Subcutaneous injection technique of injection. Safe injection technique How to do p to injection

From a medical point of view, an injection refers to the introduction of a drug into the body using a syringe with a needle. As a rule, injections are used for precise dosing of the drug, its increased concentration in a certain place, or for the accelerated achievement of the effect of drugs. Consider how intradermal and subcutaneous injection is done.

Varieties of injections

Doctors distinguish several types of injections: subcutaneous, intramuscular, arterial, venous and injections directly into the organs. All of them have their own characteristics and technique of introduction. So let's look at the first two types.

What is a subcutaneous injection?

Injections under the skin are used to safely inject the drug precisely into those parts of the body where there are no large vessels and nerves (shoulder, subscapular interscapular region, inner thigh, and also the abdomen.) For this method, both watery and oily solutions are used. Thinner needles are used for watery needles, thicker needles for oily ones, which makes it easier for the drug to enter the tissue. In order for the oily subcutaneous injection to not require significant force, it is recommended that the ampoule with the medicine be preliminarily heated in warm water, and the solution itself should be administered more slowly. Such injections can be given with the patient lying down, sitting or standing. So, let's look at how to do subcutaneous injections.

Subcutaneous injection: execution technique

Doctors distinguish between two ways of administering the drug subcutaneously:

1. The syringe is taken in the right hand so that the little finger holds the cannula of the needle, then you need to make a small fold of the skin and inject the medicine. A feature of this method is that the needle is inserted perpendicular to the injection site.

2. The same position of the syringe in the hand involves inserting the needle from the bottom up or from the top down at an angle of 30-45 degrees (often used for subscapular or interscapular areas).

It is worth emphasizing that the site of the future injection must first be treated with a sterile, preferably alcoholic solution, and after the administration of the medicine, this procedure should be repeated. It is also worth paying attention: if some time after the injection a seal has formed in its place, it is no longer possible to inject medicines into this area.

What is an intradermal injection?

Intradermal injections, in turn, are used to identify a patient's allergy to a drug. Often they are a biological test (for example, the Mantoux test) or are used for local anesthesia of a small area. Injections of this type are made in the upper and middle parts of the forearm if the patient does not have respiratory diseases at the time of injection, and he does not have skin problems at the site of the biological test.

Intradermal injection technique:

• treat the surface of the hands, put on sterile gloves;
• prepare an ampoule with medicine;
• draw up the medicine in a syringe;
• change the needle, exclude the presence of air in the syringe;
• treat the place of the future injection with an alcohol solution;
• slightly stretch the skin at the test site;
• insert the needle under the skin parallel to the middle or upper part of the forearm;
• enter the solution. With its correct introduction, a subcutaneous bubble is formed, which must be treated with alcohol without pressing on it. If the technique is followed, both intradermal and subcutaneous injection will not lead to serious consequences, but, on the contrary, will help in the diagnosis or become the most important weapon in the treatment of the disease.

- a method of administering drugs, in which the drug enters the body by injecting an injection solution through a syringe into the subcutaneous tissue. When conducting a subcutaneous injection of the drug, it enters the bloodstream by absorption of the drug into the vessels of the subcutaneous tissue. Usually, most drugs in the form of solutions are well absorbed in the subcutaneous tissue and provide relatively rapid (within 15-20 minutes) absorption into the systemic circulation. Usually, the effect of the drug with subcutaneous administration begins more slowly than with intramuscular and intravenous administration, but faster than with oral administration. Most often, drugs are administered subcutaneously, which do not have a local irritant effect, and are well absorbed in the subcutaneous adipose tissue. Heparin and its derivatives are administered exclusively subcutaneously or intravenously (due to the formation of hematomas at the injection site). Subcutaneous injection is used when it is necessary to introduce into the muscle both an aqueous and an oily solution of drugs, or a suspension, in a volume of not more than 10 ml (preferably not more than 5 ml). Vaccinations against infectious diseases are also carried out subcutaneously by introducing a vaccine into the body.

