Injection technique. Subcutaneous injection technique: execution algorithm Do p to injection

In diabetes, patients have to inject insulin into the body every day to regulate blood sugar levels. To this end, it is important to be able to independently use insulin syringes, calculate the dosage of the hormone and know the algorithm for administering a subcutaneous injection. Also, parents of children with diabetes should be able to perform such manipulations.

The subcutaneous injection method is used most often in cases where it is required that the drug be absorbed into the blood evenly. The drug thus enters the subcutaneous fatty tissue.

This is a fairly painless procedure, so this method can be used with insulin therapy. If the intramuscular route is used to inject insulin into the body, the absorption of the hormone occurs very quickly, so such an algorithm can harm a diabetic by causing glycemia.

It is important to bear in mind that diabetes mellitus requires a regular change of sites for subcutaneous injection. For this reason, after about a month, a different part of the body should be chosen for the injection.

The technique of painless insulin administration is usually practiced on oneself, while the injection is made using sterile saline. The algorithm for a competent injection can be explained by the attending physician.

The rules for performing subcutaneous injections are quite simple. Before each procedure, it is necessary to wash hands thoroughly with antibacterial soap, they can also be additionally treated with an antiseptic solution.

The introduction of insulin using syringes is performed in sterile rubber gloves. It is important to ensure proper lighting in the room.

For a subcutaneous injection, you will need:

An insulin syringe with a needle of the required size.
Sterile tray where cotton napkins and balls are placed.
Medical alcohol 70%, which is used to treat the skin at the injection site.
Special container for the material used.
Disinfectant solution for syringes.

Before injecting insulin, you need to conduct a thorough inspection of the injection site. The skin should not have any damage, symptoms of a dermatological disease and irritation. If there is swelling, a different area is selected for the injection.

For subcutaneous injection, you can use parts of the body such as:

Outer shoulder surface;
Anterior surface of the thigh;
Lateral surface of the abdominal wall;
The area under the shoulder blade.

Since there is usually practically no fatty subcutaneous tissue in the area of \u200b\u200bthe arms and legs, insulin injections are not given there. Otherwise, the injection will not be subcutaneous, but intramuscular.

In addition to the fact that such a procedure is very painful, the introduction of the hormone in this way can lead to complications.

How is a subcutaneous injection given?

With one hand, a diabetic makes an injection, and the second holds the desired area of \u200b\u200bthe skin. The algorithm for the correct administration of the drug is primarily in the correct capture of the skin fold.

With clean fingers, you need to grab the area of \u200b\u200bthe skin where the injection will be injected into the fold.

In this case, it is not necessary to squeeze the skin, as this will lead to the formation of bruises.

It is important to choose a suitable area where there is a lot of subcutaneous tissue. With thinness, the gluteal region can become such a place. For an injection, you don’t even need to make a fold, you just need to feel the fat under the skin and make an injection into it.
The insulin syringe should be held like a dart - with the thumb and three other fingers. The technique of administering insulin has a basic rule - so that the injection does not cause pain to the patient, you need to do it quickly.
The algorithm for performing an injection in actions is similar to throwing a dart, the technique of playing darts will be an ideal clue. The main thing is to hold the syringe firmly so that it does not jump out of your hands. If the doctor taught to make a subcutaneous injection, touching the skin with the tip of the needle and gradually pressing it in, this method is erroneous.
The skin fold is formed depending on the length of the needle. For obvious reasons, insulin syringes with short needles will be the most convenient and will not cause pain to a diabetic.
The syringe accelerates to the desired speed when it is ten centimeters away from the site of the future injection. This will allow the needle to instantly penetrate the skin. Acceleration is given by the movement of the whole arm, the forearm is also involved in this. When the syringe is close to the skin, the wrist directs the tip of the needle to the exact target.
After the needle penetrates the skin, you need to press the piston to the end, squirting the entire volume of insulin. After the injection, you cannot immediately remove the needle, you need to wait five seconds, after which it is removed with quick movements.

You should not use oranges or other fruits as a workout.

