What types of injections are there and how to do them. Injections for joints: a review of drugs and injection treatments

Muscles have a wider network of blood vessels 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 muscle tissue, and don't even come close large vessels And nerve trunks. The length of the needle depends on the thickness of the subcutaneous fat layer, since it is necessary that the needle passes through subcutaneous tissue and got into the thickness of the muscles. So, with an excessive subcutaneous fat layer, the needle length is 60 mm, with a moderate one - 50 mm.

Intramuscular injections Usually done in the gluteal muscles, less often - in the muscles of the anterior thigh. Mentally divide the buttock selected for injection into 4 quadrants. You need to get the needle into the upper outer one. In this place, slightly stretch the skin pre-treated with alcohol with your left hand, and with your right hand, taking a filled syringe, quickly inject the needle perpendicular to the surface of the skin along the entire length of the needle (this is the only way you will get into the muscle). After the injection, you need to check whether the needle has entered the lumen of the vessel. To do this, slightly pull the plunger towards you: if blood gets into the syringe, you need to pull the needle slightly towards yourself so that it comes out of the vessel. Slowly inject the contents of the syringe into the muscle, after which the needle must be quickly removed and the injection site covered with an alcohol ball, without rubbing or massaging the surface (the likelihood of infection increases). For repeated injections, try to change the injection site, alternating between the right and left buttocks.

Possible complications of IM injections

• The needle enters the vessel when intramuscular injection. This may be dangerous if you enter oil solutions or suspensions that should not enter the bloodstream (so-called embolism). To make sure that the syringe is not in the container, pull the plunger back a little. If blood enters the syringe, it is necessary to slightly change the direction of the needle and the depth of its insertion.

• Often infiltrates occur at the injection site. This painful lumps, occurring on the 2-3rd day or later after administration. Their cause may be insufficient compliance with the rules of asepsis (the injection site or the doctor’s hand was poorly treated, the injection was carried out with a non-sterile syringe, etc.), multiple administration drugs to the same place, increased sensitivity human tissues to the administered drug (oil solutions, some antibiotics, etc.). If infiltration occurs, its resolution can be accelerated by using heat (a heating pad, alcohol compresses). If the infiltrate is very painful, the skin over it is red and hot, the body temperature has increased, under no circumstances should you warm this area. These are signs of the formation of an abscess (ulcer), for which you need to see a doctor.

• Allergic complications to the administered drug. Be sure to find out before administering any medicine whether the person has ever had an allergic reaction before. Keep in mind that even a mild reaction to this drug previously should serve as a reason to discontinue or replace the drug, since the fact that six months ago a person had a mild rash after the administration of this drug does not mean that the reaction will be the same this time : the same person can give you the same drug anaphylactic shock or suffocation. If a person was allergic to pills or, for example, eye drops some drug, it is even more impossible to inject this drug (that is, the allergic reaction is not associated with a specific method of administering the drug). In addition, an allergy to one drug often implies the presence of allergic reaction and for other drugs from the same pharmacological group(for example, intolerance to penicillin antibiotics).

Subcutaneous injections

Due to the fact that the subcutaneous fat layer is well supplied with blood vessels, for more fast action medicinal substance is used subcutaneous injections. 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 areas for subcutaneous administration are: outside surface shoulder; subscapular space; anterior outer surface of the thigh; side surface abdominal wall; Bottom part axillary area. In these places, the skin is easily caught in the fold and there is no danger of damage blood vessels, nerves and periosteum. It is not recommended to inject: into 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 in right hand syringe (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 3-4th 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 a 45° angle into the base skin fold to a depth of 1–2 cm (2/3 of the needle length), hold index finger needle cannula; move left hand onto 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; do light massage injection sites without removing the cotton wool from the skin; Place the cap on the disposable needle and throw the syringe into the trash container.

Intravenous injections

Intravenous injections involve the administration of a drug directly into the bloodstream. The first and indispensable condition for this method of administering drugs 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 a large diameter, lie superficially and move relatively little, and also superficial veins hands, forearms, less often veins of the lower extremities.

Saphenous veins upper limb- radial and ulnar saphenous veins. Both of these veins, connecting over the entire surface of the upper limb, form many connections, the largest of which is the middle vein of the elbow, most often used for punctures. Depending on how clearly the vein is visible under the skin and palpated (palpable), three types of veins are distinguished.

Type 1 - well contoured vein. The vein is clearly visible, clearly protrudes above the skin, and is voluminous. The side and front walls are clearly visible. During palpation, almost the entire circumference of the vein can be felt, with the exception of the inner wall.

Type 2 - weakly contoured vein. Only the anterior wall of the vessel is very clearly visible and palpated; the vein does not protrude above the skin.

Type 3 - non-contoured vein. The vein is not visible, it can only be palpated in the depths of the subcutaneous tissue by an experienced nurse, or the vein is not visible or palpated at all.

The next indicator by which veins can be divided is fixation in the subcutaneous tissue (how freely the vein moves along the plane). The following options are distinguished: fixed vein - the vein moves along the plane slightly, it is almost impossible to move it to a distance the width of the vessel;

sliding vein - the vein easily moves in the subcutaneous tissue along the plane, it can be moved to a distance greater than its diameter; the lower wall of such a vein, as a rule, is not fixed.