Application

Subcutaneous injection is a fairly common type of parenteral administration of drugs due to the good vascularization of the subcutaneous tissue, which contributes to the rapid absorption of drugs; and also due to the simplicity of the administration technique, which makes it possible to apply this method of administration to persons without special medical training after mastering the relevant skills. Most often, patients self-administer at home subcutaneous insulin injections (often with a syringe pen), and subcutaneous injection of growth hormone can also be performed. Subcutaneous administration can also be used to administer oily solutions or suspensions of medicinal substances (subject to the condition that the oily solution does not enter the bloodstream). Usually, drugs are administered subcutaneously when there is no need to obtain an immediate effect from the administration of the drug (absorption of the drug during subcutaneous injection disappears within 20-30 minutes after administration), or when it is necessary to create a kind of depot of the drug in the subcutaneous tissue to maintain the concentration of the drug in the blood at constant level for a long time. Solutions of heparin and its derivatives are also injected subcutaneously due to the formation of hematomas at the injection site during intramuscular injections. Local anesthetics may also be administered subcutaneously. When administered subcutaneously, it is recommended to administer drugs in a volume of not more than 5 ml in order to avoid tissue overstretching and the formation of an infiltrate. Do not administer subcutaneously drugs that have a locally irritating effect and can cause necrosis and abscesses at the injection site. For the injection, it is necessary to have sterile medical equipment - a syringe, and a sterile form of the drug. Intramuscularly, drugs can be administered both in a medical institution (inpatient and outpatient departments) and at home by inviting a medical worker home, and when providing emergency medical care - in an ambulance.

Execution technique

Subcutaneous injection is most often given to the outer surface of the shoulder, the anterior thigh, the subscapularis, the lateral surface of the anterior abdominal wall, and the area around the navel. Before subcutaneous injection, the drug (especially in the form of an oily solution) must be warmed up to a temperature of 30-37 ° C. Before starting the injection, the health worker treats the hands with a disinfectant solution and wears rubber gloves. Before the introduction of the drug, the injection site is treated with an antiseptic solution (most often ethyl alcohol). Before the injection, the skin at the puncture site is taken into a fold, and after that the needle is set at an acute angle to the skin surface (for adults - up to 90 °, for children and people with a mild subcutaneous fat layer, injection at an angle of 45 °). After piercing the skin, the syringe needle is inserted into the subcutaneous tissue approximately 2/3 of the length (at least 1-2 cm), to prevent needle breakage, it is recommended to leave at least 0.5 cm of the needle above the skin surface. After puncturing the skin, before administering the drug, it is necessary to pull the plunger of the syringe back to check that the needle has entered the vessel. After checking the correct location of the needle, the drug is injected under the skin in full. After the end of the administration of the drug, the injection site is re-treated with an antiseptic.

Advantages and disadvantages of subcutaneous drug administration

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

The disadvantages of subcutaneous administration are that often with the introduction of drugs intramuscularly, pain and the formation of infiltrates at the injection site (less often, the formation of abscesses) are observed, and with the introduction of insulin, lipodystrophy can also be observed. With poor development of blood vessels at the injection site, the absorption rate of the drug may decrease. With subcutaneous administration of drugs, as with other types of parenteral use of drugs, there is a risk of infection of the patient or health worker with blood-borne pathogens. With subcutaneous administration, the likelihood of side effects of drugs increases due to the higher rate of entry into the body and the absence of biological filters of the body along the route of the drug - the mucous membrane of the gastrointestinal tract and hepatocytes (although lower than with intravenous and intramuscular use) .. With subcutaneous application, it is not recommended to inject more than 5 ml of the solution once due to the likelihood of overstretching of muscle tissue and reducing the likelihood of infiltrate formation, as well as drugs that have a locally irritating effect and can cause necrosis and abscesses at the injection site.

Possible complications of subcutaneous injection

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

One of the complications that arise when the technique of drug administration is violated is the formation of abscesses and phlegmon. These complications most often occur against the background of incorrectly treated post-injection infiltrates, or if the rules of asepsis and antisepsis are violated during the injection. Treatment of such abscesses or phlegmon is carried out by a surgeon. In case of violation of the rules of asepsis and antisepsis during injections of imovine, infection of patients or health workers with pathogens of infectious diseases transmitted through the blood, as well as the occurrence of a septic reaction due to bacterial infection of the blood.

