The middle vein is the most often used for blood sampling and injections, this is due to the fact that it is well contoured, that is, clearly visible, protrudes above the skin, has a diameter larger than average, its edges are clearly visible and palpable. A weakly contoured and non-contoured vein is also distinguished. They are less suitable for injections, as they create certain difficulties, and therefore increase the risk of intravenous injections.

Complications of intravenous infections

One of the important features of veins is their fragility. Theoretically, this does not carry any contraindications for this type of injection, however, a hematoma often forms at the puncture site even if the needle gets into a vein. In some cases, a rupture along the vein is possible.

Other complications of this procedure include complications associated with improper execution. The entry of the solution into the subcutaneous tissue can also cause extremely negative consequences. It is possible that the solution may flow partially into the vein, partially into the nearby area; this situation is most often associated with the use of disposable needles, which are usually sharper than reusable needles.

Progress of intravenous injection:

The specialist puts on gloves treated with a special solution
The medicine is drawn into the syringe and checked for the absence of air.
The patient takes a comfortable position, sitting or lying on his back
A tourniquet is applied to the middle of the shoulder, the patient actively squeezes and unclenches his hand
The patient's skin is treated with a special solution
Holding the needle almost parallel, it is inserted into the vein until a peculiar feeling of emptiness occurs.
The tourniquet is untied and the patient releases his fist.
Without changing the position of the syringe, slowly inject the medicine
A cotton ball soaked in a disinfectant solution is pressed to the injection site, after which the syringe is removed.
The patient's arm is held in a flexed position for five minutes.

Intramuscular injections

This type of injection is the most common for administering a small amount of product. Good conditions for penetration and absorption of the drug are provided thanks to a branched system of lymphatic and blood vessels. Intramuscular injection creates a kind of depot from which the drug is absorbed into the bloodstream, thereby maintaining the same concentration of the active substance in the blood for several hours, which creates a long-lasting effect.

To minimize complications, these types of injections are usually performed in areas where there is a significant amount of muscle mass and the absence of large vessels and nerves nearby. Most often, the gluteal muscle, the surface of the thigh, and less often the deltoid muscle are chosen for intramuscular injection.

Possible complications

If a needle gets into a vessel, blockage of the bloodstream may occur; in the case of the introduction of suspensions and oil solutions, this outcome is especially likely. When administering such drugs, it is checked that the needle has entered the muscle by pulling the piston back and checking for the absence of blood.
A few days after the injection, you may experience infiltrates – painful areas.
Increased sensitivity of tissues, repeated injection into the same place, as well as non-compliance with aseptic standards are the most common causes of this phenomenon.
An allergic reaction to the drug is a common complication characteristic of any type of injection.

Progress

The selected injection site (it is recommended to use the upper third of the gluteal muscle) is disinfected with an alcohol solution
The skin is stretched slightly with your free hand, and a puncture is made with a sharp movement (to reduce pain) with the other hand.
The depth of needle insertion is about 5 mm, this is usually enough to reach muscles, the density of which is greater than fat, so entering the muscle is usually noticeable
Before administration, the piston is slightly pulled back, which allows you to check whether a large vessel is affected; if there is no blood, the drug is slowly injected into the muscle.
The needle is removed, cotton wool with alcohol is applied to the injection site
It is recommended to change the location for the next injection

Subcutaneous injections

One of the most common examples of subcutaneous injection is the injection insulin .
Due to the presence of a large vascular network, subcutaneous injections have a rapid effect on the body. With such injections, medications with a volume of no more than 2 milliliters are usually administered no deeper than 2 mm under the skin. The result is rapid absorption without harmful effects.

The most common sites for subcutaneous injections are:

Under the shoulder blade
Shoulder
Lateral abdominal wall
Anterior thigh

These places are common because the fold of skin is easily caught, and the danger of damaging blood vessels and nerves is minimal.

Subcutaneous injections are not performed in the following places:

In compactions caused by poorly absorbed previous injections
In areas with swelling

In order for the drug to be injected to the desired depth, the injection site, needle and angle at which the needle is inserted must be correctly selected.

Remember! All instruments and injection solutions must be sterile!

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;
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.
Injections are not recommended:

in places with edematous subcutaneous fat;
in compactions from poorly absorbed previous injections.

Performing a subcutaneous injection:

wash your hands (wear gloves);
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 hold the cylinder from 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;
move your left hand to the plunger and inject the medicine (do not transfer the syringe from one hand to the other);

Attention! If there is a small air bubble in the syringe, inject the medicine slowly and do not release the entire solution under the skin, leave a small amount along with the air bubble in the syringe.

remove the needle, holding it by the cannula;
apply pressure to the injection site with a cotton ball and alcohol;

Intramuscular injections

Some drugs, when administered subcutaneously, cause pain and are poorly absorbed, which leads to the formation of infiltrates. When using such drugs, as well as in cases where a faster effect is desired, subcutaneous administration is replaced by intramuscular administration. Muscles have a wider network of blood and lymphatic vessels, which creates conditions for rapid and complete absorption of drugs. With intramuscular injection, a depot is created from which the drug is slowly absorbed into the bloodstream, and this maintains its required concentration in the body, which is especially important in relation to antibiotics.

