Manipulation “Technique of intravenous injection. Algorithms for performing nursing manipulations Contraindications for performing probe procedures

Date: 08.03.2020

FLUSHING THE STOMACH WITH A THICK PROBE

Target: therapeutic and diagnostic.

Indications: acute poisoning, preparation for research, operations.

Equipment: system for gastric lavage - 2 thick sterile gastric tubes connected by a glass tube (the blind end of one tube is cut off); glass funnel for 0.5-1 l, towel, napkins, sterile container for collecting wash water for research, container with water (10 l) at room temperature, jug, container for draining wash water, gloves, waterproof apron - 2 pieces, liquid liquid paraffin or glycerin (saline).

Contraindications: ulcers, tumors, bleeding from the gastrointestinal tract, bronchial asthma, severe cardiovascular insufficiency.

Stages	Justification
I. Preparation for the procedure 1. Kindly and respectfully introduce yourself to the patient, clarify how to contact him. Explain the purpose and course of the upcoming procedure. Explain that nausea and vomiting may occur when the tube is inserted, which can be suppressed by breathing deeply. Obtain consent to the procedure. Measure blood pressure, calculate the pulse, if the patient's condition allows it	Psychological preparation of the patient for the procedure. Motivation for cooperation. Respect for the Patient's Rights to Information
2. Prepare equipment	Fulfillment of the necessary condition for the effectiveness of the procedure
II. Procedure execution 1. Help the patient to take the position necessary for the procedure: sitting, leaning against the back of the seat and slightly tilting his head forward (or lying on the couch in a lateral position)	Ensuring free passage of the probe
2. Remove dentures from the patient, if any	Prevention of complications
3. Separate the patient with a screen, if necessary	Providing psychological comfort
4. Put on a waterproof apron on yourself and the patient	Protecting clothing from getting wet and dirty
5. Wash and dry your hands, wear clean gloves	Ensuring infectious safety

6. Place the pelvis at the patient's feet or at the head end of the couch or bed if the procedure is performed in the supine position	Ensuring the hygiene of the procedure
7. Determine the depth to which the probe should be inserted: measure the distance from the incisors to the navel, add the width of the patient's palm or subtract 100 cm from his height	Fulfillment of the necessary condition for the introduction of the probe into the stomach
8. Transfer the mark to the probe, starting from the blind end. Moisten the probe with water or glycerin	Ensuring the advancement of the probe through the esophagus
9. Stand to the right of the patient, invite him to open his mouth, slightly lower his head down. Place the blind end of the probe on the root of the tongue	Preparing for Probe Insertion
10. Ask the patient to make a swallowing movement, while simultaneously advancing the probe into the esophagus (during swallowing, the epiglottis closes the entrance to the trachea, at the same time opens the entrance to the esophagus)	Carrying out the procedure
11. Invite the patient to wrap their lips around the probe and breathe deeply through the nose. Advance the probe slowly and evenly up to the marked mark with the patient's head tilted forward and downward. If resistance is encountered, stop and remove the probe. Then try again (resistance when introducing the probe, coughing, cyanosis, vomiting, change in voice indicate the introduction of the probe into the trachea)	Facilitating the advancement of the probe through the esophagus and relieving the urge to vomit
12. Make sure that the probe is in the stomach: draw 50 ml of air into Janet's syringe and attach it to the probe. Introduce air into the stomach under the control of a phonendoscope (characteristic sounds are heard)	Prevention of complications
13. Advance the probe another 7-10 cm	Ensuring the effectiveness of the procedure
14. Attach a funnel to the probe and lower it below the level of the patient's stomach. Fill the funnel completely with water, holding it at an angle	Preventing air from entering the stomach
15. Slowly lift the funnel up 1 m.	Ensuring the flow of water into the stomach
16. Watch for decreasing liquid. Lower the funnel to knee level as soon as it reaches the mouth of the funnel. Keep the funnel in this position until the funnel is completely filled with rinsing water	According to the law of communicating vessels, it enters the stomach, and then again into the funnel
17. Drain the rinsing water into a basin. If necessary, drain the first water into a test vessel.	In case of exogenous poisoning, the first and last portion of wash water is collected in clean containers. The first is to determine the unknown poison, the second is to assess the quality of washing
18. Repeat the two previous steps, if it is necessary to collect the wash water for research in a sterile container.	The intake of wash water into a sterile container is carried out with food toxicoinfection