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

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

With subcutaneous administration of insulin (more often with prolonged administration of the drug in the same place), there may be a site of lipodystrophy (a site of resorption of subcutaneous fatty tissue). Prevention of this complication is the alternation of insulin injection sites and the introduction of insulin, which has room temperature, the treatment consists in administering 4-8 units of suinsulin in areas of lipodystrophy.

If a hypertonic solution (10% sodium chloride or calcium chloride solution) or other locally irritating substances are erroneously injected under the skin, tissue necrosis may occur. When this complication occurs, it is recommended to prick the affected area with a solution of adrenaline, 0.9% sodium chloride solution and novocaine solution. After chipping the injection site, a pressure dry bandage and cold are applied, and later (after 2-3 days) a heating pad is applied.

When using an injection needle with a defect, when the needle is inserted too deep into the subcutaneous tissue, as well as when the injection technique is violated, the needle may break. With this complication, it is necessary to try to independently obtain a fragment of the needle from the tissues, and if the attempt fails, the fragment is removed surgically.

A very serious complication of subcutaneous injection is drug embolism. This complication occurs rarely, and is associated with a violation of the injection technique, and occurs in cases where the health worker, when performing a subcutaneous injection of an oily solution of the drug or suspension, does not check the position of the needle and the possibility of getting this drug into the vessel. This complication can be manifested by bouts of shortness of breath, the appearance of cyanosis, and often ends in the death of patients. Treatment in such cases is symptomatic.

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

Rice. Subcutaneous injection: needle position.

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

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

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

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

Subcutaneous Injection Algorithm:
1. Check the expiration date and tightness of the syringe package. Open the package, assemble the syringe and place it in a sterile patch.
2. Check the expiration date, name, physical properties and dosage of the drug. Check with destination sheet.
3. Take 2 cotton balls with alcohol with sterile tweezers, process and open the ampoule.
4. Draw the required amount of the drug into the syringe, release the air and put the syringe in a sterile patch.
5. Lay out 3 cotton balls with sterile tweezers.
6. Put on gloves and rub the ball in 70% alcohol, drop the balls into the waste tray.
7. Treat a large area of ​​skin with the first ball in alcohol centrifugally (or in the direction from bottom to top), treat the puncture site directly with the second ball, wait until the skin dries from alcohol.
8. Discard the balls into the waste tray.
9. With your left hand, grasp the skin at the injection site in the warehouse.
10. Bring the needle under the skin at the base of the skin fold at an angle of 45 degrees to the skin surface with a cut to a depth of 15 mm or 2/3 of the length of the needle (depending on the length of the needle, the indicator may be different); index finger; hold the cannula of the needle with your index finger.
11. Move the hand that fixes the fold to the plunger and slowly inject the drug, try not to shift the syringe from hand to hand.
12. Remove the needle, continuing to hold it by the cannula, hold the puncture site with a sterile cotton swab moistened with alcohol. Put the needle in a special container; if a disposable syringe is used, break the needle and cannula of the syringe; take off your gloves.
13. Make sure that the patient feels comfortable, take the 3 balloon from him and escort the patient.

Rules for the introduction of oil solutions. Oily solutions are often administered subcutaneously; intravenous administration is prohibited.

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

A subcutaneous injection is an injection made directly into the fatty layer under the skin (as opposed to an intravenous injection made directly into a vein). Because subcutaneous injections provide a more even and slower distribution of medications than intravenous injections, subcutaneous injections are commonly used to administer vaccines and drugs (for example, type 1 diabetics often administer insulin this way). A prescription for medicines to be injected subcutaneously usually contains detailed instructions on how to give the subcutaneous injection correctly.

Note: Please note that the instructions in this article are provided as an example only. Talk to your health care provider before giving an injection at home.

Steps

Training

Prepare everything you need. Getting a proper hypodermic injection requires more than just a needle, syringe, and medication. Before you start, make sure you have:

• The dose of medication in a sterile package (usually packaged in a small ampoule with proper labeling)
• Sterile syringe of the correct size. Depending on the amount of medication and the weight of the patient, you can choose from the following sizes of syringe or other sterile injection method:
  • volumes of 0.5, 1 and 2 ml with a needle size 27 (0.40 × 10 mm 27G × 1/2);
  • syringe with Luer lock, 3 ml (for large doses);
  • refilled syringe disposable.
• Capacity for safe disposal of the syringe.
• Sterile gauze pad (usually 5 x 5 cm).
• Sterile band-aid (make sure your patient is not allergic to the adhesive in the band-aid as this can irritate the area around the wound).
• Clean towel.

