Intradermal and subcutaneous injection: technique. How to give injections
injection needles have the following parts:
1. Injection cylinder (tube) for immersion into tissue.
2. Cannula (head, pavilion) for connection to a syringe or adapter.
Requirements for injection needles:
1. Strength, eliminating the possibility of fracture.
2. Sharpness of sharpening for easier penetration into fabrics.
3. Reliability of the connection of the cannula (pavilion) with the syringe or adapter.
4. Maximum wide clearance with minimum outer diameter.
The sharpening angle of the end of injection and puncture needles varies from 15 to 45°.
To penetrate complex tissues of significant thickness, the sharpening angle must be larger, and if it is necessary to penetrate into superficial tissues of small thickness, the sharpening angle must be small.
There are the following options for sharpening injection needles:
Flat;
- dagger;
- spear-shaped;
- diamond-shaped (Fig. 42).
The needle cannula (pavilion) can have different shapes:
Conical;
- square;
- spherical.
Rice. 42. Options for sharpening needles:
a - flat; b - dagger; c - spear-shaped; g - diamond-shaped.
The square-shaped cannula is especially convenient for finger fixation during venipuncture.
The inner diameter of the needle varies from 0.1 to 4.0 mm.
The outer diameter ranges from 0.2 to 5.0 mm.
The length of injection needles ranges from 15 to 300 mm.
The length of needles for intradermal injections corresponds to 15-20 mm.
- The length of hypodermic needles ranges from 35 to 45 mm.
- The length of needles for intramuscular injections is 45-70 mm.
Before injection, the needle cannula is placed on the end of the syringe. To increase the reliability of fixation on the tip of the syringe, the needle cannula must be rotated 10-15° along the longitudinal axis.
Holding the syringe vertically and gently pressing on the plunger, you should check the patency of the needle. The needle lumen and the inner diameter of the syringe must be adapted. The rule to follow is simple: “the smaller the needle lumen, the smaller the internal diameter of the syringe.” If this proportion is violated, you will have to apply excessive force to the syringe piston handle to push the liquid through the lumen of the needle.
Needles for intradermal injections
Design features of needles for intradermal injections:
1) short length (15-20 mm);
2) internal diameter 0.1-0.2 mm.
1. Before injection, be sure to check the patency of the needle.
2. Due to the small size of the lumen, a comparable small volume syringe (1-2 ml) should be used.
When performing intradermal injections, the syringe should be held sequentially in two positions:
1. Before inserting the end of the needle into the thickness of the skin, hold the syringe in the palm of your hand, fixing the needle cannula with the distal phalanx of the index finger, and the piston handle with the distal phalanx of the little finger.
In this position, both relatively movable parts (the needle cannula and the syringe plunger) are securely fixed.
2. Before inserting into the thickness of the skin, the needles should be turned with the cut anteriorly.
3. The needle must be inserted into the thickness of the skin only at an acute angle.
After inserting the end of the needle into the thickness of the skin, it is necessary to change the position of the hands:
With your right hand you need to fix the syringe so that the piston is between fingers II and III. The distal phalanx of the thumb is pressed on the piston handle.
To develop greater force and speed up the introduction of liquid, it is prohibited to press the piston handle with your palm. If excessive force is used, the syringe body may be destroyed, causing damage to the soft tissues and neurovascular bundles of the palm. Injury to the motor branch of the median nerve can lead to disruption of the opposition of the first finger and little finger (monkey hand sign) with disability.
2. Using a pinch movement of the first and index fingers of the left hand, fix the needle cannula.
The left hand should not block the injection area.
3. Slowly inject the solution into the thickness of the skin until a “lemon peel” effect is obtained.
Hypodermic needles
Design features of needles:
For subcutaneous administration of drugs, needles 50-70 mm long with a diameter of 1-2 mm are used;
- the cannula, as a rule, has an oval or square shape.
Sequence of actions for subcutaneous injection:
1. The skin in the injection area should be folded with a pinching movement of the thumb and index finger.
2. At the base of the fold, a needle punctures the skin at an angle of approximately 45° (the initial position of the syringe in the hand is described above).
3. Changing the position of the syringe in the hand, as indicated above, inject the drug into the subcutaneous fatty tissue.
Rules for introducing novocaine into the subcutaneous fatty tissue for infiltration anesthesia:
1. The number of skin punctures for infiltration anesthesia should be minimal.
2. Both forward and backward movement of the needle should be accompanied by the introduction of novocaine solution. When a novocaine solution is administered, “hydraulic preparation” occurs, preventing damage to superficial vessels and nerves.