Intramuscular injections should be made in certain places of the body, where there is a significant layer of muscle tissue, and large vessels and nerve trunks do not come close. The length of the needle depends on the thickness of the subcutaneous fat layer, because It is necessary that when inserted, the needle passes through the subcutaneous tissue and enters the thickness of the muscles. So, with an excessive subcutaneous fat layer, the needle length is 60 mm, with a moderate one - 40 mm.

The most suitable sites for intramuscular injections are:

Injection (synonymous with injection, injection) is one of the types of parenteral administration of solutions into the body in small quantities. The injection is made into the skin, subcutaneous tissue, muscle, spinal canal, . Advantages of injection of drugs over oral administration: faster action of these substances; dosage accuracy; turning off the barrier function of the liver; the possibility of administering medications for any condition of the patient. A relative disadvantage of the injection is the possibility of anaphylactic shock during (see). If the patient is conscious, he should be warned about the upcoming injection. The injection is made in certain places of the body in which there is no risk of damaging blood vessels or nerves - in the outer surfaces of the limbs, the skin of the subscapular areas, the skin of the abdomen, the upper outer quadrant of the gluteal region.

Compliance with the rules of asepsis is mandatory. The injection is usually done using disposable syringes. The paramedic performing the injection, before taking the syringe, must thoroughly wash his hands with soap and a brush and wipe them with alcohol. Do not touch the bottom section of the needle with your hands.

Liquid medicinal solutions are sucked with a needle from a glass ampoule or bottle (Fig. 2), following the rules (see) and (see). Oily and thick medicinal substances are sucked without a needle. Having drawn up the medicinal solution, the syringe must be held with the needle up and, slowly extending the piston, push out the air and part of the solution from it so that there are no air bubbles left in it (Fig. 3). Even a small air bubble remaining in the syringe can cause suppuration during intradermal and subcutaneous injection and intravenous injection. The area of skin intended for injection is thoroughly wiped with cotton wool moistened with alcohol or iodine. The technique and location of the injection depend on its type.

Rice. 2. Suction of liquid from ampoules

Rice. 3. Removing air bubbles from the syringe

Rice. 4. Intradermal injection

Rice. 5. Subcutaneous injection

Rice. 6. Intramuscular injection

For intradermal injection, a thin needle is inserted into the thickness of the skin at an acute angle to a slight depth (Fig. 4). When the needle is positioned correctly, after introducing the solution, a small rounded elevation is formed, reminiscent of a lemon peel. Intradermal injection is used for superficial anesthesia and for diagnostic purposes (Casoni, McClure-Aldrich tests).

For a subcutaneous injection, the needle is inserted 2-3 cm into a fold of skin taken between the fingers (Fig. 5). Solutions are injected under the skin in an amount of 0.5-10 ml; medications prepared in isotonic sodium chloride solution (saline) are absorbed quickly, while in oil they are absorbed slowly.

Intramuscular injections are made to a greater depth and in certain anatomical areas: usually in the gluteal (Fig. 6) region and less often along the outer surface of the thigh. To avoid damage, the injection site is chosen as follows: the buttock is mentally divided into four parts by a vertical line and a horizontal line perpendicular to it. The injection is made in the area of the outer upper quadrant. Take the syringe in the right hand with the first, second and third fingers. At the same time, use the thumb and index fingers of the left hand to stretch the skin at the injection site. Then, with a sharp movement of the right hand perpendicular to the surface of the skin, a needle is inserted into the thickness of the muscle to a depth of 4-6 cm and, pressing the piston, the medicinal substance is injected. It is necessary to strictly ensure that the needle does not go too deep to the coupling, as this may break off. To prevent an allergic reaction when administering certain medications (bicillin, etc.) intramuscularly, you must first inject with one needle (without a syringe with a solution) and wait a while to make sure that no blood flows through the needle. If a drop of blood appears in the lumen of the needle, the drug solution should not be administered, and the injection with the same needle must be repeated in another place, observing the same precautions.

Injection into the spinal canal - see.

An intracardiac injection is made in the middle of the 4th and 5th intercostal space at the left edge of the sternum or under the sternum, as during pericardial puncture. A needle is inserted into the right ventricle. The needle should be long (6-10 cm) and thin. Intracardiac injection is performed urgently in case of sudden cardiac arrest (electric shock, gas poisoning, anesthesia). A 0.1% solution (0.5-1 ml) or corazol (2 ml) is injected into the heart.