Based on the severity of the wall, the following types can be distinguished: thick-walled vein - a thick, dense vein; thin-walled vein - a vein with a thin, easily vulnerable wall.

Using all of the listed anatomical parameters, the following clinical options are determined:

well contoured fixed thick-walled vein; such a vein occurs in 35% of cases; well contoured sliding thick-walled vein; occurs in 14% of cases; weakly contoured, fixed thick-walled vein; occurs in 21% of cases; weakly contoured sliding vein; occurs in 12% of cases; uncontoured fixed vein; occurs in 18% of cases.

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

The veins of the third and fourth options are less convenient, for the puncture of which a thin needle is most suitable. You just need to remember that when puncturing a “sliding” vein, it must be fixed with the finger of your free hand.

The veins of the fifth option are the most unfavorable for puncture. When working with such a vein, you should remember that you must first palpate (feel) it well; you cannot puncture it blindly.

One of the most common anatomical features veins is so-called fragility. Currently, this pathology is becoming more and more common. Visually and palpably, fragile veins are no different from ordinary ones. Their puncture, as a rule, also does not cause difficulty, but sometimes a hematoma appears literally before our eyes at the puncture site. All control methods show that the needle is in the vein, but, nevertheless, the hematoma is growing. It is believed that what is probably happening is that the needle is a wounding agent, and in some cases the puncture of the vein wall corresponds to the diameter of the needle, and in others, due to anatomical features, a rupture occurs along the course of the vein.

In addition, it can be assumed that violations of the technique of fixing the needle in the vein play an important role here. A weakly fixed needle rotates both axially and in a plane, causing additional trauma to the vessel. This complication occurs almost exclusively in elderly people. If such a pathology occurs, then there is no point in continuing to administer the drug into this vein. Another vein should be punctured and infused, paying attention to fixing the needle in the vessel. A tight bandage must be applied to the area of ​​the hematoma.

Enough a common complication there is an arrival infusion solution into the 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. The needle in the elbow bend must be fixed in at least two points, and in restless patients, the vein must be fixed throughout the limb, excluding the area of ​​the joints.

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.

It is necessary to remember one more feature of veins. If the central and peripheral circulation the veins collapse. Puncture of such a vein is extremely difficult. In this case, the patient should be 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. As a rule, this technique more or less helps with puncture of a collapsed vein. It must be remembered that initial training on such veins is unacceptable.

Performing an intravenous injection.

Prepare: on a sterile tray: syringe (10.0 - 20.0 ml) with medication and needle 40 - 60 mm, cotton balls; tourniquet, roller, gloves; 70% ethanol; tray for used ampoules, vials; container with a disinfectant solution for used cotton balls.

Sequence of actions: wash and dry your hands; draw medicine; help the patient occupy comfortable position- lying on your back or sitting; Give the limb into which the injection will be made the required position: the arm is extended, palm up; place an oilcloth pad under the elbow (for maximum extension of the limb in elbow joint); wash your hands, put on gloves; place a rubber band (on a shirt or napkin) on middle third shoulder so that the free ends are directed up, the loop is down, the pulse is at radial artery however, it should not change; ask the patient to work with his fist (to better pump blood into the vein); find a suitable vein for puncture; treat the skin of the elbow area with the first cotton ball with alcohol in the direction from the periphery to the center, discard it (the skin is disinfected); take the syringe in your right hand: fix the needle cannula with your index finger, and use the rest to cover the cylinder from above; check that there is no air in the syringe; if there are a lot of bubbles in the syringe, you need to shake it, and the small bubbles will merge into one large one, which can be easily pushed out through the needle into the tray; again with your left hand, treat the venipuncture site with a second cotton ball with alcohol, discard it; Fix the skin in the puncture area with your left hand, stretching the skin in the area of ​​the elbow with your left hand and slightly shifting it to the periphery; holding the needle almost parallel to the vein, pierce the skin and carefully insert the needle 1/3 of the length with the cut up (with the patient’s fist clenched); Continuing to fix the vein with your left hand, slightly change the direction of the needle and carefully puncture the vein until you feel “entering the void”; pull the plunger towards you - blood should appear in the syringe (confirmation that the needle has entered a vein); untie the tourniquet with your left hand by pulling one of the free ends, ask the patient to unclench his hand; Without changing the position of the syringe, press the plunger with your left hand and slowly inject medicinal solution, leaving 0.5 -1-2 ml in the syringe; apply a cotton ball with alcohol to the injection site and remove the needle from the vein with a gentle movement (prevention of hematoma); bend the patient's arm at the elbow, leave the alcohol ball in place, ask the patient to fix the arm in this position for 5 minutes (bleeding prevention); dump the syringe into a disinfectant solution or cover the needle (disposable) with a cap; after 5-7 minutes, take the cotton ball from the patient and throw it into a disinfectant solution or into a bag containing a disposable syringe; take off your gloves and throw them into the disinfectant solution; wash your hands.

Types of injections

Intradermal injections

The introduction of a medicinal substance in a strong dilution into the thickness of the skin is called an intradermal (intracutaneous) injection. Most often, intradermal administration of drugs is used to obtain local superficial anesthesia of the skin and to determine the local and general immunity of the body to the drug (intradermal reactions).

Local anesthesia occurs from the effect of an anesthetic substance injected intradermally on the endings of the thinnest branches of the sensory nerves.

