Intravenous and intramuscular injections are the most common medical procedures, the development of which is mandatory for all medical professionals.
The necessary conditions
Intravenous injection is performed in a control room, in a hospital ward or in the intensive care unit. In exceptional cases, namely in case of a life threat, intravenous injection can be performed at home or in transport. The drug, its dosage, frequency and duration of administration is chosen only by the doctor. Despite the existence of other routes of administration, intravenous injection (technique, algorithms) is a mandatory skill of any health worker.
Everything that comes into contact with the vein should be sterile, because the medicine enters directly into the general bloodstream. Before the injection, you need to clarify all the details on the prescription sheet, and if something is unclear, ask your doctor. It is also necessary to talk with the patient and find out from him whether an allergic reaction to the drug was previously noted, how he felt after the injection. Particularly nervous patients need to be reassured by explaining in simple words the purpose of the drug. Immediately before the injection, you need to wash your hands with soap and treat them with an antiseptic.
Algorithm: Performing Intravenous Injection
For this manipulation you need to prepare:
- disposable syringe with a needle;
- sterile cotton balls;
- sterile gloves;
- a hard pad of oilcloth under the elbow;
- harness;
- file for ampoules;
- a drug;
- closed containers for disinfectant;
- closed containers for waste needles, syringes and cotton balls (in extreme conditions, all waste material can be collected in one container).
Security Needed
First of all, you always need to think about security - your own and other patients. Materials in contact with blood carry a potential threat of HIV infection, hence the strict sanitary conditions. Intravenous injections are performed only with gloves.
If the gloves are non-sterile, then after putting on they are treated with two balls with alcohol. Thus, the algorithm (performing intravenous injection) involves a double treatment of the hands: washing, treating the skin with an antiseptic and treating the gloves with alcohol. These actions are necessary in order to break the chain of transmission of a possible infection. This is especially important when you have to perform many injections. The algorithm for performing medical services (for example, intravenous injection) involves the disinfection of not only the hands of personnel, but also syringes, cotton balls, as well as couches, pads, rooms, i.e., everything that could have left biological traces. Compliance is the best way to protect all patients and themselves.
Sequencing
The algorithm (intravenous injection) implies the following actions.
- Inspect the syringe and ampoule, check the appointment. With sterile hands, open the packaging with the syringe and collect it, put it in the sterile tray. Open the ampoule and collect the drug, completely releasing air. The cap must be worn on the needle.
- The patient should sit comfortably or lie down, his hand is on a solid motionless surface.
- An external examination needs to find a clearly visible vein. Most often this is the brachial vein, but sometimes the introduction is made into the veins of the hand. You need to examine both hands and choose the best vein.
- A hard pillow is placed under the elbow, and a tourniquet is placed in the middle third of the shoulder (a towel can be used on clothes or a dense napkin). If the tourniquet is applied to the skin, then when it is squeezed, the patient will experience pain. The ends of the tourniquet should be directed to the healthcare provider.
- After the tourniquet is tightened, they ask the patient to squeeze and unclench his fist several times. The vein should swell, become clearly visible and easily palpated by the fingers. The patient holds his fist clenched.
Direct introduction
These actions are also included in the algorithm (intravenous injection). First, a large area of the skin should be treated with cotton balls moistened with alcohol - approximately 10 x 10 cm around the intended injection site. Then, with the other ball, the injection site itself. The third ball is clamped by the little finger of the nurse's left hand.
Remove the cap from the syringe, take it in the right hand, the needle is located with the cut up, the index finger fixes the cannula. The left hand covers the patient's forearm, while the thumb holds the vein and stretches the skin.
The technique of intravenous injection (algorithm) suggests that you need to pierce the skin and vein at an angle of about 15 degrees, and then advance the needle by one and a half centimeters. The syringe is in the right hand, and with the left you need to gently pull the piston toward yourself, blood should appear in the syringe. The appearance of blood means that the needle is in the vein.