19. Repeat rinsing several times until clear rinsing water appears. Make sure that the amount of the injected portion of the liquid corresponds to the amount of rinsing water released. Collect rinsing water in a basin	Ensuring the quality of the manipulation
III. End of procedure 1. Remove the funnel, remove the probe, passing it through a napkin	Protecting clothing from contamination
2. Place the used equipment in a container with a disinfectant solution. Drain the rinsing water down the drain. Pre-disinfect them in case of poisoning. Remove the aprons from yourself and the patient and place them in a container with a disinfectant solution. Remove gloves. Place them in a disinfectant solution. Wash and dry your hands	Prevention of nosocomial infection
3. Give the patient the opportunity to rinse the mouth and escort (deliver) to the ward. Shelter warmth, watch the state	Patient safety
4. Make a mark on the completion of the procedure	Ensuring continuity of nursing care
Criteria for evaluating the performance of the procedure Timeliness of execution Availability of a record of execution No complications during and after the procedure Patient satisfaction with the quality of service delivery Timeliness of rinsing water delivery to the laboratory

Equipment
1. A set of bed linen (2 pillowcases, duvet cover, sheet).
2. Gloves.
3. Dirty laundry bag.

Preparing for the procedure
4. Explain to the patient the course of the upcoming procedure.
5. Prepare a set of clean linen.
6. Wash and dry your hands.
7. Put on gloves.

Procedure execution
8. Lower the handrails on one side of the bed.
9. Lower the head of the bed to a horizontal level (if the patient's condition allows).
10. Raise the bed to the required level (if this is not possible, change the linen, observing the biomechanics of the body).
11. Remove the duvet cover from the blanket, fold it and hang it on the back of a chair.
12. Make sure the clean bedding you have prepared is nearby.
13. Stand on the side of the bed opposite to which you will fill (from the side of the lowered handrail).
14. Make sure there are no small personal items of the patient on this side of the bed (if there are such items, ask where to put them).
15. Turn the patient on its side towards you.
16. Raise the side rail (the patient can hold himself on his side by holding the rail).
17. Return to the opposite side of the bed, lower the handrail.
18. Raise the patient's head and remove the pillow (if there are drain tubes, make sure they are not kinked).
19. Make sure there are no patient small items on this side of the bed.
20. Roll the dirty sheet towards the patient's back and slip this roller under his back (if the sheet is heavily soiled (with secretions, blood), put a diaper on it so that the sheet does not come into contact with the contaminated area with the patient's skin and a clean sheet).
21. Fold a clean sheet in half lengthwise and place its center fold in the center of the bed.
22. Spread the sheet towards you and tuck the sheet at the head of the bed using the bevelling method.
23. Tuck in the middle third, then the lower third of the sheet under the mattress, placing your hands, palms up.
24. Make the roll of a rolled-up clean and dirty sheet as flat as possible.
25. Help the patient to "roll" over these sheets towards you; make sure that the patient is lying comfortably and if there are drainage tubes they are not kinked.
26. Raise the side rail on the side of the bed where you just worked.
27. Go to the other side of the bed.
28. Change the bedding on the second side of the bed.
29. Lower the side rail.
30. Roll up the dirty sheet and put it in the dirty laundry bag.
31. Spread out a clean sheet and tuck it under the mattress, first its middle third, then - the upper, then - the lower, using the technique in p. 22, 23.
32. Help the patient to lie on his back and lie in the middle of the bed.
33. Tuck the blanket into a clean duvet cover.
34. Spread the blanket so that it hangs equally on both sides of the bed.
35. Tuck the edges of the blanket under the mattress.
36. Remove the dirty pillowcase and dump it into the dirty laundry bag.
37. Turn a clean pillowcase inside out.
38. Take the pillow by its corners through the pillowcase.
39. Pull the pillowcase over the pillow.
40. Raise the patient's head and shoulders and place a pillow under the patient's head.
41. Raise the side rail.
42. Make a fold in the blanket for the toes.