3. A planar change in the direction of movement of the needle, immersed for its entire length in the thickness of the subcutaneous fatty tissue, is unacceptable. The inevitable damage to blood vessels with the formation of a hematoma can lead to the formation of subcutaneous phlegmon.
Sequence of actions for infiltration anesthesia of subcutaneous fat tissue:
1. At one end of the intended incision line, a needle is inserted into the subcutaneous fatty tissue.
2. Sending a stream of novocaine solution, pass the needle the entire length under the incision line.
3. Continuing to inject the novocaine solution, remove the needle from the subcutaneous fatty tissue, leaving the end of the needle in the thick skin.
4. From this point, directing the needle at an angle of 45° to the incision line, infiltrate the adjacent fatty tissue with novocaine.
5. Continuing to inject the novocaine solution, the needle is returned to its original position. Its end should remain in the thickness of the skin.
6. Change the direction of needle movement in the other direction at an angle of 45 ° to the cut line.
7. Novocaine is injected into the subcutaneous fatty tissue according to the previously described rules.
8. Remove the needle from the subcutaneous fat and skin.
9. From the other extreme point of the line of the intended incision, a solution of novocaine is administered in a similar way. As a result of the combination of movements with the needle, a figure resembling a rhombus is formed. When the length of the incision exceeds twice the length of the needle, several such figures are sequentially formed to introduce the novocaine solution.
Needles for intramuscular injections
Design features of needles for intramuscular injections:
1) length 50-70 mm;
2) diameter 1-1.5 mm;
3) pavilion (cannula) of oval or cone-step shape.
Intramuscular injections should be made in places where large vessels and nerves do not pass, but there is a good blood supply to the tissues.
Such places include:
1) gluteal region (outer superior quadrant);
2) deltoid region;
3) superolateral (outer) thigh.
Immediately before the injection, you should read the label on the medicine again to avoid the mistaken administration of another substance.
The following rules must be observed to perform a painless intramuscular injection:
The muscles in the injection area should be as relaxed as possible;
- you do not need to fold the skin, but stretch it between the 1st and 2nd fingers of your left hand;
- the needle should not be inserted obliquely, but perpendicular to the surface of the skin;
- it is necessary to insert the end of the needle only intramuscularly.
The intramuscular injection should not be performed too aggressively. “With one blow” you can pierce all tissues by inserting the end of the needle into the axillary tissue.
Insertion of the needle to a given depth should be vigorous but controlled.
Do not hold the syringe barrel in your fist, like a spear. A painless, precisely targeted injection to a given depth will be ensured by fixing the syringe barrel in the “bow” or “pen” position (Fig. 43).
The introduction of large quantities of the drug into the axillary tissue can, after some time, lead to the development of aseptic inflammation with compression of the nerves.
Subcutaneous administration of a drug intended for intramuscular administration not only sharply reduces the effectiveness of its action, but can also be dangerous.
When performing the described injection, the end of the needle passes through the following zones (layers) of resistance:
1. Skin.
2. Own fascia.
You need to learn to feel them when moving the needle. This is achieved by training on a phantom.
Rice. 43. Correct position of the syringe in the hand during intramuscular injection (according to: Lopukhin Yu. M., Molodenkov M. N. Workshop on operative surgery, 1968).
Before the injection, you should try to hypothetically imagine the thickness of the subcutaneous fatty tissue and, when choosing a needle, compare its length and the thickness of the layer being passed through. The needle is usually inserted to 2/3 of its length.
Before administering the drug, be sure to pull the needle back to prevent it from entering a blood vessel. The criterion for the correct stratigraphic position of the needle is the absence of blood in the syringe.
When injecting into the gluteal region, the patient in a standing position should lean only on the leg of the opposite side to relax the injected muscles.
When performing an injection into the deltoid muscle, the arm on the side of the injection should be lowered and the muscles relaxed.
When injecting into the upper lateral thigh, the patient should lie on his back. The leg should be slightly bent at the hip joint. The solution should be administered intramuscularly very slowly.
After insertion, the needle should be removed quickly and accurately along the wound channel.
Cicatricial compression of the nerves emerging through the infrapiriform foramen is possible when large quantities of medicinal solutions (in particular, a solution of magnesium sulfate) are administered not intramuscularly, but into the cellular space under the gluteus maximus muscle.
In this case, compression of the sciatic, pudendal and inferior gluteal nerves may develop due to indirect swelling of the gluteus maximus muscle. In addition, direct aseptic swelling of the fatty tissue is possible when a needle pierces the thickness of the gluteus maximus muscle and injects a drug under it.