Intradermal reactions (tests) are characterized by high sensitivity and are widely used in medical practice for determining:

a) general nonspecific reactivity of the body;

b) increased sensitivity of the body to various substances (allergens) in allergic conditions of a constitutional or acquired type;

c) the allergic condition of the body with Tuberculosis, glanders, brucellosis, echinococcosis, actinomycosis, fungal diseases, syphilis, typhoid diseases and others and for the diagnosis of these diseases;

d) the state of antitoxic immunity, characterizing the degree of immunity to certain infections (diphtheria - Schick reaction, scarlet fever - Dick reaction).

Intradermal administration of killed bacteria or metabolic 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 administered substance enters general circle blood circulation, intradermal injection causes and general reaction the body, the manifestation of which is general malaise, a state of excitement or depression of the nervous system, headache, appetite disorder, fever.

Technique intradermal injection consists of injecting 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; V) 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 region. In some cases, the subcutaneous tissue of the abdomen may be chosen as the injection site. The skin is treated with alcohol or iodine tincture.

The injection technique is as follows. Holding the syringe with the thumb and three middle fingers of the right hand in the direction of the lymph flow, with the thumb and index fingers of the left hand, grab the skin and subcutaneous tissue into a fold, which is pulled upward towards the needle tip.

With a short, quick movement, the needle is inserted into the skin and advanced into the subcutaneous tissue between the fingers of the left hand to a depth of 1-2 cm. After this, the syringe is intercepted, placing it between the index and middle fingers of the left hand, and the pulp of the nail phalanx thumb Place it on the syringe plunger handle and squeeze out the contents. At the end of the injection, quickly remove the needle. The injection site is lightly lubricated with iodine tincture. There should be no backflow of the medicinal solution from the injection site.

Subcutaneous infusions (infusions). They are performed with the aim of introducing into the body, bypassing the digestive canal, a liquid that can quickly be absorbed from the subcutaneous tissue without harming the tissues and without changing the osmotic tension of the blood.

Indications. Subcutaneous infusions are performed when:

1) the impossibility of introducing fluid into the body through digestive tract(obstruction of the esophagus, stomach, persistent vomiting);

2) severe dehydration of the patient after prolonged diarrhea and uncontrollable vomiting.

For infusion use a physiological solution of table salt (0.85-0.9%), Ringer's solution (sodium chloride 9.0 g; potassium chloride 0.42 g; calcium chloride 0.24 g; sodium bicarbonate 0.3 g; distilled water 1 l), Ringer-Locke solution (sodium chloride 9.0 g; calcium chloride 0.24 g; potassium chloride 0.42 g; sodium bicarbonate 0.15 g; glucose 1.0 g;

water up to 1 l).

Technique. The infused liquid is placed in a special vessel - a cylindrical funnel, which is connected to a needle through a rubber tube. The speed of blood flow is controlled by Morr clamps located on the tube.

The injection site is the subcutaneous tissue of the thigh or anterior abdominal wall.

Intramuscular injections

Those drugs that have a pronounced irritating effect on the subcutaneous tissue (mercury, sulfur, digitalis, hypertonic solutions of certain salts) are subject to intramuscular administration.

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

The sites for intramuscular injections are shown in Fig. 30. Most often they are made into the muscles of the gluteal region at a point located at the intersection of a vertical line running in the middle of the buttock and a horizontal line - two transverse fingers below the iliac crest, i.e. in the area of ​​the upper outer quadrant of the gluteal region. IN extreme cases intramuscular injections can be made into the thigh along the anterior or outer surface.

Technique. When performing intramuscular injections into the gluteal region, the patient should lie on his stomach or side. Injections into the thigh area are made while lying on your back. A needle with a length of at least 5-6 cm of sufficient caliber is used. The needle is inserted into the tissue with a sharp movement of the right hand perpendicular to the skin to a depth of 5-6 cm (Fig. 31, b). This ensures minimal pain sensation and insertion of the needle into the muscle tissue. When injecting into the thigh area, the needle should be directed at an angle to the skin.

After the injection, before administering the drug, you need to slightly pull the piston outward, remove the syringe from the needle and make sure that no blood flows out of it. The presence of blood in the syringe or flowing out of the needle indicates that the needle has entered the lumen of the vessel. After making sure that the needle is positioned correctly, you can administer the drug. At the end of the injection, the needle is quickly removed from the tissue, and the injection site on the skin is treated with iodine tincture.

After injections, painful infiltrates sometimes form at the injection site, which soon resolve on their own. To speed up the resorption of these infiltrates, you can use warm heating pads applied to the area of ​​infiltration.

Complications arise when asepsis is violated and the injection site is incorrectly chosen. Among them, the most common is the formation of post-injection abscesses and traumatic injury sciatic nerve. The literature describes such a complication as air embolism, which occurs when a needle penetrates the lumen of a large vessel.

Intravenous injections and infusions

Intravenous injections are made for introduction into the body remedy if it is necessary to obtain a quick therapeutic effect or it is impossible to administer the drug into the gastrointestinal tract subcutaneously or intramuscularly.

Carrying out intravenous injections, the doctor must ensure that the administered drug does not leave the vein. If this happens, then either the rapid therapeutic effect, or a pathological process associated with the irritating effect of the ingested drug will develop in the tissues surrounding the vein. In addition, you must be very careful to prevent air from entering the vein.

