Intravenous and intramuscular injections are the most common medical manipulations, the development of which is mandatory for all medical workers.
Necessary conditions
Intravenous injection is performed in a manipulation room, in a hospital ward or intensive care unit. In exceptional cases, namely in case of a threat to life, 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 injections (techniques, algorithms) are a must-have skill for any he althcare worker.
Everything that comes into contact with the vein must be sterile, because the medicine goes directly into the general bloodstream. Before performing the injection, you need to clarify all the details on the prescription list, and if something is unclear, ask your doctor. It is also necessary to talk with the patient and find out if he had an allergic reaction to the drug before, what was the state of he alth after the injection. Particularly nervous patientsyou need to reassure, explaining in simple terms 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 an intravenous injection
For this manipulation you need to cook:
- disposable syringe with needle;
- sterile cotton balls;
- sterile gloves;
- a hard pad of oilcloth under the elbow;
- harness;
- ampoule file;
- drug;
- closed containers for disinfectant solution;
- closed containers for waste needles, syringes and cotton balls (in extreme conditions, all waste material can be collected in one container).
Necessary Security
First of all, you should always think about the safety - your own and other patients. Materials that come into contact with blood pose a potential threat of HIV infection, hence the strict sanitary conditions. Intravenous injections are performed only with gloves.
If the gloves are not sterile, then after putting them on, they are treated with two balls of alcohol. Thus, the algorithm (performing an intravenous injection) implies a double treatment of hands: washing, treating the skin with an antiseptic and treating gloves with alcohol. These actions are necessary in order to interrupt 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 staff, but also syringes, cotton balls, as well as couches, pads,premises, i.e. everything on which biological traces could remain. Following the rules is the best way to protect all patients and yourself.
Sequence of actions
The algorithm (performing an intravenous injection) involves the following steps.
- Inspect the syringe and ampoule, check the appointment. With sterile hands, open the package with a syringe and collect it, put it in a sterile tray. Open the ampoule and draw up the drug, completely releasing the air. The cap must be put on the needle.
- The patient should sit or lie comfortably with their hand on a firm, immovable surface.
- External examination should find a clearly visible vein. Most often it 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 pad is placed under the elbow, and a tourniquet is applied in the middle third of the shoulder (you can use a towel on clothes or a thick 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 he alth worker.
- After the tourniquet is tightened, the patient is asked to intensively clench and unclench his fist several times. The vein should swell, become clearly visible and easily palpable with your fingers. The patient holds his fist clenched.
Direct introduction
These actions are also included in the algorithm (performing intravenousinjections). First, you need to treat a large area of \u200b\u200bthe skin with cotton balls moistened with alcohol - approximately 10 x 10 cm around the intended injection site. Then with another ball - directly to the injection site. The third ball is clamped with the little finger of the nurse's left hand.
Remove the cap from the syringe, take it in your right hand, the needle is cut up, the index finger fixes the cannula. The left hand covers the patient's forearm, while the thumb holds the vein and tightens the skin.
The intravenous injection technique (algorithm) suggests that you need to pierce the skin and vein at an angle of about 15 degrees, and then advance the needle one and a half centimeters. The syringe is in the right hand, and with the left you need to gently pull the piston towards you, blood should appear in the syringe. The appearance of blood means that the needle is in the vein.
Remove the tourniquet with the left hand, the patient opens his fist. Pull the plunger towards you again, check that the needle is in the vein. Slowly press the plunger until the drug is completely injected. 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 to sit for 10 minutes. Ask to straighten the arm, there should be no blood.
The algorithm for performing an intravenous injection according to SanPin assumes that after the completion of the injection, the room is disinfected, and an entry is made in the medical documentation.
Intramuscular injection algorithm
Preparing the syringe withthe preparation and hands of the nurse perform in a similar way. The patient should be placed face down on the couch. Intramuscular injections are best done with the patient lying down, because a person can fall - everyone tolerates injections differently.
The buttock is divided into 4 squares by conditional lines, the injection site is the upper outer one. The skin is treated with two balls of alcohol: first a wide field, then the injection site itself. The syringe is held in the right hand, and the skin at the injection site is stretched with the left. With a sharp movement, the needle is inserted into the gluteal muscle, leaving 1/3 of the length outside. The insertion angle is about 90 degrees (only in the thigh the insertion angle is about 45 degrees).
The piston is pulled towards itself with the left hand, while there should be no blood in the needle. If the needle enters the vessel, a new puncture is made. 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 a few minutes, you need to follow his reaction.
Where to put syringes and balls after the injection?
The intramuscular injection algorithm assumes that everything that comes into contact with blood is biological waste. Therefore, there should be containers in the manipulation room:
- for washing syringes;
- for soaking used syringes;
- for used needles;
- for used cotton balls.
The containers are filled with disinfectant solution, which is changed daily. The syringe with the needle is washed in the solution, then the needle with the cap is disconnected andplaced 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 solution are disposed of under an agreement with a disinfection institution.
Which syringes are best?
For injection, 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 the administered drug 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. In syringes with a smaller volume, the needle is thin and short, the medicine can get close to the skin. In addition, drugs for intramuscular injection 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, it is necessary to clarify with him the likelihood of allergies and other adverse reactions. Also, the intramuscular injection algorithm assumes that the inscription on the ampoule must be read immediately before administration, even if the ampoule is taken out of the box with the appropriate name. Packaging errors are rare, but they do happen.
Infusion: infusion, implementation algorithm
Intravenous infusion is a quick way to improve the patient's condition. The only difference between an infusion and an injection is the amount of fluid injected. If 10-20 ml is injected by jet, then up to 1 liter of liquid or more can be injected by drip.
For drip administration of drugs, PR systems (transfusion of solutions) are used. Manufacturers produce various models, the required parts are:
- long tube with filter and infusion rate regulator;
- air duct - needle with closed filter and short tube;
- wide needle for piercing the drug vial, puncture needle.
The algorithm for performing intravenous drip injection includes filling the system and the actual introduction. The bottle is pierced with a wide needle, placed in a tripod. On a long tube, the regulator is fully opened before filling with liquid so that the drug begins to drip from the puncture needle.
Then the system is attached according to the rules of intravenous injection. A ball with alcohol is placed under the needle, the needle is fixed to the arm with adhesive tape. The lower the rate of administration, the lower the likelihood of complications. After the end of the infusion, the patient lies on the couch for some time with the arm bent at the elbow until the bleeding from the puncture stops completely.