To learn how to accurately hit the right target, the throwing technique is practiced with a syringe, on the needle of which a plastic cap is put on.

How to fill a syringe

It is important not only to know the injection algorithm, but also to be able to correctly fill the syringe and know.

After removing the plastic cap, you need to draw a certain amount of air into the syringe, equal to the volume of insulin injected.
Using a syringe, the rubber cap on the vial is pierced, after which all the collected air is released from the syringe.
After that, the syringe with the vial is turned upside down and held vertically.
The syringe must be pressed tightly to the palm with the help of the little fingers, after which the piston sharply stretches down.
It is necessary to dial into the syringe a dosage of insulin that is 10 units more than necessary.
The piston is gently pressed until the desired dose of the drug is in the syringe.
After removing from the vial, the syringe is held vertically.

Simultaneous administration of different types of insulin

Diabetics often use different types of insulin in order to urgently normalize blood sugar levels. Usually such an injection is carried out in the morning.

The algorithm has a certain sequence of injections:

Initially, you need to prick ultra-thin insulin.
Next, short-acting insulin is injected.
After that, prolonged insulin is used.

If Lantus acts as a long-acting hormone, the injection is performed using a separate syringe. The fact is that if any dose of another hormone enters the vial, the acidity of insulin changes, which can lead to unpredictable consequences.

In no case should you mix different types of hormones in a common bottle or in one syringe. An exception may be insulin with neutral Hagedorn protamine, which slows down the action of short-acting insulin before meals.

If insulin leaks out at the injection site

After the injection, you need to touch the injection site and bring your finger to your nose. If there is a smell of preservatives, this indicates that insulin has leaked from the puncture area.

In this case, you should not additionally enter the missing dose of the hormone. It should be noted in the diary that there was a loss of the drug. If a diabetic has an increase in sugar, the cause of this condition will be obvious and clear. It is necessary to normalize blood glucose levels when the effect of the administered hormone is completed.

Intramuscular injections

Intramuscular injections are most often carried out in the upper outer quadrant of the gluteal region (to determine the injection site, the buttock region is conditionally divided into four squares by two lines (Fig. 9, Appendix)) or the anterolateral surface of the thigh.

Patient position- lying on your stomach or on your side (this position helps to relax the muscles of the gluteal region).

Order of execution:

preparation of a syringe with a drug for injection:

Open the package of a disposable syringe, with tweezers in your right hand, take the needle by the sleeve, put it on the syringe;

Check the patency of the needle by passing air or a sterile solution through it, holding the sleeve with your index finger, put the prepared syringe into a sterile tray;

Before opening the ampoule or vial, carefully read the name of the medicine to make sure it matches the doctor's prescription, clarify the dosage and expiration date;

Lightly tap the neck of the ampoule with your finger so that the entire solution is in the wide part of the ampoule;

File the ampoule in the area of its neck with a nail file and treat it with a cotton ball dipped in a 70% alcohol solution; when collecting the solution from the vial, remove the aluminum cap from it with non-sterile tweezers and wipe the rubber stopper with a sterile cotton ball moistened with 70% alcohol solution;

With a cotton ball, which was used to wipe the ampoule, break off the upper (narrow) end of the ampoule;

Take the ampoule in your left hand, holding it with your thumb, forefinger and middle fingers, and in your right hand - a syringe;

Carefully insert the needle put on the syringe into the ampoule, and, pulling the piston, gradually draw the required amount of the contents of the ampoule into the syringe, tilting it if necessary;

When taking the solution from the vial, pierce the rubber stopper with a needle, put the needle with the vial on the cone of the syringe, lift the vial upside down and draw the required amount of the drug into the syringe;

Remove the syringe from the injection needle and put the injection needle on it;

To remove the air bubbles present in the syringe, to do this, turn the syringe with the needle up and, holding it vertically at eye level, pressing on the piston to release air and the first drop of the medicinal substance, holding the needle by the sleeve with the index finger of the left hand;

Perpendicular to the surface of the skin with a vigorous movement at an angle of 90º, insert the needle to a depth of 3/4 of its length (it is necessary to insert the needle so that 2-3 mm remains between the needle sleeve and the patient's skin);

Then, slowly pressing on the syringe plunger, inject the drug evenly;

The needle should be removed from the patient's body with a sharp movement, at the same angle, without making unnecessary movements of the needle in the tissues;

Clean the injection site with a clean cotton swab dipped in 70% ethanol.