Completion of the procedure
43. Remove gloves, place them in a disinfectant solution.
44. Wash and dry your hands.
45. Make sure the patient is comfortable.

Patient Eye Care

Equipment
1. Sterile tray
2. Sterile tweezers
3. Sterile gauze napkins - at least 12 pcs.
4. Gloves
5. Waste material tray
6. Antiseptic solution for the treatment of mucous eyes

Preparing for the procedure
7. Clarify the patient's understanding of the purpose and course of the upcoming procedure and obtain his consent
8. Prepare everything you need

Equipment
9. Wash and dry your hands
10. Examine the mucous membranes of the patient's eyes in order to identify purulent discharge
11. Put on gloves

Procedure execution
12. Put at least 10 napkins in a sterile tray and moisten them with an antiseptic solution, squeeze the excess over the edge of the tray.
13. Take a napkin and rub it on the eyelids and eyelashes from top to bottom or from the outer corner of the eye to the inner
14. Repeat the treatment 4-5 times, changing napkins and placing them in the waste tray.
15. Wipe the rest of the solution with a dry sterile cloth

Completion of the procedure
16. Remove all used equipment with subsequent disinfection
17. Help the patient get into a comfortable position
18. Place the wipes in a container with a disinfectant for subsequent disposal.
19. Remove gloves and place them in a disinfectant solution.
20. Wash and dry hands.
21. Make an entry in the medical record about the patient's reaction

Study of the arterial pulse on the radial artery

Equipment
1. Clock or stopwatch.
2. Temperature sheet.
3. Pen, paper.

Preparing for the procedure
4. Explain to the patient the purpose and course of the study.
5. Obtain the patient's consent to the study.
6. Wash and dry your hands.

Procedure execution
7. During the procedure, the patient can sit or lie down (hands are relaxed, hands should not be suspended).
8. Press with 2, 3, 4 fingers (1 finger should be on the back of the hand) the radial arteries on both hands of the patient and feel the pulsation.
9. Determine the rhythm of the pulse within 30 seconds.
10. Choose one comfortable hand for further examination of the pulse.
11. Take a watch or stopwatch and examine the pulsation of the artery for 30 seconds. Multiply by two (if the pulse is rhythmic). If the pulse is not rhythmic, count it for 1 minute.
12. Press the artery harder than before to the radius and determine the pulse voltage (if the pulsation disappears with moderate pressure, the voltage is good; if the pulsation does not weaken, the pulse is intense; if the pulsation has completely stopped, the voltage is weak).
13. Record the result.

End of procedure
14. Inform the patient about the test result.
15. Help the patient get into a comfortable position or stand up.
16. Wash and dry hands.
17. Record the test results on the temperature sheet (or nursing plan).

Blood pressure measurement technique

Equipment
1. Tonometer.
2. Phonendoscope.
3. Handle.
4. Paper.
5. Temperature sheet.
6. Napkin with alcohol.

Preparing for the procedure
7. Warn the patient about the upcoming study 5 - 10 minutes before its start.
8. Clarify the patient's understanding of the purpose of the study and obtain his consent.
9. Ask the patient to lie down or sit down at the table.
10. Wash and dry your hands.

Performance
11. Help remove clothes from your hand.
12. Put the patient's hand in an extended position, palm up, at the level of the heart, the muscles are relaxed.
13. Place the cuff 2.5 cm above the cubital fossa (clothes should not squeeze the shoulder above the cuff).
14. Secure the cuff so that two fingers pass between the cuff and the shoulder surface.
15. Check the position of the pressure gauge pointer relative to the zero mark.
16. Find (by palpation) the pulse on the radial artery, quickly pump air into the cuff until the pulse disappears, look at the scale and remember the manometer readings, quickly release all the air from the cuff.
17. Find the place of pulsation of the brachial artery in the region of the ulnar fossa and place the stethophonendoscope membrane tightly on this place.
18. Close the valve on the bag and pump air into the cuff. Inject air until the pressure in the cuff, according to the tonometer readings, exceeds 30 mm Hg. Art., the level at which the pulsation of the radial artery or Korotkov's tones ceases to be determined.
19. Open the valve and slowly, at a speed of 2-3 mm Hg. per second, release air from the cuff. At the same time, listen to the tones on the brachial artery with a stethophonendoscope and monitor the readings of the manometer scale.
20. When the first sounds appear above the brachial artery, note the level of systolic pressure.
21. Continuing to release air from the cuff, note the level of diastolic pressure, which corresponds to the moment of complete disappearance of tones on the brachial artery.
22. Repeat the procedure in 2-3 minutes.