In order to perform an intravenous injection, it is necessary to puncture the vein - perform venipuncture. It is produced for the introduction into a vein of a small amount of drugs or a large amount various liquids, as well as for extracting blood from a vein.

Technical accessories. To perform venipuncture, you must have: a syringe of appropriate capacity; a short needle of sufficient caliber (it is best to use a Dufault needle) with a short bevel at the end; Esmarch rubber band or a regular rubber drainage tube 20-30 cm long; hemostatic clamp.

Technique. Most often, veins located subcutaneously in the elbow area are used for puncture.

In cases where the veins of the elbow are poorly differentiated, the veins of the dorsum of the hand can be used. Veins of the lower extremities should not be used, as there is a risk of developing thrombophlebitis.

During venipuncture, the patient's position can be sitting or lying down. The first is applicable for infusing a small amount of medicinal substances into a vein or when taking blood from a vein to study its components. The second position is indicated in cases of prolonged administration of liquid solutions into a vein for therapeutic purposes. However, given that venipuncture is often accompanied by the development of a fainting state in the patient, it is best to always perform it in a supine position. It is necessary to place a towel folded several times under the elbow joint to give the limb a position of maximum extension.

To facilitate puncture, the vein must be clearly visible and filled with blood. To do this, you need to apply an Esmarch tourniquet or a rubber tube to the shoulder area. A soft pad should be placed under the tourniquet so as not to injure the skin. The degree of compression of the shoulder tissues should be such as to stop the flow of blood through the veins, but not to compress the underlying arteries. The patency of the arteries is checked by the presence of a pulse in the radial artery.

The sister's hands and the patient's skin in the elbow area are treated with alcohol. The use of iodine is not recommended, as it changes the color of the skin and does not reveal complications during puncture.

To ensure that the vein chosen for puncture does not move when the needle is inserted, it is carefully held at the site of the intended injection with the middle (or index) and thumb of the left hand.

A vein is punctured either with one needle or with a needle attached to a syringe. The direction of the needle tip should correspond to the blood flow towards the center. The needle itself should be positioned at an acute angle to the surface of the skin. The puncture is performed in two stages: first the skin is pierced, and then the vein wall. The depth of the puncture should not be large so as not to puncture the opposite wall of the vein. Having felt that the needle is in the vein, you should advance it along the course by 5-10 mm, placing it almost parallel to the course of the vein.

The fact that the needle has entered a vein is indicated by the appearance of a stream of dark venous blood from the outer end of the needle (if a syringe is connected to the needle, blood is detected in the lumen of the syringe). If blood does not flow out of the vein, you should slightly pull the needle outward and repeat the stage of piercing the vein wall again.

When injected into a vein medicinal product causing tissue irritation, venipuncture should be performed with a needle without a syringe. The syringe is attached only when there is complete confidence in the correct position of the needle in the vein. When a drug that does not irritate the tissue is injected into a vein, venipuncture can be done with a needle attached to a syringe into which the drug is drawn.

Injection technique. After performing venipuncture and making sure correct position needles in the vein, begin administering the drug. To do this, you need to remove the tourniquet that was applied to fill the vein. This should be done carefully so as not to change the position of the needle. The injection itself, even in cases where a small volume of medicinal liquid is administered, must be done very slowly. Throughout the injection, it is necessary to monitor whether the injected liquid enters the vein. If the liquid begins to flow into nearby tissues, then swelling appears in the circumference of the vein, and the syringe plunger does not move forward well. In such cases, the injection should be stopped and the needle removed from the vein. The procedure is repeated.

At the end of the injection, the needle is quickly removed from the vein in the direction of its axis, parallel to the surface of the skin, so as not to damage the vein wall. The pinhole at the needle insertion site is pressed with a cotton or gauze swab moistened with alcohol. If the injection was performed into the antecubital vein, the patient is asked to bend the arm at the elbow joint as much as possible, while holding the tampon.

Recently in clinical practice puncture of the subclavian vein became widely used. However, due to the possibility of developing serious complications during manipulation, it must be performed according to strict indications by doctors who are proficient in the technique of performing it. It is usually performed by resuscitators.

Complications that arise from intravenous injections are caused by the ingress of blood and fluid into the tissues, which is injected into the vein. The reason for this is a violation of the venipuncture and injection technique.

When blood leaks from a vein, a hematoma forms in nearby tissues, which usually does not pose a danger to the patient and resolves relatively quickly. If an irritating liquid gets into the tissue, burning pain in the injection area and a very painful, long-lasting infiltrate may form or tissue necrosis may occur.

The last complication often occurs when a calcium chloride solution gets into the tissue.

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

Intravenous infusions are used to introduce large volumes of transfusion agents into the body. They are performed to restore the volume of circulating blood, detoxify the body, normalize metabolic processes in the body, and maintain the vital functions of organs.

Infusions can be performed both after venipuncture and after venesection. Due to the fact that the infusion lasts a long period of time (in some cases a day or more), it is best carried out through a special catheter inserted into the vein with a puncture needle or installed during venesection.

The catheter should be fixed to the skin either with adhesive tape or, more securely, by suturing it to the skin with silk thread.

The liquid intended for infusion must be in vessels of various capacities (250-500 ml) and connected through special systems to a needle or catheter inserted into a vein. The characteristics of transfusion agents and indications for their use are described in detail in the relevant manuals on transfusiology.