G. M. Semenov
Modern surgical instruments
Ticket No. 46 Intradermal injection. Places of production. Target. Equipment. Action algorithm. Prevention of possible complications.
Intradermal injection
Purpose: diagnostic, used for allergy tests and preventive vaccinations. Equipment: tuberculin syringe or single-use syringe, capacity 1 ml, needle 15 mm long, cross-section 0.4 mm, sterile needle in a package for a medicine kit, medicine, ethyl alcohol 70% (or other skin antiseptic), tray, three sterile cotton balls, mask, latex gloves, containers for disinfecting used syringes, needles and cotton balls.
Preparation for the procedure
Establish a friendly relationship with the patient.
Explain to the patient the purpose and course of the procedure, clarify information about the drug, obtain consent, and make sure that there are no contraindications for the use of this drug.
Put on a mask, prepare your hands for work, put on gloves.
Check the suitability of the medicine (read the name, dose, expiration date on the package, determine by appearance).
Check doctor's prescriptions.
Treat the neck of the ampoule (bottle cap) with a swab moistened with alcohol.
Open the package and collect the syringe.
Draw the required amount of medicine into the syringe.
Change the needle, place a needle for intradermal injection on the cone of the syringe, release the air from the syringe so that the specified dose remains in it. Put on the cap.
Place the syringe on a sterile tray or in a sterile package.
Executing the procedure
Sit the patient down and place his hand with the front surface of the forearm up.
Take the syringe in your right hand with the needle cut up, remove the cap.
Treat the skin in the area of the middle third of the anterior surface of the forearm twice with different tampons with the fingers of your left hand, dump the balls into the disinfectant solution.
Stretch the skin at the injection site with the fingers of your left hand. Insert only the bevel of the needle into the skin at an angle of 5° to the surface of the patient’s body.
Secure the needle with your second finger, pressing it against the knit.
Place your left hand on the plunger and inject the medicine.
Remove the needle with a quick movement, holding it by the cannula.
Take a cotton ball moistened with alcohol and apply a light tangential movement to the injection site. Note: do not press sterile cotton wool moistened with alcohol to the injection site.
Check to see if there is any bleeding from the puncture site.
End of the procedure
Explain to the patient that water should not come into contact with the injection site until the reaction is determined (if the injection was performed for diagnostic purposes).
Disinfect the syringe, needles, and cotton swabs.
Remove gloves and place in disinfectant solution.
Wash and dry your hands.
Make a record of the procedure on the assignment sheet.
Intradermal injections
Intradermal injection is the most superficial of injections. For diagnostic purposes, 0.1 to 1 ml of liquid is administered. The injection site is the anterior surface of the forearm.
To carry out an intradermal injection, a needle 2-3 cm long with a small lumen is required. The palmar surface of the forearm is mainly used, and with novocaine blockades other parts of the body are used.
Before intradermal injection, you must wash your hands and wear rubber gloves. The site of the intended injection is treated with a cotton ball moistened with 70° alcohol, making strokes in one direction. Stretch the skin at the injection site and insert the needle into the skin with the cut side up, then move it 3-4 mm, releasing a small amount of the medicinal substance. Lumps appear on the skin, which, with further administration of the medicine, turn into a “lemon peel”. The needle is removed without pressing the injection site with cotton wool.
Used syringes and needles are washed in a disinfectant solution using two containers: one with freshly prepared disinfectant solution, from where the disinfectant solution is drawn into the syringe for disinfection, and the second - an intermediate one, where the disinfectant solution is poured from the syringe. Next, the used syringes are accumulated in the third container. After the last injection, used syringes and needles are filled with freshly prepared disinfectant solution, maintaining the appropriate exposure time (depending on the disinfectant used). After disinfection, reusable syringes and needles are washed under running water, followed by the use of a washing solution and further sterilization in the sterilization department. Disposable syringes are disposed of after disinfection. Spent cotton balls are accumulated in a specially marked container for used cotton balls and filled with freshly prepared disinfectant solution, maintaining the appropriate exposure time.
Purpose: diagnostic, used for allergy tests, preventive vaccinations.
Equipment:
Tuberculin syringe with a capacity of 1 ml, a needle 15 mm long, 0.4 mm cross-section.
A sterile needle in a package for a medicine kit.
Medicine
Ethyl alcohol 70%
3 sterile gauze balls
Containers for disinfecting used syringes, needles and cotton balls
Latex gloves
Intradermal injection is the most superficial, as the needle is inserted shallowly. Intradermal injection is used for diagnostic purposes (tuberculin test, detection of allergies to various substances, etc.), as well as for local anesthesia. For diagnostic purposes, 0.1 to 1.0 ml of liquid is administered.