Completion of the procedure
23. Round off the measurement data to the nearest even number, write it down as a fraction (in the numerator - systolic blood pressure, in the denominator - diastolic blood pressure).
24. Wipe the phonendoscope membrane with a napkin moistened with alcohol.
25. Record the research data in the temperature sheet (protocol to the care plan, outpatient card).
26. Wash and dry your hands.

Determination of the frequency, depth and rhythm of breathing

Equipment
1. Clock or stopwatch.
2. Temperature sheet.
3. Pen, paper.

Preparing for the procedure
4. Alert the patient that a pulse test will be performed.
5. Obtain the consent of the patient to conduct the study.
6. Ask the patient to sit or lie down to see the upper chest and / or abdomen.
7. Wash and dry your hands.

Procedure execution
8. Take the patient's hand as for the pulse study, hold the patient's hand on the wrist, put your hands (yours and the patient's) on the chest (for women) or on the epigastric region (for men), imitating the study of the pulse and counting the respiratory movements for 30 seconds by multiplying the result by two.
9. Record the result.
10. Help the patient to take a comfortable position.

End of procedure
11. Wash and dry your hands.
12. Record the result on the Nursing Assessment Sheet and Temperature Sheet.

Measuring the temperature in the armpit

Equipment
1. Clock
2. Medical maximum thermometer
3. Handle
4. Temperature sheet
5. Towel or napkin
6. Container with disinfectant

Preparing for the procedure
7. Warn the patient about the upcoming study 5 - 10 minutes before its start
8. Clarify the patient's understanding of the purpose of the study and obtain his consent
9. Wash and dry your hands
10. Make sure that the thermometer is intact and that the reading on the scale does not exceed 35 ° C. Otherwise, shake the thermometer so that the mercury column drops below 35 ° C.

Performance
11. Examine the axillary region, if necessary, wipe it dry with a napkin or ask the patient to do it. In the presence of hyperemia, local inflammatory processes, temperature measurement cannot be carried out.
12. Place the reservoir of the thermometer in the armpit so that it is in close contact with the patient's body on all sides (press the shoulder against the chest).
13. Leave the thermometer for at least 10 minutes. The patient must lie in bed or sit.
14. Remove the thermometer. Assess the readings by holding the thermometer horizontally at eye level.
15. Inform the patient about the results of thermometry.

Completion of the procedure
16. Shake the thermometer so that the mercury column falls into the reservoir.
17. Immerse the thermometer in the disinfectant solution.
18. Wash and dry your hands.
19. Mark the temperature readings on the temperature sheet.

Algorithm for measuring height, body weight and BMI

Equipment
1. Heightometer.
2. Libra.
3. Gloves.
4. Disposable wipes.
5. Paper, pen

Preparation and procedure
6. Explain to the patient the purpose and course of the upcoming procedure (learning how to measure height, body weight and determining BMI) and obtain his consent.
7. Wash and dry your hands.
8. Prepare the stadiometer for work, raise the stadiometer bar above the expected height, put a napkin on the stadiometer platform (under the patient's feet).
9. Ask the patient to take off his shoes and stand in the middle of the stadiometer platform so that it touches the vertical bar of the stadiometer with the heels, buttocks, interscapular region and the back of the head.
10. Set the patient's head so that the tragus of the auricle and the outer corner of the orbit are on the same horizontal line.
11. Lower the stadiometer bar on the patient's head and determine the patient's height on the scale along the lower edge of the bar.
12. Ask the patient to leave the stadiometer platform (if necessary, help to get off). Inform the patient about the measurement results, record the result.
13. Explain to the patient about the need to measure body weight at the same time, on an empty stomach, after going to the toilet.
14. Check the health and accuracy of medical scales, establish balance (for mechanical scales) or turn on (for electronic), lay a napkin on the platform of the scales
15. Offer the patient to take off his shoes and help him to stand in the middle of the platform of the scales, to determine the patient's body weight.
16. Help the patient to get off the platform of the scales, tell him the result of the study of body weight, write down the result.