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 through the mouth, because. they are rapidly absorbed. Subcutaneous injections are made with a needle of the smallest diameter to a depth of 15 mm and up to 2 ml of drugs are injected, which are quickly absorbed in loose subcutaneous tissue and do not have a harmful effect on it.

The most convenient sites for subcutaneous injection are:

The outer surface of the shoulder;

Subscapular space;

Anterior surface of the thigh;

Lateral surface of the abdominal wall;

The lower part of the armpit.

In these places, the skin is easily captured in the fold and there is no danger of damage to blood vessels, nerves and periosteum.

In places with edematous subcutaneous fat;

In seals from poorly absorbed previous injections.

Order of execution:

Wash hands thoroughly with soap and running warm water; without wiping with a towel, so as not to violate the relative sterility, wipe them with alcohol; put on sterile gloves;

Preparation of a syringe with a drug (see i / m injections);

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 the left hand;

Take the syringe in the right hand (hold the needle cannula with the 2nd finger of the right hand, hold the syringe piston with the 5th finger, hold the cylinder from below with the 3rd-4th fingers, and hold the cylinder from above with the 1st finger);

Gather the skin with your left hand 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 length of the needle), hold the cannula of the needle with your index finger;

Move your left hand to the piston and inject the drug (without shifting the syringe from one hand to the other).

Remove the needle by holding it by the cannula;

Press the injection site with a cotton ball with alcohol;

Make a light massage of the injection site without removing the cotton wool from the skin.

Intravenous injections

To perform intravenous injections, it is necessary to prepare on a sterile tray: a syringe (10.0 - 20.0 ml) with a drug and a 40 - 60 mm needle, cotton balls; tourniquet, roller, gloves; 70% ethyl alcohol; tray for spent ampoules, vials; a container with a disinfectant solution for used cotton balls.

Order of execution:

Wash hands thoroughly with soap and running warm water; without wiping with a towel, so as not to violate the relative sterility, wipe them with alcohol; put on sterile gloves;

Draw up the drug from the ampoule into a disposable syringe;

Help the patient to take a comfortable position - lying on his back or sitting;

Give the limb into which the injection will be made, the necessary position: the arm is in an extended state, palm up;

Place an oilcloth pad under the elbow (for maximum extension of the limb in the elbow joint);

Apply a rubber tourniquet (on a shirt or napkin) to the middle third of the shoulder so that its free ends are directed upwards, the loop is downwards, the pulse on the radial artery should not change;

Ask the patient to work with his fist (for better pumping of blood into the vein);

Find a suitable vein for puncture;

Treat the skin in the area of the elbow with the first cotton ball soaked in 70% ethyl alcohol in the direction from the periphery to the center, discard it (skin pre-treatment);

Take the syringe in your right hand: fix the cannula of the needle with your index finger, cover the cylinder from above with the rest;

Check the absence of air in the syringe, if there are a lot of bubbles in the syringe, you need to shake it, and small bubbles will merge into one large one, which is easy to force out through the needle into the tray;

Again with the left hand, treat the venipuncture site with a second cotton ball with alcohol, discard it;

Fix the skin in the puncture area with the left hand, pulling the skin in the area of the elbow bend with the left hand and slightly shifting it to the periphery;

Holding the needle with the cut up at an angle of 45 °, insert it under the skin, then reducing the angle of inclination and holding the needle almost parallel to the skin surface, move it along the vein and carefully insert the needle 1/3 of its length (with the patient's fist clenched);

Continuing to fix the vein with the left hand, slightly change the direction of the needle and carefully puncture the vein until "hitting in the void" is felt;

Pull the piston towards you - blood should appear in the syringe (confirmation that the needle has entered the vein);