Complications. A great danger for the patient is the entry of air into the transfusion system, which leads to the development air embolism. Therefore, the nurse must be able to “charge” the transfusion system without violating its sterility and creating complete tightness.

To connect the container containing the transfusion medium to the needle-catheter inserted into the vein, a special disposable tubing system is used (Fig. 34).

Technique. Preparing the system for intravenous infusion is as follows. With sterile hands, the nurse handles the stopper that closes the vessel with the transfusion fluid, and inserts a needle through it (the length of the needle must be no less than the height of the vessel). Next to this needle, a needle is inserted into the cavity of the vessel, connected to a system of tubes through which the liquid will flow into the vein. The vessel is turned upside down, a clamp is applied to the tube near the vessel, and a glass dropper filter located on the tube system is located at the mid-height of the vessel. After removing the clamp from the tube, fill half of the dropper filter with transfusion fluid and re-apply the clamp to the tube. Then the vessel is placed on a special stand, the tube system along with the dropper filter is lowered below the vessel, and the clamp is removed from the tube again. In this case, the liquid begins to flow intensively from the vessel and the dropper filter into the corresponding elbows of the system, filling them, it flows out through the cannula at its end. Once the tube system is filled with fluid, a clamp is applied to the bottom tube. The system is ready for connection to a catheter or needle located in the patient’s vein.

If the system tubes are made of transparent plastic

mass, then determining the presence of air bubbles in it does not present much difficulty. When rubber opaque tubes are used, the presence of air bubbles is monitored by a special glass tube located between the cannula connecting the tubes to the needle in the vein and the tube.

If during the infusion there is a need to replace the bottle of liquid, then this should be done without leaving the vein. To do this, a clamp is placed on the tube near the vessel, and the needle to which the tube is connected is removed from the vessel and inserted into the plug of the vessel with the new transfusion medium. In this case, it is very important that at the time of rearranging the vessels, the tube system is filled with liquid from the previous infusion.

After the intravenous infusion of fluid is completed, a clamp is placed on the tube near the vein and the needle is removed from the vein. The vein puncture site is pressed with a cotton or gauze swab moistened with alcohol. The same is done with a catheter inserted into a vein during puncture. As a rule, active bleeding from a wound in the vein wall is not observed.

Inhalation

A method of treatment in which a drug in a finely sprayed, vapor or gaseous state is carried with inhaled air into the nasal cavity, mouth, pharynx and into the deeper respiratory tract is called inhalation. Inhaled substances are partly absorbed in the respiratory tract, and also pass from the mouth and pharynx into the digestive tract and thus affect the entire body.

Indications. Inhalation is used for: 1) inflammation of the mucous membranes of the nose, pharynx and pharynx, especially accompanied by the formation of thick mucus that is difficult to separate; 2) inflammatory processes respiratory tract, both medium (laryngitis, tracheitis) and deep (bronchitis); 3) the formation of inflammatory cavities in the lungs associated with bronchial tree, for introducing balsamic and deodorizing agents into them.

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

In order for most of the steam to enter the respiratory tract, the patient’s head is placed over a pan of water and covered with a blanket on top. A teapot can be used for the same purpose. After the water boils, place it on low heat, put a tube made of a folded sheet of paper over the spout and breathe steam through it.

The domestic industry produces steam inhalers. The water in them is heated using a built-in electric element. Steam exits through the nozzle and enters a glass mouthpiece, which the patient takes into his mouth. The mouthpiece must be boiled after each use. Medicines to be administered into the body are placed in a special tube installed in front of the nozzle.

IMPACT ON CAVITY ORGANS

GASTRIC WASHING

Gastric lavage is a technique in which its contents are removed from the stomach through the esophagus: stagnant, fermented liquid (food); poor quality food or poisons; blood; bile.

Indications. Gastric lavage is used for:

1) diseases of the stomach: atony of the stomach wall, obstruction of the antrum of the stomach or duodenum;

2) poisoning with food substances, various poisons;

3) intestinal obstruction due to paresis of its wall or mechanical obstruction.

Methodology. For gastric lavage, a simple device is used, consisting of a glass funnel with a capacity of 0.5-1.0 liters with engraved divisions of 100 cm3, connected to a thick-walled rubber tube 1-1.5 m long and about 1-1.5 cm in diameter. Washing is carried out with water at room temperature (18-20° C).

Technique. The position of the patient during gastric lavage is usually sitting. A probe connected to a funnel is inserted into the stomach. The outer end of the probe with a funnel is lowered to the patient’s knees and the funnel is filled with water to the brim. Slowly raise the funnel upward, approximately 25-30 cm above the patient’s mouth. At the same time, water begins to enter the stomach. You need to hold the funnel in your hands somewhat obliquely so that the column of air that is formed during the rotational movement of the water passing into the tube does not enter the stomach. When the water drops to the point where the funnel enters the tube, slowly move the funnel to the height of the patient’s knees, holding it with the wide opening upward. The return of fluid from the stomach is determined by the increase in its amount in the funnel. If as much liquid comes out into the funnel as it entered the stomach or

more, then it is poured into a bucket, and the funnel is filled again with water. The release of a smaller amount of fluid from the stomach, compared to what was injected, indicates that the tube in the stomach is not positioned correctly. In this case, it is necessary to change the position of the probe, either by tightening it or deepening it.