End of procedure
17. Put on gloves, remove the napkins from the platform of the height meter and scales and place them in a container with a disinfectant solution. Treat the surface of the height meter and scales with a disinfectant solution once or twice with an interval of 15 minutes in accordance with the guidelines for the use of a disinfectant.
18. Remove gloves and place them in a container with a disinfectant solution,
19. Wash and dry hands.
20. Determine BMI (body mass index) -
body weight (in kg) height (in m 2) Index less than 18.5 - underweight; 18.5 - 24.9 - normal body weight; 25 - 29.9 - overweight; 30 - 34.9 - obesity of the 1st degree; 35 - 39.9 - degree II obesity; 40 and more - obesity III degree. Record the result.
21. Tell the patient BMI, record the result.

Setting the warming compress

Equipment
1. Compressed paper.
2. Cotton wool.
3. Bandage.
4. Ethyl alcohol 45%, 30 - 50 ml.
5. Scissors.
b. Tray.

Preparing for the procedure
7. Clarify the patient's understanding of the purpose and course of the upcoming procedure and obtain his consent.
8. It is convenient to place or lay down the patient.
9. Wash and dry your hands.
10. Cut off the necessary piece with scissors (depending on the area of application, a piece of bandage or gauze and fold it into 8 layers).
11. Cut a piece of compress paper: around the perimeter 2 cm more than the prepared napkin.
12. Prepare a piece of cotton wool around the perimeter 2 cm larger than the compress paper.
13. Fold the layers for the compress on the table, starting with the outer layer: at the bottom - cotton wool, then - compress paper.
14. Pour alcohol into the tray.
15. Moisten a napkin in it, wring it out slightly and place on top of the compress paper.

Procedure execution
16. Put all layers of the compress at the same time on the desired area (knee joint) of the body.
17. Fix the compress with a bandage so that it fits snugly to the skin, but does not restrict movement.
18. Mark the time of setting the compress in the patient's card.
19. Remind the patient that the compress is on for 6 - 8 o'clock, give the patient a comfortable position.
20. Wash and dry hands.
21. In 1.5 - 2 hours after applying the compress with your finger, without removing the bandage, check the moisture level of the napkin. Secure the compress with a bandage.
22. Wash and dry your hands.

Completion of the procedure
23. Wash and dry your hands.
24. Remove the compress after the prescribed time 6-8 hours.
25. Wipe the skin in the area of the compress and apply a dry bandage.
26. Dispose of used material.
27. Wash and dry your hands.
28. Make an entry in the medical record about the patient's reaction.

Statement of mustard plasters

Equipment
1. Mustard plasters.
2. Tray with water (40 - 45 * C).
3. Towel.
4. Gauze napkins.
5. Clock.
6. Tray for waste material.

Preparing for the procedure
7. Explain to the patient the purpose and course of the upcoming procedure and
get his consent.
8. Help the patient to take a comfortable position, lying on his back or stomach.
9. Wash and dry your hands.
11. Pour water at a temperature of 40 - 45 * C into the tray.

Procedure execution
12. Examine the patient's skin at the place of setting mustard plasters.
13. Submerge the mustard plasters one by one in water, let the excess water drain off and place on the patient's skin with the side covered with mustard or the porous side.
14. Cover the patient with a towel and blanket.
15. After 5-10 minutes, remove the mustard plasters by placing them in the waste material tray.