1. Make sure you have the right medicines and their dosage. Most subcutaneous preparations are transparent and come in similar packaging, so it is easy to confuse them. Double-check the label on the drug before use and make sure it is the right drug and dosage for you.

   • Please note that some ampoules contain only enough of the drug for one injection, and some for several. Before you continue, make sure you have enough medication for your scheduled injection.

2. Keep the work area clean and tidy. Before the introduction of a subcutaneous injection, it is desirable to avoid contact with non-sterile objects. Arrange the materials you need in order in advance in a clean workplace - this way the injection will be faster, easier and more sterile. Place a towel next to you so that it can be easily reached. Lay out the tools on a towel.

   • Arrange the tools on the towel in the order you need them. Please note that in order to quickly remove the wipe, you can tear the package of alcohol wipes (do not open the inner package that contains the wipes).

3. Choose a puncture site. A subcutaneous injection is made into the fatty layer under the skin. In some parts of the body, this layer is easier to reach than in others. Some medicines come with instructions for exactly where they should be injected. Check with your doctor or medication manufacturer if you are unsure where to inject. The following are the places where a hypodermic injection is usually given:

   • The soft part of the triceps, behind and on the side of the arm, between the elbow and shoulder
   • The soft part of the leg on the front of the thigh between the knee, thigh and groin
   • The soft part of the abdomen, below the ribs in front and above the thighs, but not around the navel
   • Remember: it is very important to change the injection site; injecting in the same places can scar the skin and harden the fatty layer, making subsequent injections more difficult and the drug may not dissolve properly.

4. Wipe the injection site. Using a fresh alcohol pad, wipe the injection site in a spiral and light motion from the center to the edge; be careful not to rub in the opposite direction, on an already cleaned surface. Let the injection site dry.

   • Before wiping the site of the future puncture, if necessary, free it by moving clothing or jewelry to the side. This will not only make it easier to get to the injection site, but it will also reduce the risk of infection if the person comes into contact with anything non-sterile after the injection before applying a dressing or band-aid.
   • If you find that the skin at the intended injection site is bruised, irritated, discolored, or inflamed, you should choose another injection site.

5. Wash your hands with soap . Since a subcutaneous injection is made with penetration through the skin, it is imperative to wash your hands before the injection. Washing your hands kills all the germs on your hands, which, if accidentally introduced into a small puncture wound, can lead to infection. After washing your hands, dry them thoroughly.

Taking a dose of medication

Remove the stopper insert from the medicine ampoule. Lay it on a towel. If the stopper has already been opened, if the ampoule contains several doses, wipe the rubber stopper of the ampoule with a clean alcohol wipe.

• If you are using an already filled disposable syringe, skip this step.

1. Take the syringe. Hold the syringe firmly in your working hand. Hold it like a pencil. Needle up (without opening the needle).

   • Even though you have not yet opened the cap of the syringe, hold it carefully.

2. Open the syringe cap. Take the needle cap with the thumb and forefinger of the other hand and remove the needle cap from the needle. From now on, make sure that the needle does not touch anything other than the patient's skin while he is receiving the injection. Place the needle cap on a towel.

   • Now you are holding a small but very sharp needle in your hands - handle it very carefully, never swing it or make sudden movements.
   • If you are using a pre-filled syringe, skip this step.

3. Pull the syringe plunger back. Keep the needle pointing up and away from you, with your other hand, pull the plunger back to the desired volume, filling the syringe with air.

   Take the medicine vial. Using your non-dominant hand, take the medicine vial. Keep it upside down. Handle the ampoule with extreme care, do not touch the stopper of the ampoule, as it must remain sterile.

   Insert the needle into the rubber stopper. At this time, there should still be air in the syringe.

   Press the plunger to inject air into the medicine vial. Air should rise through the liquid medicine to the top of the ampoule. This is done for two reasons - firstly, it will ensure the absence of air during the filling of the syringe with medicine, and secondly, it will create an increased pressure in the ampoule, which in turn will facilitate the intake of medicine.