The effectiveness of lavage is assessed by the nature of the fluid flowing from the stomach. Obtained from the stomach clean water without admixture of gastric contents indicates complete lavage.

In case of acidic reaction of gastric contents, it is advisable to use salt-alkaline solutions for gastric lavage: add 10.0 soda (NaHCO3) and salt (NaCl) to 3 liters of water.

enemas and gas removal

FROM THE INTESTINE

A technical technique that involves introducing a liquid substance (water, medicine, oil, etc.) into the intestines through the rectum is called an enema.

Anatomical and physiological data on which

based on the method of using enemas

The natural release of the contents of the large intestine - defecation - is a complex reflex act that occurs with the participation of the central nervous system. Liquid contents from the small intestines pass into the large intestine, where they linger for 10-12 hours, and sometimes more. As it passes through the large intestine, the contents gradually become denser due to the vigorous absorption of water and turn into feces. In the intervals between bowel movements, feces move distally due to peristaltic contractions of the muscles of the colon, descend to the lower end of the sigmoid colon and accumulate here. Their further advancement into the rectum is prevented by the third sphincter of the rectum. Accumulation feces V sigmoid colon does not feel like a “urge to go down”. The urge to defecate occurs in a person only when feces enter the rectum and fill its cavity. It is caused by mechanical and chemical irritation of the receptors of the rectal wall and especially by stretching of the intestinal ampulla. During defecation, the anal sphincters (external - made of transverse muscles, internal - made of smooth muscles) are constantly in a state of tonic contraction. The tone of the sphincters especially increases when feces enter the rectal cavity. When the “urge to go down” appears and during defecation, the tone of the sphincters reflexively decreases and they relax. This removes the obstacle to the excretion of feces. At this time, under the influence of irritation of rectal receptors, the circular muscles contract intestinal wall and pelvic floor. 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.

Absorption of the injected liquid occurs in the colon, and it depends on various conditions. Highest value at the same time, it has the composition of the liquid and the degree of mechanical and thermal irritation provided, as well as the condition of the intestine itself.

Warm hypotonic solutions of glucose (1%) and table salt (0.7%) are best absorbed. Drinking water, remaining in the intestine, although it irritates it, is also gradually absorbed. With intestinal atony, absorption increases; with increased peristalsis, it occurs to a small extent; with prolonged spasm, absorption can be complete.

The most common types of drug injections include intradermal, subcutaneous, and intramuscular. More than one lesson at a medical school is devoted to how to give an injection correctly; students practice it over and over again. correct technique. But there are situations when professional help It is not possible to get an injection, and then you will have to master this science yourself.

Rules for drug injections

Every person should be able to give injections. Of course, we are not talking about such complex manipulations as intravenous injections or placing a drip, but ordinary intramuscular or subcutaneous administration of drugs in some situations can save lives.

Currently, for all injection methods, disposable syringes are used, which are sterilized at the factory. Their packaging is opened immediately before use, and after injection the syringes are disposed of. The same applies to needles.

So, how to give injections correctly so as not to harm the patient? Immediately before the injection, you must thoroughly wash your hands and wear sterile disposable gloves. This allows you not only to comply with the rules of asepsis, but also protects against possible blood-borne infections (such as HIV).

The syringe packaging is torn apart while wearing gloves. The needle is carefully placed on the syringe, and it can only be held by the coupling.

Injectable medications come in two main forms: liquid solution in ampoules and soluble powder in vials.

Before making injections, you need to open the ampoule, and before that, its neck needs to be treated with a cotton swab dipped in alcohol. Then the glass is filed with a special file, and the tip of the ampoule is broken off. To avoid injury, it is necessary to grasp the tip of the ampoule only with a cotton swab.

The drug is drawn into a syringe, after which the air is removed from it. To do this, holding the syringe with the needle up, carefully squeeze out the air from the needle until a few drops of the drug appear.

According to the rules for injections, the powder is dissolved in distilled water for injection before use, saline solution or glucose solution (depending on the drug and type of injection).

Most bottles with soluble drugs They have a rubber stopper that can be easily pierced by a syringe needle. The required solvent is pre-drawn into the syringe. The rubber stopper of the bottle with the drug is treated with alcohol and then pierced with a syringe needle. The solvent is released into the bottle. If necessary, shake the contents of the bottle. After dissolving the drug, the resulting solution is drawn into the syringe. The needle is not removed from the bottle, but removed from the syringe. The injection is carried out with another sterile needle.

Technique for performing intradermal and subcutaneous injections

Intradermal injections. To perform an intradermal injection, take a small-volume syringe with a short (2-3 cm) thin needle. The most convenient place for injection is inner surface forearms.

The skin is pre-treated thoroughly with alcohol. According to the intradermal injection technique, the needle is inserted almost parallel to the surface of the skin with the cut upward, and the solution is released. When administered correctly, a lump or “lemon peel” remains on the skin, and no blood comes out of the wound.

Subcutaneous injections. Most comfortable places for subcutaneous injections: the outer surface of the shoulder, the area under the shoulder blade, the anterior and lateral surface of the abdominal wall, the outer surface of the thigh. Here the skin is quite elastic and easily folded. In addition, when performing an injection in these very places, there is no risk of damage to the surface and.