Preparatory stage

The algorithm for performing any medical procedure, as a result of which the integrity of the patient’s tissues is violated, begins with preparation. Before giving the injection, you should disinfect your hands: wash them with antibacterial soap or treat them with an antiseptic.

Important: In order to protect their own health, the standard algorithm for the work of medical personnel during any type of contact with patients involves wearing sterile gloves.

Preparation of instruments and preparations:

a sterile tray (a clean ceramic plate that has been disinfected by wiping) and a tray for waste materials;
a syringe with a volume of 1 or 2 ml with a needle with a length of 2 to 3 cm and a diameter of no more than 0.5 mm;
sterile wipes (cotton swabs) – 4 pcs.;
prescribed drug;
alcohol 70%.

Everything that will be used during the procedure should be on a sterile tray. You should check the expiration date and tightness of the packaging of the medicine and the syringe.

The place where you plan to give the injection must be inspected for the presence of:

mechanical damage;
swelling;
signs of dermatological diseases;
manifestation of allergies.

If the selected area has the problems described above, the location of the intervention should be changed.

Taking medicine

The algorithm for withdrawing the prescribed drug into a syringe is standard:

checking the compliance of the medicine contained in the ampoule with that prescribed by the doctor;
clarification of dosage;
disinfection of the neck at the point of its transition from the wide part to the narrow part and incision with a special file supplied in the same box with the medicine. Sometimes ampoules have specially weakened places for opening, made in a factory way. Then there will be a mark on the vessel in the indicated area - a colored horizontal stripe. The removed top of the ampoule is placed in a waste tray;
the ampoule is opened by wrapping the neck with a sterile swab and breaking it away from you;
the syringe is opened, its cannula is combined with the needle, and then the case is removed from it;
the needle is placed in the opened ampoule;
the syringe plunger is pulled back with the thumb, and liquid is drawn out;
the syringe rises with the needle up; the cylinder should be lightly tapped with your finger to displace the air. Push the medicine with the plunger until a drop appears at the tip of the needle;
attach the needle case.

Before making subcutaneous injections, it is necessary to disinfect the surgical field (side, shoulder): with one (large) swab soaked in alcohol, a large surface is treated, with a second (middle) one, the place where the injection is directly planned to be placed. Technique for sterilizing the work area: moving the swab centrifugally or from top to bottom. The injection site should be dry from alcohol.

Manipulation algorithm:

the syringe is taken in the right hand. The index finger is placed on the cannula, the little finger is placed on the piston, the rest will be on the cylinder;
With your left hand – thumb and index finger – grab the skin. There should be a skin fold;
to make an injection, the needle is inserted with a cut upward at an angle of 40-45º for 2/3 of the length into the base of the resulting skin fold;
the index finger of the right hand maintains its position on the cannula, and the left hand moves to the piston and begins to press it, slowly injecting the medicine;
a swab soaked in alcohol is easily pressed against the insertion site of the needle, which can now be removed. Safety precautions stipulate that during the process of removing the tip, you should hold the place where the needle is attached to the syringe;
after finishing the injection, the patient should hold the cotton ball for another 5 minutes, the used syringe is separated from the needle. The syringe is thrown away, the cannula and needle break.

Important: Before giving the injection, the patient must be positioned comfortably. During the injection process, it is necessary to continuously monitor the person’s condition and his reaction to the intervention. Sometimes it is better to give the injection while the patient is lying down.

When you finish giving the injection, remove the gloves if you were wearing them and disinfect your hands again: wash or wipe with an antiseptic.

If you completely follow the algorithm for performing this manipulation, then the risk of infections, infiltrates and other negative consequences is sharply reduced.

Oil solutions

It is prohibited to make intravenous injections with oil solutions: such substances clog blood vessels, disrupting the nutrition of adjacent tissues, causing their necrosis. Oil emboli may well end up in the vessels of the lungs, blocking them, which will lead to severe suffocation, followed by death.

Oily preparations are poorly absorbed, so infiltrates are common at the injection site.

Tip: To prevent infiltration, you can put a heating pad (make a warm compress) at the injection site.

The algorithm for introducing the oil solution involves preheating the drug to 38ºC. Before injecting and administering the medicine, you should insert the needle under the patient's skin, pull the plunger of the syringe towards you and make sure that no blood vessel has been damaged. If blood enters the cylinder, lightly press the needle insertion site with a sterile swab, remove the needle and try again in another place. In this case, safety precautions require replacing the needle, because used is no longer sterile.

How to inject yourself: rules of procedure

Rules for performing various types of injections. Intradermal and subcutaneous injection: technique of execution Injections and their types

Subcutaneous injection of oil solutions.

Subcutaneous injections

Intramuscular injections

Determining the injection site

Performing an intramuscular injection:

Intravenous injections

Performing an intravenous injection.

Preparatory stage

Taking medicine

Oil solutions