   • It is not always necessary to do this - it all depends on how thick the medicine is.

4. Draw the medicine into the syringe. Making sure that the needle is immersed in the liquid medicine and not the air bag in the ampoule, pull the plunger slowly and gently until you reach the desired dosage.

   • You may need to tap on the sides of the syringe to force air bubbles to the top. After that, gently press the plunger and squeeze the air bubbles back into the ampoule.

5. If required, repeat the previous steps. Repeat the process of drawing up the medicine and releasing the air bubbles until you have drawn up the right amount of medicine and the air in the syringe has been eliminated.

   Remove the ampoule from the syringe. Put the ampoule back on the towel. Do not lay down the syringe, as this may contaminate the syringe and infect the wound. It may be necessary to replace the needle at this stage. When typing the medicine, the needle may become blunt - if you replace it, the injection will be easier to administer.

Making a subcutaneous injection

Prepare the syringe in your dominant hand. Hold the syringe the same way you hold a pencil or dart. Make sure you can easily reach the syringe plunger.

Gather the skin at the injection site. Using your non-dominant hand, gather approximately 2.5-5 cm of skin between your thumb and forefinger, creating a small fold. Do everything carefully so as not to bruise or damage the surrounding tissues. Skin harvesting is necessary to increase the thickness of subcutaneous fat at the injection site, which will allow the drug to be injected into the fat layer, and not into the muscle tissue.

• When picking up the skin, don't pick up the muscle underneath. You will be able to feel the difference between the soft fat layer and the hard muscle tissue underneath.
• Subcutaneous preparations are not designed for intramuscular administration and can cause bleeding in muscle tissue, especially if the drug has blood-thinning properties. However, intramuscular injection needles are generally small enough that drug administration is unlikely to cause any difficulty.

1. Insert the syringe into the skin. With a slight acceleration of the brush, insert the needle under the skin to its full length. Typically, the needle is inserted into the skin at a 90-degree angle (vertically down from the surface of the skin) to ensure that the drug is completely injected into the subcutaneous fat. Sometimes for muscular or very thin people who have very little subcutaneous fat, the needle is inserted at a 45-degree angle (diagonal) to avoid getting the drug into the muscle tissue.

   • Act quickly and confidently, but not too abruptly. Slow down, and the needle may pop out of the skin, causing increased pain.

2. Press the syringe plunger firmly and evenly. Squeeze the plunger without additional effort until you have injected all the medicine. Use the same constant and confident movement.

   Gently place a piece of gauze pad next to the injection site. The sterile material will absorb some of the blood that will be released after the needle is removed. The pressure you apply to the surface of the skin through the gauze or cotton will prevent the needle from pulling on the skin while the needle is being withdrawn, which can also be painful.

   Remove the needle from the skin in one smooth motion. You can ask the patient to hold a gauze pad or cotton at the injection site, or you can do it yourself. Do not rub or massage the injection site as this may cause bleeding or bruising under the skin.

   Put the needle and syringe in a safe place. Carefully place the needle and syringe into a sturdy sharps container. It is very important not to throw away used needles with the regular trash - they can contain potentially harmful bacteria.

   Apply gauze to the injection site. With the syringe and needle removed, you can attach gauze or cotton to the patient's skin with adhesive tape. Most likely, bleeding will be minimal, so it is not necessary to secure the bandage - tell the patient to hold the gauze or bandage for a couple of minutes at the injection site. If using a band-aid, make sure the patient is not allergic to adhesives.

   Remove all tools. You have successfully performed a hypodermic injection.

• Give your child an age-appropriate task, such as holding the needle cap after you have removed it. And say that "when he's old enough" you'll let him take it off. Children love to take an active part in this kind of thing.
• An ice cube can be used for mild pain relief.
• To prevent a bruise or small scar from forming at the injection site, press the injection site with gauze or cotton for 30 seconds after removing the needle. If we are talking about an injection to a child, tell him that he himself can control the degree of pressure - the main thing is that he does not press too hard.
• Also alternate injection sites between injections on the legs, arms, or body (left and right, front and back, bottom and top), so that you do not inject in the same place more than once every two weeks. Just stick to the same sequence for the 14 spots and the injection sites will rotate automatically! Children love predictability. Or let them choose their own injection sites - write a list and cross off injection sites.
• Press down on the injection site with gauze or cotton to avoid pulling on the skin when you withdraw the needle, and the pain from the injection will be less.
• Go to the manufacturer's website for exact instructions.
• If you give an injection to a child and he is afraid of pain, use Emla as an anesthetic. Apply it to the injection site half an hour before the injection.