Untie the tourniquet with the left hand, pulling on one of the free ends, ask the patient to unclench the hand;

Without changing the position of the syringe, press the plunger with your left hand and slowly inject the drug solution, leaving 0.5 ml in the syringe (if it was not possible to completely remove air from the syringe);

Attach a cotton ball with alcohol to the injection site and gently remove the needle from the vein (prevention of hematoma);

Bend the patient's arm in the elbow joint, leave the ball with alcohol in place, ask the patient to fix the arm in this position for 5 minutes (bleeding prevention);

Discard the syringe in a disinfectant solution or cover the needle with a cap;

After 5-7 minutes, take the cotton ball from the patient and drop it into a disinfectant solution or into a bag from a disposable syringe;

Remove gloves, discard them in a disinfectant solution;

Wash the hands.

Preparing the system for intravenous transfusion

(Fig. 10, appendix)

1. Put on a mask, wash your hands thoroughly with soap and running warm water, without wiping with a towel, so as not to violate relative sterility, wipe them with 70% ethyl alcohol, put on sterile gloves.

2. Check the expiration date and tightness of the package with the system by squeezing it from both sides.

3. Prepare a sterile tray with wipes, cotton balls.

4. Take a vial with a medicinal substance, check the expiration date, appearance, compare with medical prescriptions.

5. Remove the central part of the metal cap from the bottle with tweezers and treat the bottle cap twice with cotton balls soaked in 70% ethanol.

6. Open the package and remove the system.

7. Close the clamp on the system.

8. Remove the cap from the polymer needle and insert it into the vial until it stops.

9. Turn the vial upside down and fix it on a tripod.

10.Open the duct plug on the system.

11. Fill the dropper to half of the control container, periodically pressing on its body.

12.Open the clamp and bleed the air from the tube system.

13.Close the clamp and fix the system on the tripod.

14. Perform venipuncture.

15. Use the clamp to adjust the required infusion rate.

16. After the manipulation, the used system must be disinfected (before soaking the system in the solution, it must be cut with scissors).

The subcutaneous fat layer is well supplied with blood vessels, therefore, subcutaneous injections (s / c) are used for a faster action of the medicinal substance. Subcutaneously administered medicinal substances are absorbed faster than when administered through the mouth. Subcutaneous injections are made with a needle to a depth of 15 mm and up to 2 ml of drugs are injected, which are quickly absorbed in loose subcutaneous tissue and do not have a harmful effect on it.

Characteristics of needles, syringes for s / c injections:

Needle length -20 mm

Cross section -0.4 mm

Syringe volume - 1; 2 ml
Sites for subcutaneous injection:

The middle third of the anterolateral surface of the shoulder;

The middle third of the anterolateral surface of the thigh;

Subscapular region;

Anterior abdominal wall.

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

Equipment:

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

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

Execution algorithm:

1. Explain to the patient the course of the manipulation, get his consent.

2. Put on a clean gown, mask, treat your hands at a hygienic level, put on gloves.

3. Draw up the drug, release the air from the syringe, put it in the tray.

4. Sit or lay the patient down, depending on the choice of injection site and drugs.

5. Inspect and palpate the injection site.

6. 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, put it under the little finger of the left hand.

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

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

9. 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 length of the needle), hold the cannula of the needle with your index finger.

10. Move your left hand to the plunger and inject the drug (do not transfer the syringe from one hand to the other).

11. Press the injection site with a cotton ball with 70% alcohol.

12. Remove the needle by holding it by the cannula.

13. Discard the disposable syringe and needle in a container of 3% chloramine for 60 minutes.

14. Remove gloves, place in a container with a disinfectant solution.

15. Wash your hands, dry.

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

Fig.1.Places for s / c injections

Fig.2. Technique of subcutaneous injection.

Characteristics of needles, syringes for s / c injections :

Needle length -20 mm

Cross section -0.4 mm

Syringe volume - 1; 2 ml Sites for subcutaneous injection:

The middle third of the anterolateral surface of the shoulder;

The middle third of the anterolateral surface of the thigh;

Subscapular region;

Anterior abdominal wall.