Intradermal injections are used for diagnostic purposes to perform the tuberculin Mantoux reaction, various allergy tests, as well as in the initial stages when administering local anesthesia. Typically, the inner surface of the forearm is chosen for intradermal injections. It is necessary that the needle (preferably short) enters the skin to a shallow depth (until its lumen disappears), after which the contents of the syringe are injected at an acute angle. With the correct technique, a “lemon peel”-shaped bump remains at the site of the intradermal injection.
Violations in the technique of fixing the needle in the vein can also lead to complications. A loosely fixed needle causes additional trauma to the vessel. This complication occurs almost exclusively in elderly people. With this pathology, the administration of the drug into this vein is stopped, another vein is punctured and infusion is carried out, paying attention to fixing the needle in the vessel. A tight bandage is applied to the area of the hematoma.
Ticket No. 47 Subcutaneous injection. Equipment. Algorithm of actions. Prevention of possible complications.
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 drugs have an effect faster than when administered orally, since drugs administered in this way are quickly absorbed.
Subcutaneous injections are made with a needle of the smallest diameter to a depth of 15 mm and up to 2 ml of medications are injected, which are quickly absorbed into the loose subcutaneous tissue and do not have a harmful effect on it.
Performing a subcutaneous injection:
Wash your hands (wear gloves);
Treat the injection site sequentially with two cotton balls with alcohol: first the large area, then the injection site itself;
Take the syringe in your right hand ("place" it in your hand - hold the needle cannula with the 2nd finger of your right hand, hold the cylinder from below with the 3rd-4th fingers, and from above with the 1st finger);
With your left hand, gather the skin into a triangular fold, base down;
Insert the needle at an angle of 45° into the base of the skin fold to a depth of 2/3 of the needle length, hold the needle cannula with your index finger;
Place your left hand on the plunger and inject the medication (do not transfer the syringe from one hand to the other);
Apply a clean cotton ball with alcohol to the injection site.
Subcutaneous injections
Used, for example, when administering insulin.
The subcutaneous fat layer has a dense vascular network, so medicinal substances administered subcutaneously have an effect faster than administered orally - they bypass the gastrointestinal tract, entering directly into the bloodstream. Subcutaneous injections are made with a needle of the smallest diameter to a depth of 1.5 mm and up to 2 ml of medications are injected, which are quickly absorbed into the loose subcutaneous tissue and do not have a harmful effect on it.
The most convenient sites for subcutaneous injection are:
outer surface of the shoulder;
subscapular space;
anterior outer surface of the thigh;
lateral surface of the abdominal wall;
lower part of the axillary region.
In these places, the skin is easily caught in the fold and the risk of damage to blood vessels, nerves and periosteum is minimal.
in places with edematous subcutaneous fat;
in compactions from poorly absorbed previous injections.
The skin in front of the injection site is folded, the needle is inserted into the skin at an angle of 45°, then the drug solution is smoothly injected into the subcutaneous fat.
Necessary things: disposable syringe 1-2 ml, needles 5 cm and 3-4 cm, sterile tray, which should be covered with a sterile napkin. The tray should contain: gauze swabs, tweezers, 70% ethyl alcohol, an ampoule with medicine, rubber gloves, a container with a disinfectant solution.
A prerequisite is to observe the sites for the subcutaneous injection. This is the subscapular region, the lateral surface of the abdominal wall.
System and sequence of the procedure:
1. Wash your hands, put on gloves.
2. Treat the injection site sequentially with two cotton balls with alcohol: first a large area, then the injection site itself; Place the third ball of alcohol under the 5th finger of your left hand.
3. Take the syringe in your right hand (with the 2nd finger of your right hand you need to hold the needle cannula, with the 5th finger - the syringe piston, with the 3rd-4th fingers hold the cylinder from below, and with the 1st finger - from above).
4. With your left hand, gather the skin into a triangular fold, base down.
5. Insert the needle at an angle of 45° into the base of the skin fold to a depth of 1-2 cm (2/3 of the needle length), holding the needle cannula with your index finger.
6. Place your left hand on the plunger and inject the medication without transferring the syringe from one hand to the other.
It must be remembered that if there is a small air bubble in the syringe, inject the medicine slowly and do not release the entire solution under the skin, leaving a small amount along with the air bubble in the syringe.
7. Remove the needle by holding it by the cannula.
8. Press the injection site with a cotton ball and alcohol.
9. Lightly massage the injection site without removing the cotton from the skin.
10. Place a cap on the disposable needle, dispose of the syringe in a waste container, or pre-sterilize the reusable syringe.