To perform subcutaneous injections, syringes with a small needle are used. The injection site is treated with alcohol, the skin is grabbed into a fold and a puncture is made at an angle of 45° to a depth of 1-2 cm. The subcutaneous injection technique is as follows: the drug solution is slowly injected into the subcutaneous tissue, after which the needle is quickly removed and the injection site is pressed with a cotton swab swab soaked in alcohol. If it is necessary to inject a large volume of the drug, you can not remove the needle, but disconnect the syringe to re-draw the solution. However, in this case, it is preferable to give another injection in a different location.

Technique for intramuscular injection

Most often, intramuscular injections are performed into the muscles of the buttocks, less often into the abdomen and thighs. The optimal volume of the syringe used is 5 or 10 ml. If necessary, a 20 ml syringe can be used to perform an intramuscular injection.

The injection is made into the upper outer quadrant of the buttock. The skin is treated with alcohol, after which the needle is injected with a quick movement at a right angle to 2/3-3/4 of its length. After the injection, the syringe plunger must be pulled towards you to check whether the needle has entered the vessel. If no blood flows into the syringe, inject the drug slowly. When the needle enters the vessel and blood appears in the syringe, the needle is pulled back slightly and the drug is injected. The needle is removed in one quick movement, after which the injection site is pressed with a cotton swab. If the drug is difficult to absorb (for example, magnesium sulfate), place a warm heating pad at the injection site.

The technique for performing intramuscular injection into the thigh muscles is somewhat different: it is necessary to inject the needle at an angle, while holding the syringe like a pen. This will prevent damage to the periosteum.

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Injections with a lifting effect are modern procedures that allow you to restore youth to your face and body. They do a great job with correction. age-related changes and rejuvenation. For example, with the help of hyaluronic acid injections, you can restore volume to your lips, smooth out wrinkles on the face, neck and décolleté.

Botulinum toxin injections will relieve deep wrinkles between the eyebrows, around the eyes and on the forehead.

Anti-aging facial injections: what are they?

Exist the following drugs and procedures:

1. Botox – facial contouring and botulinum therapy. Designed to correct imperfections and get rid of facial wrinkles;
2. Preparations with hyaluronic acid– contour plastic surgery, biorevitalization. Hyaluronic acid improves skin condition through rejuvenation and hydration;
3. Fillers with hyaluronic acid – lip correction, contouring. Designed to correct imperfections, eliminate ptosis, age-related changes, replenish volume, moisturize and nourish the skin;
4. Cocktails with hyaluronic acid, minerals and vitamins - mesotherapy. The condition of the skin after the introduction of acid improves, the face rejuvenates;
5. Radiesse filler – Radiesse rejuvenation, contouring. Corrects defects, eliminates age-related imperfections, ptosis, fills wrinkles.

Peptides and hyaluronic acid

These two substances are similar to each other, in addition, hyaluronic acid and peptides enhance each other’s effects. Therefore, it is recommended to use acids in tandem.

Peptides are artificial protein substances that stimulate the regeneration of skin cells, as a result of which the epidermis is rejuvenated. They eliminate pigmentation and age-related defects.

Benefits of hyaluronic acid and peptides:

1. The number of wrinkles/folds is reduced;
2. Bruises under the eyes, peeling, small scars/scars disappear;
3. The color and structure of the dermis improves - sagging decreases, dryness/oilyness disappears;
4. Acids help restore skin after intense cosmetic procedures and tanning.

The process of introducing peptides and hyaluronic acid

First of all, the skin is lubricated with anesthetic cream. Then they give subcutaneous injections. Sometimes the result is noticeable in the first day after the procedure.

The optimal course is 3-4 procedures, carried out at intervals of 2 weeks. In the future, it is enough to introduce hyaluronic acid and peptides 1-2 times a year.

Peptides in mesotherapy

Similar procedures are carried out without hyaluronic acid. They are aimed at eliminating fat deposits, cellulite, reducing scars, enlarged pores, facial oiliness, as well as treating rosacea.

Mesotherapy with peptides is carried out in courses - 4-5 procedures with an interval of 10 days.

Hyaluronic acid injections

Fillers are products that are injected under the skin of the face and body. They fill wrinkles and create volume. The basis of most drugs is hyaluronic acid, a substance produced by the body itself. With age, its production decreases, skin defects appear - wrinkles, folds.

Injections with hyaluronic acid replenish the lost volume of this substance, which gradually restores elasticity, a healthy complexion, and rejuvenates it.

Injections of hyaluronic acid allow you to perform contouring, change the shape of the face, remove nasolabial folds, and correct the chin without surgery.

The first result is noticeable 1-4 days after the first procedure. For full effect, 3-4 sessions are required with an interval of 2 weeks.

Collagen injections for the face

Collagen, like hyaluronic acid, is a substance found in tissues human body. Collagen is a protein that can absorb and bind moisture, thereby strengthening and toning tissues.

After its administration, the skin on the face becomes elastic, its structure improves, and it is saturated with nutrients.

In a young body, hyaluronic acid and other substances are produced in sufficient quantity, but with age, production decreases, resulting in wrinkles.

Collagen, like hyaluronic acid, is used to combat aging, to eliminate scars, scars, contour plastic surgery lips

The effect becomes noticeable after an hour, so many people prefer collagen instead of hyaluronic acid.