End of procedure
16. Wipe the patient's skin with a damp warm cloth and dry with a towel.
17. Used material, mustard plasters, a napkin should be placed in the waste material tray, then disposed of.
18. Cover and lay the patient in a comfortable position, warn the patient that he must stay in bed for at least 20 - 30 minutes.
19. Wash and dry hands.
20. Make a record of the performed procedure in the patient's medical record.

Using a heating pad

Equipment
1. Heating pad.
2. A diaper or towel.
3. A jug with water T - 60-65 ° "С.
4. Thermometer (water).

Preparing for the procedure
5. Explain to the patient the course of the upcoming procedure and obtain his consent to the procedure.
6. Wash and dry your hands.
7. Pour hot (T - 60–65 ° C) water into the heating pad, slightly squeeze it at the neck, releasing air, and close it with a stopper.
8. Turn the heating pad upside down to check the water flow and wrap it in a blanket or
towel.

Procedure execution
9. Place the heating pad on the desired area of the body for 20 minutes.

End of procedure
11. Examine the patient's skin, in the area of contact with the heating pad.
12. Pour out the water. Treat the heating pad with a rag abundantly moistened with a disinfectant solution of bactericidal action twice with an interval of 15 minutes.
13. Wash and dry hands.
14. Make a note about the procedure and the patient's response to it in the inpatient card.

Setting the ice bladder

Equipment
1. Ice bubble.
2. Diaper or towel.
3. Pieces of ice.
4. A jug of water T - 14 - 16 C.
5. Thermometer (water).

Preparing for the procedure
6. Explain to the patient the course of the upcoming procedure and obtain consent to the procedure.
7 Wash and dry hands.
8. Put the pieces of ice prepared in the freezer into the bubble and fill them with cold water (T - 14 - 1b ° С).
9. Place the bubble on a horizontal surface to expel air and screw the cap back on.
10. Turn the ice pack upside down, check the tightness and wrap it in a diaper or towel.

Procedure execution
11. Place the bladder on the desired area of the body for 20-30 minutes.
12. Remove the ice pack after 20 minutes (repeat items 11-13).
13. As the ice melts, the water can be drained and the pieces of ice added.
End of procedure
14. Examine the patient's skin where the ice pack is applied.
15. At the end of the procedure, the water is drained ^ treat the bubble with a rag moistened with a disinfectant solution of bactericidal action twice with an interval of 15 minutes.
16. Wash and dry hands.
17. Make a note about the procedure and the patient's response to it in the inpatient card.

Care of the external genitals and perineum of a woman

Equipment
1. A jug with warm (35–37 ° С) water.
2. Absorbent diaper.
3. Kidney tray.
4. The ship.
5. Soft material.
6. Kortsang.
7. Container for disposal of used material.
8. Screen.
9. Gloves.

Preparing for the procedure
10. Explain to the patient the purpose and course of the study.
11. Obtain the patient's consent to perform the manipulation.
12. Prepare the necessary equipment. Pour warm water into a jug. Put cotton swabs (napkins), forceps in the tray.
13. Separate the patient with a screen (if necessary).
14. Wash and dry hands.
15. Put on gloves.

Procedure execution
16. Lower the head of the bed. Turn the patient to one side. Place an absorbent diaper under the patient.
17. Place the boat in close proximity to the patient's buttocks. Turn it on its back so that the crotch is over the opening of the vessel.
18. Help to take the optimal comfortable position for the procedure (Fowler position, legs slightly bent at the knees and apart).
19. Stand to the right of the patient (if the nurse is right-handed). Place a tray of tampons or napkins in your immediate vicinity. Secure the tampon (napkin) with a forceps.
20. Hold the jug in your left hand and the forceps in your right. Pour water on the woman's genitals, use tampons (changing them) to move from top to bottom, from the inguinal folds to the genitals, then to the anus, washing: a) with one tampon - the pubis; b) the second - the groin area on the right and left c) then the right and left labia (large) lips c) the anus area, intergluteal fold Used tampons to be thrown into the vessel.
21. Dry the pubis, inguinal folds, genitals and the anus area of the patient in the same sequence and in the same direction as when washing with dry napkins, using dry napkins, changing napkins after each stage.
22. Turn the patient to one side. Remove the ship, oilcloth and diaper. Return the patient to her original position, on her back. Place the oilcloth and diaper in a container for disposal.
23. Help the patient to take a comfortable position. Cover her. Make sure she feels comfortable. Remove the screen.