Performing subcutaneous injections
Purpose: administer the drug subcutaneously.
Equipment Sterile syringe 1-2 ml. Ampoules with medicinal substance. The tray is sterile. Sterile needles for subcutaneous administration. Sterile needles for collecting medicinal substances. Cotton balls are sterile. Alcohol 70%. Files. Rubber gloves. Containers with disinfectant solutions. Towel. Liquid soap dispenser. Anti-HIV first aid kit. Anti-shock first aid kit.
Sequence of m/s actions to ensure safety Inform the patient about the upcoming manipulation and the progress of its implementation. Provide the patient with the necessary information about the drug. Read the name and expiration date of the drug. Help the patient take the desired position. Expose the injection site to the patient. Wash your hands, put on gloves, and treat them with a ball of alcohol. Fill the syringe with the prescribed medication. Determine the injection site. Treat the injection site with an area of 10 x 10 cm with a sterile ball moistened with alcohol in one direction. Apply a second sterile ball moistened with alcohol to the injection site with an area of 5x5 cm in one direction. Change the needle used to draw up the medicinal substance to an injection needle. Release the air from the syringe. Take the syringe in your right hand, hold the needle sleeve with your second finger, the piston with your fifth finger, and the cylinder with the rest. Grasp the skin at the injection site in the fold with the first and second fingers of your left hand. Insert the needle under the skin into the base of the skin fold at an angle of 30-45° to the surface of the skin with the cut up 2/3 of the length of the needle. Place your left hand on the plunger. Pull the plunger slightly towards you, make sure that the needle does not fall into the vessel (no blood in the syringe). Introduce the drug slowly. Press the injection site with a dry sterile ball and quickly remove the needle. Ask the patient how he is feeling. Place the syringe, needles, balls, gloves in a container with a disinfectant solution. Take off your gloves and also place them in the disinfection area. Wash your hands. Sites for subcutaneous injections: upper outer surface of the shoulder;
upper outer surface of the thigh; subscapular region; anterior abdominal wall.
Ticket No. 48 Intramuscular injection. Places of administration. Action algorithm. Prevention of possible complications.
Intramuscular injection is one of the most common methods of administering small volumes of drugs. Muscles have an extensive network of blood and lymphatic vessels, which creates good conditions for the absorption of drugs. With intramuscular injection, a depot is created from which the drug is gradually absorbed into the bloodstream, which allows maintaining approximately the same concentration of the active substance in the blood for several hours and thereby ensuring its long-term effect.
To prevent complications, intramuscular injections are recommended to be performed in areas of the body where there is a significant layer of muscle tissue and large vessels and nerve trunks are not located close. The length of the needle used depends on the thickness of the subcutaneous fat layer, since it is necessary that when inserted, the needle passes through the subcutaneous tissue and its cut is located directly in the muscle. Injections are usually made into the gluteal muscles, less often into the muscles of the anterior thigh or deltoid muscle.
When performing an injection into the gluteal muscle, the following actions are performed:
Treating the skin area at the injection site with alcohol.
With your free hand, the skin over the injection site is stretched and pierced with a needle. It is recommended to perform the puncture with a sharp movement to reduce pain (the time of interaction of the needle tip with pain receptors, located mainly in the skin, is reduced).
The needle is inserted deep into the tissue until it penetrates the muscle, which is felt by an increase in resistance (the density of muscle tissue is higher than that of fatty tissue). The needle is inserted approximately 5 mm into the muscle tissue. The thickness of the fatty tissue, and, accordingly, the required depth of immersion of the needle, is individual.
Before injecting the drug, pull the syringe plunger back to check whether the needle has entered a large blood vessel. If blood enters the syringe, without removing the needle, change the direction and depth of immersion to bypass the damaged vessel.
The contents of the syringe are slowly injected into the muscle.
The needle is quickly removed, and a cotton ball with alcohol is pressed to the injection site.
The following complications are possible with intramuscular injections:
The needle enters a blood vessel, which can lead to embolism if oil solutions or suspensions are injected, which should not enter directly into the bloodstream. When using such drugs, after inserting the needle into the muscle, pull the piston back and make sure that there is no blood in the syringe.
Infiltrates are painful compactions in the thickness of the muscle tissue at the injection site. They may occur on the second or third day after the injection. The reasons for their occurrence can be either non-compliance with the rules of asepsis (non-sterile syringe, poorly treated injection site), or repeated administration of drugs in the same place, or increased sensitivity of human tissues to the injected drug (typical of oil solutions and some antibiotics).