With his left hand to remove the tourniquet, the patient unclenches his fist. Pull on the piston again, check the needle is in the vein. Slowly press the piston until the drug is fully administered. During the introduction, you need to carefully monitor the condition of the person. Then, quickly remove the needle, press the puncture with a cotton ball, bend the patient’s arm at the elbow, leave it to sit for about 10 minutes. Ask to extend the arm, there should be no blood.
The algorithm for performing intravenous injection according to SanPin suggests that after the completion of the injection, the room is disinfected, and an entry is made in the medical documentation .
Intramuscular injection algorithm
The preparation of the syringe with the drug and the hands of the nurse is performed in a similar way. The patient should be laid face down on the couch. Intramuscular injections are best done when the patient is lying down, because a person can fall - everyone tolerates injections in different ways.
The buttocks are divided by standard lines into 4 squares, the injection site is the upper outer. The skin is treated with two balls with alcohol: first, a wide field, then the injection site itself. The syringe is held in the right hand, and the skin is stretched with the left at the injection site. With a sharp movement, the needle is inserted into the gluteal muscle, leaving 1/3 of the length outside. The angle of introduction is about 90 degrees (only in the thigh angle of introduction is about 45 degrees).
With the left hand they pull the piston towards themselves, while there should be no blood in the needle. If the needle gets into the vessel, make a new puncture. If there is no blood, slowly inject the entire drug. Take the third cotton ball and press it to the injection site. It is advisable that the patient sit for several minutes, you need to monitor his reaction.
Where to get syringes and balls after injection?
The intramuscular injection algorithm assumes that everything in contact with blood is a biological waste. Therefore, in the handling room should be capacity:
- for washing syringes;
- for soaking used syringes;
- for used needles;
- for used cotton balls.
Tanks are filled with disinfectant, which is changed daily. The syringe with the needle is washed in the solution, then the needle and cap are disconnected and placed in a separate container. The washed syringe is disassembled, placed in another container. The balls are soaked separately. Syringes, needles and balls washed in a disinfectant are disposed of under an agreement with a disinfection institution.
Which syringes are better?
For administration, as the intramuscular injection algorithm implies, it is better to use syringes with a capacity of 5.0 or 10.0 ml. Most often, the amount of drug administered does not exceed 3.0 ml. These syringes are used because they have a long enough needle for the medicine to get into the thickness of the muscles and dissolve well there. For smaller syringes, the needle is thin and short, and the medicine may get close to the skin. In addition, preparations for intramuscular administration are quite viscous, and injecting them with thin needles is uncomfortable and painful.
Always, in all cases, even if the patient has been treated for a long time, you need to clarify with him the likelihood of allergies and other adverse reactions. Also, the intramuscular injection algorithm suggests that the inscription on the ampoule should be read immediately before administration, even if the ampoule is removed from the box with the corresponding name. Packaging errors are rare, but they do happen.
Infusion: infusion, algorithm
Intravenous infusion is a quick way to improve the patient's condition. The difference between an injection and an injection is only the volume of injected fluid. If 10-20 ml is injected jet, then up to 1 liter of liquid or more can be added dropwise.
For drip administration of drugs using the PR system (transfusion of solutions). Manufacturers produce various models, the mandatory parts are:
- a long tube with a filter and an infusion rate controller;
- air duct - a needle with a closed filter and a short tube;
- wide needle for piercing the bottle with the drug, puncture needle.
The algorithm for performing intravenous drip injection involves filling the system and the actual administration. The bottle is pierced with a wide needle, placed in a tripod. On a long tube, the regulator fully opens before filling with liquid so that the drug begins to drip from the puncture needle.
Then the system is connected according to the rules of intravenous injection. A ball of alcohol is placed under the needle, the needle is fixed to the arm with a band-aid. The lower the rate of administration, the less likely the occurrence of complications. After the end of the infusion, the patient for some time lies on the couch with a bent arm at the elbow until the blood flow from the puncture stops completely.