Types of injections

Intradermal injections

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

Local anesthesia arises from the effect of an anesthetic substance administered intradermally on the endings of the finest branches of sensory nerves.

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

a) general nonspecific reactivity of the organism;

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

c) the allergic state of the body in 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, which characterizes the degree of immunity to certain infections (diphtheria - Schick's reaction, scarlet fever - Dick's reaction).

Intradermal administration of killed bacteria or waste products of pathogenic microbes, as well as medicinal substances to which the patient has an 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 reddening of the skin around the injection site. At the same time, since the injected substance enters the general circulation, an intradermal injection also causes a general reaction of the body, the manifestation of which is general malaise, a state of excitation or depression of the nervous system, headache, anorexia, fever.

The technique of intradermal injection consists in sticking a very thin needle at an acute angle to a shallow depth so that its hole penetrates only under the stratum corneum of the skin. Gently pressing on the plunger of the syringe, 1-2 drops of the solution are injected into the skin. If the tip of the needle is set correctly, a whitish elevation in the form of a spherical blister up to 2-4 mm in diameter is formed in the skin.

When conducting an intradermal test, the injection of the medicinal substance is done only once.

The site for intradermal injection is the outer surface of the upper arm or the anterior surface of the forearm. If there is hair on the skin at the site of the proposed injection, they should be shaved off. The skin is treated with alcohol and ether. Do not use tincture of iodine.

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 they are introduced through the digestive tract.

For subcutaneous (parenteral) administration, such drugs are used that do not irritate the subcutaneous tissue, do not cause pain reactions and are well absorbed. Depending on the volume of the drug solution injected into the subcutaneous tissue, one should distinguish between subcutaneous injections (inject up to 10 cm3 of solution) and infusions (inject up to 1.5-2 liters of solution).

Subcutaneous injections are used for:

1-general effect of a medicinal substance on the body, when: a) it is necessary to cause a rapid action of the drug; b) the patient is unconscious; c) the medicinal substance irritates the mucous membrane of the gastrointestinal tract or significantly decomposes in the alimentary 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) induce local anesthesia during surgery; b) neutralize the introduced toxic substance on the spot.

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 must 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 should be in a zone 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, the thumb and forefinger of the left hand capture the skin and subcutaneous tissue into a fold, which is pulled up towards the tip of the needle.

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

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

Indications. Subcutaneous injections are made with:

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

2) severe dehydration of the patient after prolonged diarrhea, indomitable vomiting.

For infusion, physiological saline solution (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's solution - Locke (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 liter).

Technics. The poured liquid is placed in a special vessel - a cylindrical funnel, which is connected to the needle through a rubber tube. The rate of blood flow is regulated by Morr clamps located on the tube.

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

Intramuscular injections

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

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

Places for performing intramuscular injections are shown in Fig. 30. Most often they are made in the muscles of the gluteal regions at a point located at the intersection of a vertical line passing in the middle of the buttock, and a horizontal one - two transverse fingers below the iliac crest, i.e., in the zone of the upper outer quadrant of the gluteal region. In extreme cases, intramuscular injections can be made into the thigh on the anterior or outer surface.

Technics. When conducting intramuscular injections into the gluteal region, the patient should lie on his stomach or on his side. Injections into the thigh area are made in the supine position. A needle with a length of at least 5-6 cm of sufficient caliber is used. The needle is inserted into the tissues with a sharp movement of the right hand perpendicular to the skin to a depth of 5-6 cm (Fig. 31, b). This provides a minimal sensation of pain and the introduction of the needle to 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, it is necessary 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 its leakage from the needle indicates that the needle has entered the lumen of the vessel. After making sure that the needle is in the correct position, you can administer the drug. At the end of the injection, the needle is quickly removed from the tissues, 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 accelerate the resorption of these infiltrates, you can use warm heating pads applied to the infiltrate area.