Abscess - manifested by hyperemia and soreness of the skin over the infiltrate, elevated body temperature. Requires urgent surgical treatment and antibiotic treatment.
Allergic reactions to the administered drug. To avoid these complications, before administering the drug, an anamnesis is collected to determine the presence of allergic reactions to any substances. For any manifestation of an allergic reaction (regardless of the method of previous administration), it is advisable to discontinue the drug, since repeated administration of this drug can lead to anaphylactic shock.
An intramuscular injection can also be performed into the deltoid muscle. The brachial artery, veins and nerves run along the shoulder, so this area is used only when other injection sites are not available, or when multiple intramuscular injections are performed daily. Free the patient's shoulder and shoulder blade from clothing.
Ask the patient to relax his arm and bend it at the elbow joint.
Feel the edge of the acromion process of the scapula, which is the base of the triangle, the apex of which is in the center of the shoulder.
Determine the injection site - in the center of the triangle, approximately 2.5-5 cm below the acromion process. The injection site can also be determined in another way by placing four fingers across the deltoid muscle, starting from the acromion process.
LEARNING OBJECTIVES:
Students must KNOW:
Indications for various injections: intradermal, subcutaneous, intramuscular
Anatomical areas for parenteral administration of drugs
Basic rules for diluting penicillin, streptomycin, bicillin, calculating the dose of insulin
Rules and features of injections of antibiotics and insulin
Prepare for injections the nurse’s workplace, syringe, needles, nurse’s hands and patient’s skin
Perform intradermal, subcutaneous, intramuscular injections
QUESTIONS FOR SELF-PREPARATION:
Rated "3"
1. Cleaning the nurse’s hands before starting the injection.
2. Treatment of the injection site for intradermal injection.
3. Anatomical areas most commonly used for subcutaneous injections.
Rated "4"
1. Rules for introducing the oil solution.
2. Rules for performing intramuscular injection.
3. Solvents used for diluting antibiotics.
Rated "5"
1. A complication that occurs if an intramuscular injection is made into the center of the gluteal area.
2. Instruments and medications necessary for local anesthesia.
3. Rules for diluting penicillin.
4. Rules for diluting streptomycin.
5. Rules for diluting bicillin.
6. Features of bicillin injections.
7. Rules for putting insulin into a syringe.
ETHICAL AND DEONTOLOGICAL CONSIDERATIONS
The patient's problem associated with the parenteral route of administration is fear of pain.
Therefore, before the injection, a restless patient should be reassured and explained that the pain is not related to the size of the needle; on the contrary, if the needle is short, the medicine will not enter the muscle, but subcutaneously. This will cause severe irritation and pain.
Psychological problems such as:
Patient refusal to inject
Negative attitude of the patient towards the administration of antibiotics
THEORETICAL PART
Intradermal injection
This type of injection is the most superficial, as its name suggests. The needle is inserted no deeper than the stratum corneum of the skin. The purposes of such injections are diagnostics or local anesthesia. For diagnostics (for the presence of immunity to tuberculosis, allergy tests, hydrophilic test), 0.01 to 0.1 ml of the drug is injected into the skin. Such a small dose is provided with a syringe with a capacity of up to 1 ml (tuberculin). If the sample is placed correctly, a bubble 5 mm in diameter will form at the injection site. There shouldn't be any blood. After 30 minutes, this papule resolves.
For local anesthesia, take a larger amount of medicine (this is a 0.5% solution of novocaine) - about 0.5 ml. It is not injected into one place, but the needle is gradually moved and a few drops of liquid are squeezed out of the syringe. At the injection site, the skin looks like a lemon peel.
When checking sensitivity to medications, 0.1 ml of a medicinal substance (for example, antibiotics) is injected into the skin. When an allergic reaction occurs, redness and swelling appear on the skin after 20-30 minutes. The place for diagnostic tests is the inner surface of the forearm.
Cleaning the nurse's hands before injection Algorithm of action:
1) Wash your hands under the tap with soap.
2) Dry your hands under an electric dryer or towel.
3) Clean your hands with alcohol using two cotton balls. Use one ball to treat the palmar surfaces of both hands in the direction from the fingertips to the wrist. Another is to treat the back surfaces of both hands in the same direction.
Intradermal injection
Action algorithm:
1) Prepare your hands for injection.
2) Assemble the syringe (tuberculin), check whether the piston is well ground.
3) Prepare two needles: for taking the medicine and for performing the injection.
4) Draw about 0.5 ml of medication from the ampoule or vial with a long (15 mm long, 0.4 mm diameter) needle. (To perform the injection, you need 0.1 ml of solution; we take more, since we will release part of the solution from the syringe when checking the patency of the needle).