Collagen injections, as with the use of hyaluronic acid, are used for shallow wrinkles; insufficient volume of lips/cheekbones; folds on the skin of the lower eyelid/in the area of ​​the nasolabial triangle; irregular shape chin; excessive skin texture.

The procedure lasts about an hour. The effect lasts 3-6 months.

Collagen for the face, in addition to standard contraindications, is not used if there is oncological pathologies; after recent dermabrasion, chemical peeling, laser resurfacing; in the presence of inflammation at the sites of intended injection.

Ozone injections

Ozone therapy should be included in the treatment complex, for example, used with hyaluronic acid. It will help with sagging, aging facial skin, inflammatory processes (pimples, acne), rosacea and even hair loss.

Ozone injections affect the causes of defects and are therefore very effective. They stimulate redox processes, activating cell functions. Ozone renews and makes the immune system work. Facial injections not only smooth out the skin, but also rejuvenate it from the inside.

They rejuvenate the face with courses of 5-10 procedures, depending on the condition of the skin and the desired result.

A big plus of injections is practically complete absence contraindications. They can be done even for pregnant women and teenagers.

Ozone injections for the face, like hyaluronic acid, can correct the skin and eliminate defects. In addition, with their help you can get rid of cellulite by making injections for the body, dandruff and a number of fungal skin diseases.

Injections for vitaminizing the face

Various cocktails are used for mesotherapy - preparations rich in vitamins, minerals, and acids are injected under the skin of the face. They actively affect dermal cells, restoring them from the inside.

You can rejuvenate your face with hyaluronic acid and vitamins in 7-10 sessions. Maintenance courses are held every 1-2 years.

Injection - the introduction of medicinal substances using special injection under pressure into different environments body. There are intradermal, subcutaneous, intramuscular and intravenous injections. By special indications also used intraarterial, intrapleural, intracardiac, intraosseous, intraarticular administration medicines. If you need to achieve high concentration drug in the central nervous system, spinal (subdural and subarachnoid) administration is also used.

Injection methods of drug administration are used in situations where it is necessary quick effect, for example when treating emergency conditions. This ensures a high rate of entry of medicinal substances into the blood and the accuracy of their dosage, and the required concentration of the drug in the blood is sufficiently maintained due to repeated injections long time. The injection method is also used in cases where it is impossible or impractical to administer the medicine orally or there are no appropriate dosage forms for oral administration.

Rice. II. Types of syringes and needles.

Injections are usually given using syringes and needles. Syringes various types(“Record”, Luera, Janet, presented in Fig. 11) consist of a cylinder and a piston and have different volumes (from 1 to 20 cm 3 or more). The thinnest are syringes for administering tuberculin; their division price is 0.02 ml. Special syringes also exist for administering insulin; The divisions on the cylinder of such syringes are marked not in fractions of a cubic centimeter, but in units of insulin. Needles used for injections have different lengths (from 1.5 to 10 cm or more) and different lumen diameters (from 0.3 to 2 mm). They must be well sharpened

Currently, so-called needle-free injectors are used, which allow the administration of a medicinal substance intradermally, subcutaneously and intramuscularly without the use of needles. The action of a needleless injector is based on the ability of a jet of liquid supplied under a certain pressure -

laziness, penetrate through skin. This method is used, for example, for pain relief in dental practice, as well as for mass vaccinations. The needle-free injector eliminates the risk of transmitting serum hepatitis and is also characterized by high productivity (up to 1600 injections per hour).

Syringes and needles used for injections must be sterile. To destroy microbial flora they use various ways sterilization, based most often on the action of certain physical factors.

The most optimal and reliable methods are sterilization of syringes and needles in an autoclave using saturated water steam under a pressure of 2.5 kg/cm 2 and a temperature of 138 ° C, as well as sterilization in a drying-sterilization cabinet with dry hot air. In everyday life medical practice Boiling syringes and needles is still sometimes used, which, however, does not ensure complete sterilization, since some viruses and bacteria are not killed. In this regard, disposable syringes and needles seem ideal, providing reliable protection from HIV infection, hepatitis B and C.

Sterilization by boiling requires compliance with a number of rules and a certain sequence in the processing of syringes and needles. After performing the injection, the syringe and needle are immediately washed with cold running water to remove any remaining blood and medication (after they dry, this will be much more difficult to do). Disassembled needles and syringes are placed for 15 minutes in a hot (50 ° C) washing solution prepared at the rate of 50 g of washing powder, 200 ml of perhydrol per 9750 ml of water.

After thorough washing in the specified solution using brushes or cotton-gauze swabs, the syringes and needles are rinsed a second time in running water. Then, in order to check the quality of the treatment, samples are taken selectively to detect blood and detergent residues in needles and syringes.

The presence of traces of blood is determined using a benzidine test. To do this, mix several bepzidine crystals with 2 ml of a 50% solution acetic acid and 2 ml of 3% hydrogen peroxide solution. A few drops of the resulting solution are added to a syringe and passed through a needle. The appearance of a green color indicates the presence of blood residues in the instruments. In such cases, syringes and needles need to be reprocessed to avoid the transmission of various diseases (for example, serum hepatitis, AIDS).

Leftovers detergent determined using a sample with

Rice. 12. Placing syringes in the sterilizer.