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

Intravenous injections and infusions

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

When performing intravenous injections, the doctor must ensure that the injected drug does not go beyond the vein. If this happens, then either a quick therapeutic effect will not be achieved, or a pathological process will develop in the tissues surrounding the vein, associated with the irritating effect of the drug that has entered. 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 a vein - to perform a venipuncture. It is made to inject a small amount of drugs or a large amount of various liquids into a vein, as well as to extract blood from a vein.

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

Technics. Most often, veins located subcutaneously in the area of ​​​​the elbow are used for puncture.

In cases where the veins of the elbow bend are poorly differentiated, the veins of the dorsal surface of the hand can be used. Do not use the veins of the lower extremities, as there is a risk of developing thrombophlebitis.

During venipuncture, the position of the patient 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 of the patient, it is better to always perform it in the supine position. A towel folded several times should be placed 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, an Esmarch tourniquet or a rubber tube must be applied 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 tissues of the shoulder 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 area of ​​the elbow 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.

In order for the vein selected for puncture not to move when the needle is injected, it is carefully held at the site of the proposed injection with the middle (or index) and thumbs of the left hand.

A vein is punctured either with a single needle or with a needle attached to a syringe. The direction of the end of the needle should correspond to the blood flow to the center. The needle itself should be 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 wall of the vein. The depth of the puncture should not be large so as not to pierce the opposite wall of the vein. Feeling 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 jet 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 the blood from the vein does not pour out, you should slightly pull the needle out and repeat the stage of piercing the vein wall again.

When a drug that causes tissue irritation is injected into a vein, 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 tissues is injected into a vein, venipuncture can be done with a needle attached to a syringe in which the drug is drawn.

injection technique. After performing venipuncture and making sure that the needle is in the correct position in the vein, they begin to administer 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 amount of medicinal liquid is injected, must be done very slowly. Throughout the injection, it is necessary to control whether the injected fluid enters the vein. If the liquid begins to flow into nearby tissues, then swelling appears in the circumference of the vein, the syringe piston does not move forward well. In such cases, the injection should be stopped, the needle removed from the vein. The procedure is repeated.

At the end of the injection, the needle is quickly withdrawn 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 injection site of the needle is pressed with a cotton or gauze swab moistened with alcohol. If the injection was performed in the cubital vein, the patient is asked to bend the arm in the elbow joint as much as possible, while holding the tampon.

Recently, puncture of the subclavian vein has become widely used in clinical practice. However, due to the possibility of developing serious complications during manipulation, it must be performed according to strict indications by doctors who know the technique of its implementation. Usually it is produced by resuscitators.

Complications arising from intravenous injections are due to the ingestion of blood and fluid into the tissues, which is injected into the vein. The reason for this is a violation of the technique of venipuncture and injection.

When blood flows out of 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 enters the tissues, burning pain occurs in the injection zone and a very painful, long-term non-absorbable infiltrate may form or tissue necrosis may occur.

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

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

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

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

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

The liquid intended for infusion should 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 detailed in the relevant transfusiology manuals.

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

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

Technics. Preparation of the system for intravenous infusion is as follows. With sterile hands, the sister processes the cork that closes the vessel with the transfusion fluid, and inserts a needle through it (the length of the needle should not be less than the height of the vessel). Next to this needle, a needle is inserted into the cavity of the vessel, connected to a system of tubes through which fluid will flow into the vein. The vessel is turned upside down, a clamp is applied to the tube near the vessel, and the glass dropper filter located on the tube system is located at the level of the middle of the vessel height. After removing the clamp from the tube, fill half of the dropper filter with transfusion fluid and re-attach the clamp to the tube. Then the vessel is placed on a special stand, the tube system together with the dropper filter is lowered below the vessel, and the clamp is again removed from the tube. In this case, the liquid begins to intensively flow out of the vessel and the filter-dropper into the corresponding knees of the system, after filling them, it flows out through the cannula at its end. Once the tubing system is filled with liquid, a clamp is applied to the lower tubing. The system is ready to be connected to a catheter or needle in the patient's vein.