5) Change the needle, check its patency.
6) Treat the inner surface of the middle third of the patient’s forearm with alcohol, changing cotton balls twice.
7) Wait until the skin dries.
8) Holding the needle with the cut up and at an acute angle, almost parallel to the skin, insert the end of the needle into the thickness of the skin so that its lumen is just hidden and inject 0.1 ml of liquid. When the injection is performed correctly, a papule with a diameter of 0.5 cm is formed, which resolves after 30-40 minutes.
9) The needle is removed. The skin is not treated with anything.
Subcutaneous injection
Due to the fact that the subcutaneous fat layer is richly supplied with blood vessels, a subcutaneous injection is used for a faster effect of the medicine. Usually, solutions of drugs are administered that are quickly absorbed in the loose subcutaneous tissue and do not have a harmful effect on it. Up to 2 ml of the drug can be injected under the skin.
When performing subcutaneous injections, you should always avoid the proximity of large vessels and nerve trunks. The most convenient areas of the skin are the outer surface of the shoulder, the subscapular region, the anterior outer surface of the thigh, and the lateral surface of the abdominal wall. In these areas, the skin is easily caught in the fold and there is no danger of damage to blood vessels, nerves and periosteum. It is not recommended to make subcutaneous injections and infusions into areas with edematous subcutaneous fatty tissue or into areas of compaction (infiltrates).
Action algorithm:
1) Prepare your hands for injection,
2) Assemble a syringe with a capacity of 1 to 5 ml, prepare two needles, one for a set of drugs (with a wide bore), the other 20-30 mm long for injection. Place a wide-bore needle onto the syringe.
3) Treat the neck of the ampoule with alcohol, file it with a file and, holding it with a cotton swab moistened with alcohol, break it off.
4) Take the medicine from the ampoule or vial by holding the ampoule or vial on the needle with your finger. Take from 1 to 5 ml (as prescribed by your doctor).
5) Change the needle, and, raising the syringe vertically at eye level, free it from excess medicine and air bubbles, checking its patency.
6) Prepare two cotton balls soaked in alcohol.
7) Instruct the patient to vacate the injection site. This may be the outer surface of the shoulders and hips, the subscapular region, the lateral surfaces of the anterior abdominal wall. Treat the injection site with alcohol, first with one cotton ball on a large surface, then with another - directly on the injection site. Do not throw away the second ball, but hold it in your hand with your little finger.
8) With your left hand, gather the skin into a fold, and with your right hand, holding the syringe at an acute angle (about 45 0), insert the needle to a depth of 2/3 of the length, the bevel of the needle should be directed upward. Without switching the syringe to the other hand, inject the medicine. Apply a second cotton swab with alcohol to the injection site and, holding the needle with your finger, remove it from the soft tissue with a sharp movement.
Using your left hand with a cotton ball, lightly massage the injection site of the medicine so that it is better distributed in the subcutaneous fat.
With subcutaneous injections, complications are possible: infiltration, abscess, leaving a needle fragment in soft tissues, oil embolism, allergic reactions, erroneous administration of another medication under the skin instead of the prescribed one.
Related information.
Indications:
· Detection of hypersensitivity to a drug (biological test).
· Detection of the presence or absence of immunity to the disease (diagnostic test).
· Local anesthesia.
Contraindications:
· Swelling of subcutaneous fat at the injection site.
· Skin diseases at the injection site.
Places of administration:
· Inner surface of the middle third of the forearm.
· Upper third of the outer surface of the shoulder (for BCG vaccination).
Material support:
Sterile pack with cotton balls and napkins
· Sterile tweezers in a container
· Files
Container for waste materials
· Bottle with antiseptic
· Sterile syringe 1-1.5 ml.
· Injection needle 15 mm long, 0.4 mm cross-section.
· Needle for drug collection, length 40 mm, cross-section 0.8 mm.
· Medicine.
· Gloves
· Mask
· Protective glasses
· Container with disinfectant
Execution sequence:
1. Clarify with mother and child the understanding of the purpose and progress of the procedure, obtain consent.
2. Perform hygienic hand antiseptics.
3. Prepare an ampoule or bottle of medicine for use.
4. Assemble a sterile syringe, attach a needle to draw the medicine.
5. Draw 0.3-0.4 ml of the medicine into the syringe.
6. Change the injection needle, remove air, check the patency of the needle without removing the cap.
7. Invite the patient to lie down or sit down.
8. Treat the area of skin to be injected with a cotton ball moistened with an antiseptic on the larger surface and the second on the smaller surface.