Equipment:

Execution algorithm:

Put on a clean gown, mask, treat your hands at a hygienic level, put on gloves.

Take the medicine, release the air from the syringe, put it in the tray.

Sit or lay the patient down, depending on the choice of injection site and drug.

Inspect and palpate the injection site.

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, put it under the little finger of the left hand.

Take the syringe in your right hand (hold the cannula of the needle with the index finger of the right hand, hold the syringe plunger with the 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 length of the needle), hold the cannula of the needle with your index finger.

Place your left hand on the plunger and inject the drug (do not switch the syringe from one hand to the other).

Remove gloves, place in

Wash hands, dry.

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

Fig.1.Places for s / c injections

Fig.2. Technique of subcutaneous injection.

The introduction of oil solutions subcutaneously.

Target: medical.

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

Equipment:

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

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

Execution algorithm:

Explain to the patient the course of the manipulation, get his consent.

Put on a clean gown, mask, treat your hands at a hygienic level, put on gloves.

Before use, dip the ampoule into a container with warm water, heat it up to 38 ° C.

Draw the medicine into the syringe, release the air from the syringe.

Treat the tufikomi injection site twice with 70% alcohol.

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

Slowly inject the solution (t° oil solution 38°C).

Press the injection site with a cotton ball with 70% alcohol.

Remove the needle by holding it by the cannula.

Discard the disposable syringe and needle in a container of 3% chloramine for 60 minutes.

Remove gloves, place a container with a disinfectant solution.

Wash hands, dry.

Injection - the introduction of medicinal substances with the help of a special injection under pressure into various environments of the body. There are intradermal, subcutaneous, intramuscular and intravenous injections. For special indications, intraarterial, intrapleural, intracardiac, intraosseous, intraarticular administration of drugs is also used. If it is necessary to achieve a high concentration of the drug in the central nervous system, spinal (subdural and subarachnoid) administration is also used.

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

Rice. II. Types of syringes and needles.

Injections are usually carried out using syringes and needles. Syringes of various types ("Record", Luer, Janet, shown in Fig. 11) consist of a cylinder and a piston and have a different volume (from 1 to 20 cm 3 or more). The thinnest are the tuberculin syringes; the price of their division is 0.02 ml. Special syringes also exist for administering insulin; the divisions on the cylinder of such syringes are not in fractions of a cubic centimeter, but in units of insulin. The 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 injections are also used, which allow intradermal, subcutaneous and intramuscular administration of a medicinal substance without the use of needles. The action of a needleless injector is based on the ability of a liquid jet supplied under a certain pressure

leniya, penetrate through the skin. This method is used, for example, for anesthesia in dental practice, as well as for mass vaccinations. The needleless injector eliminates the risk of transmission of serum hepatitis and is also distinguished by high productivity (up to 1600 injections per hour).

Syringes and needles used for injection must be sterile. Various methods are used to destroy microbial flora. sterilization, most often based 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 vapor at a pressure of 2.5 kg / cm 2 and a temperature of 138 ° C, as well as sterilization in a drying and sterilization cabinet with dry hot air. Boiling syringes and needles is still sometimes used in everyday medical practice, which, however, does not provide complete sterilization, since some viruses and bacteria do not die. In this regard, disposable syringes and needles are ideal, providing reliable protection against HIV infection, hepatitis B and C.

Sterilization by boiling involves the observance of a number of rules and a certain sequence in the processing of syringes and needles. After the injection, the syringe and needle are immediately rinsed with cold running water to remove any blood and medication residues (after they dry, this will be much more difficult). Unassembled 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, syringes and needles are rinsed again in running water. Then, in order to check the quality of the treatment performed, samples are selectively placed 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, several crystals of bepzidine are mixed with 2 ml of a 50% solution of acetic acid and 2 ml of a 3% solution of hydrogen peroxide. A few drops of the resulting solution are added to the syringe and passed through the 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 transmission of various diseases (eg, serum hepatitis, AIDS).

Detergent residues are determined using a sample with

Rice. 12. Putting syringes into the sterilizer.