If the tubes of the system are made of transparent plastic

mass, then it is not difficult to determine the presence of air bubbles in it. When rubber opaque tubes are used, the presence of air bubbles is controlled 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 process it becomes necessary to replace the vial with liquid, then this should be done without leaving the vein. To do this, a clamp is applied to the tube near the vessel, and the needle to which the tube is connected is removed from the vessel and inserted into the stopper of the vessel with a new transfusion medium. At the same time, it is very important that at the moment of repositioning the vessels, the tube system is filled with liquid from the previous infusion.

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

Inhalation

A method of treatment in which a drug in a finely sprayed, vaporous or gaseous state is entrained with the 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 oral cavity and pharynx into the digestive tract and thus act on the entire body.

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

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

In order for most of the vapor to enter the respiratory tract, the patient's head is placed over a pot of water, and covered with a blanket on top. A kettle can be used for the same purpose. After the water boils, it is put on a light fire, a tube is put on the spout from a folded sheet of paper and steam is breathed through it.

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

IMPACT ON CAVITY ORGANS

gastric lavage

Gastric lavage is a technique in which its contents are removed from the stomach through the esophagus: stagnant, fermented liquid (food); junk 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) food poisoning, various poisons;

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

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

Technics. The position of the patient during gastric lavage, 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 knees of the patient and the funnel is filled with water to the brim. Slowly raise the funnel up, approximately 25-30 cm above the patient's mouth. At the same time, water begins to flow into the stomach. It is necessary to hold the funnel in the hands somewhat obliquely so that a column of air does not enter the stomach, which is formed during the rotational movement of the water passing into the tube. When the water drops to the place where the funnel passes into the tube, slowly move the funnel to the height of the patient's knees, holding it with a wide opening up. The return of fluid from the stomach is determined by an increase in its amount in the funnel. If as much liquid came out into the funnel as it entered the stomach or

more, then it is poured into a bucket, and the funnel is again filled with water. The release of a smaller amount of fluid from the stomach, compared to the entered one, indicates that the probe in the stomach is not properly positioned. In this case, it is necessary to change the position of the probe, either by pulling it up or by deepening it.

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

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

enemas and gas

FROM THE INTESTINE

The technique, which consists in introducing a liquid substance (water, drugs, oils, etc.) into the intestine through the rectum, is called an enema.

Anatomical and physiological data, on which

the method of application of enemas is based

The withdrawal of the contents of the large intestine in a natural way - defecation - is a complex reflex act that occurs with the participation of the central nervous system. The liquid content from the small intestine passes into the large intestine, where it lingers for 10-12 hours, and sometimes more. When passing through the large intestine, the contents gradually thicken due to the vigorous absorption of water and turn into feces. In the intervals between bowel movements, feces move in the distal direction due to peristaltic contractions of the muscles of the colon, descend to the lower end of the sigmoid colon and accumulate here. Their further advancement into the rectum is prevented by the third sphincter of the rectum. The accumulation of feces in the sigmoid colon is not felt as a "urge to the bottom." The urge to defecate occurs in a person only when feces enter the rectum and fill its cavity. It is caused by mechanical and chemical irritation of the rectal wall receptors and especially by stretching of the intestinal ampulla. During defecation, the anal sphincters (outer - from transverse muscles, internal - from smooth muscles) are constantly in a state of tonic contraction. The tone of the sphincters especially increases with the entry of feces into the cavity of the rectum. With the appearance of a "desire to the bottom" and during the implementation of defecation, the tone of the sphincters reflexively decreases, they relax. This eliminates the obstacle to the release of feces to the outside. At this time, under the influence of irritation of the rectal receptors, the annular muscles of the intestinal wall and pelvic floor contract. The movement of feces from the sigmoid colon into the rectum, and from the latter outward, is facilitated by contraction of the diaphragm and abdominal muscles during delayed breathing. Thanks to the participation of the cerebral cortex, a person can voluntarily carry out or delay defecation.

The extinction of the reflex from the rectal ampulla leads to proctogenic constipation. Irritation of the rectum, especially the stretching of its ampulla, reflexively affects the function of the overlying sections of the digestive apparatus, excretory organs, etc. An enema turns out to be such a mechanical stimulus.

In addition to active peristaltic contractions of the muscles of the colon wall, there is also an anti-peristaltic contraction, which contributes to the fact that the liquid introduced into the rectum, even in a small amount, quickly passes into the overlying sections of the colon and quite soon ends up in the caecum.

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