9. Take the syringe in your right hand, place your index finger on the needle collar and the rest on the barrel.
10. Remove the cap from the needle (if the syringe is disposable)
11. Make sure that the cut of the needle is on top.
12. Use your left hand to stretch the skin at the injection site.
13. Insert the needle under the stratum corneum to the length of the needle cut, keeping it parallel to the skin.
14. Fix the needle position by placing the index finger of your right hand on the needle sleeve.
15. Inject the medicine by pressing the plunger with your left thumb. When the injection is performed correctly, a papule in the form of a “lemon peel” is formed.
16. Quickly remove the needle.
17. Place a dry sterile cotton ball on the injection site for 2-3 minutes (without pressing).
18. Disinfect the used syringe and needle.
19. Soak used cotton balls in a disinfectant solution in a container for balls and napkins for 1 hour.
20. Wash your hands and dry them.
21. Mark the completion of the work in the medical record.
Note:
Date added: 2015-02-06 | Views: 851 | Copyright infringement
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Manipulation
"Technique of intradermalinjections"
Target: diagnostic local anesthesia.
Indications: for carrying out preventive vaccinations, tuberculin tests, allergy tests, local anesthesia.
Contraindications: skin diseases.
Equipment: manipulation table, couch, container for disinfection - 2 pcs., single-use injection syringe 1.0 ml, needle length 15.0 mm (1 pc.), kidney-shaped sterile tray (1 pc.), non-sterile tray - 1 pc., puncture-proof container and bag for used syringes - 1 piece, disinfectant, antiseptic for treating the injection field, for treating hands, gauze balls or napkins
(3 pcs.), liquid soap, sterile gloves (1 pair).
Manipulation algorithm
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Sequencing |
Rationale |
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Preparing for the procedure. 1.1. Prepare everything necessary for manipulation. Check the patient's name, compliance of the drug with medical prescription, transparency, color, expiration date. |
Check your allergy history. |
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Efficiency of manipulation. Prevention of complications. 1.2. Explain to the patient the meaning of the manipulation. |
Make sure that the patient has informed consent for the upcoming procedure of administering the drug. If this is not the case, check with your doctor for further steps. Prevention of complications, respect for patient rights |
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(Code of Ethics for Nurses of the Russian Federation, Art. 7). |
1.3. |
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Carry out hygienic hand antiseptics. Infection safety |
1.3. |
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1.4. Treat the neck of the ampoule (bottle cap) |
balls with alcohol - twice. 1.5. |
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Prepare a syringe and needle for aspirating the drug. Take the medicine into a syringe from an ampoule or bottle. |
Correct execution |
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manipulation. 1.6. |
Change the needle (put a needle for intramuscular injection onto the cone of the syringe). |
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Place the used needle in a container with disinfectant. r-rum. Infectious safety and compliance with the requirements for intravenous injections. |
1.7. Offer or help the patient to find a comfortable position |
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position: sitting or lying down. Access to the injection site. 1.8. Determine the injection site (select, examine, palpate). |
Prevention of complications. |
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1.9. Put on gloves (sterile), directly | |
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before the injection it is advisable treat non-sterile gloves with a solution antiseptic; Infection safety. 2. Execution of the procedure. |
Prevention of complications. |
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2.1. Clean the injection site with | |
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one direction with an antiseptic solution, the first with a ball - a wide field, with the second - directly |
injection site, wait until the antiseptic |
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will evaporate (the injection site should be dry); |
injection site, wait until the antiseptic |
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2. 2. Using the fingers of your left hand, stretch the skin at the injection site, while simultaneously fixing your hand. |
injection site, wait until the antiseptic |
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2.3. Take the syringe with the other hand, holding the cannula needle with your index finger. The needle should be cut upward; insert only the cut of the needle into the skin at an angle of 5 degrees. Ensuring the introduction of the drug into the stratum corneum of the skin. - 2.4. Use the second finger of your right hand to fix the needle, pressing it to the skin. Provide 2.5. Place your left hand on the piston and carefully introduce the medicine. |
injection site, wait until the antiseptic |
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Support 2.6. Quickly remove the needle. |
Impact effectiveness The drug and the reliability of the reaction result. |
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3. End of the procedure. | |
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3.1. All tools and materials used subject to disinfection. |
Prevention of nosocomial infections. |
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3.2. Carry out hygienic hand antiseptics. |
Prevention of nosocomial infections. |
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3.3. Make an appropriate record of the results implementation in medical documentation. |
Control of the number of injections performed and continuity in the work of the nurse. |