End of procedure
24. Empty the vessel from the contents and place it in a container with a disinfectant.
25. Take off the gloves and put them in the tray for used materials, followed by disinfection and disposal.
26. Wash and dry your hands.
27. Make a record of the procedure and the patient's response in the documentation.

Catheterization of a woman's bladder with a Foley catheter

Equipment
1. Sterile Foley catheter.
2. Gloves are sterile.
3. Clean gloves - 2 pairs.
4. Medium sterile napkins - 5-6 pcs.

6. A jug of warm water (30–35 ° С).
7. The ship.

10. 10-30 ml of saline or sterile water, depending on the size of the catheter.
11. Antiseptic solution.

13. Urine bag.

15. Plaster.
16. Scissors.
17. Tweezers are sterile.
18. Kornzang.
19. A container with a disinfectant solution.

Preparing for the procedure
20. Clarify the patient's understanding of the purpose and course of the upcoming procedure and obtain her consent.
21. Separate the patient with a screen (if the procedure is performed in the ward).
22. Place an absorbent diaper (or oilcloth and diaper) under the patient's pelvis.
23. Help the patient to take the position necessary for the procedure: lying on her back with legs apart, bent at the knee joints.
24. Wash and dry your hands. Wear clean gloves.
25. Carry out hygienic treatment of the external genital organs, urethra, perineum. Remove gloves and place them in a container with a disinfectant solution.
26. Wash and dry your hands.
27. Put sterile napkins large and medium into the tray using tweezers). Moisten medium-sized wipes with an antiseptic solution.
28. Put on gloves.
29. Leave the tray between the legs. Spread the labia minora to the sides with your left hand (if you are right-handed).
30. Treat the entrance to the urethra with a napkin dipped in an antiseptic solution (hold it with your right hand).
31. Cover the entrance to the vagina and anus with a sterile napkin.
32. Remove gloves and place them in a container for used material.
33. Treat hands with an antiseptic.
34. Open the syringe and fill it with sterile saline or water 10 - 30 ml.
35. Open a bottle with glycerin. And pour into a beaker
36. Open the package with the catheter, put the sterile catheter into the tray.
37. Put on sterile gloves.

Procedure execution
38. Take the catheter at a distance of 5–6 cm from the side hole and hold it at the beginning with 1 and 2 fingers, the outer end with 4 and 5 fingers.
39. Lubricate the catheter with glycerin.
40. Insert the catheter into the urethral opening 10 cm or until urine appears (urine into a clean tray).
41. Drain urine into a tray.
42. Fill the Foley catheter balloon 10 - 30 ml with sterile saline or sterile water.

Completion of the procedure
43. Connect the catheter to the urine collection container (urine bag).
44. Attach the bag with a band-aid to your thigh or to the edge of the bed.
45. Make sure that the tubes connecting the catheter and the container are not kinked.
46. Remove the waterproof diaper (oilcloth and diaper).
47. Help the patient to lie down comfortably and remove the screen.
48. Place the used material in a container with disinfectant. With a solution.
49. Remove gloves and place them in a disinfectant solution.
50. Wash and dry hands.
51. Make a record of the procedure performed.

Catheterization of the male urinary bladder with a Foley catheter

Equipment
1. Sterile Foley catheter.
2. Gloves are sterile.
3. Gloves, clean 2 pairs.
4. Medium sterile napkins - 5-6 pcs.
5. Large sterile napkins - 2 pcs.
b. A jug of warm water (30 - 35 ° C).
7. The ship.
8. Bottle with sterile glycerin 5 ml.
9. Sterile syringe 20 ml - 1-2 pcs.
10. 10 - 30 ml of saline or sterile water, depending on the size of the catheter.
11. Antiseptic solution.
12. Trays (clean and sterile).
13. Urine bag.
14. Absorbent diaper or oilcloth with diaper.
15. Plaster.
16. Scissors.
17. Tweezers are sterile.
18. A container with a disinfectant solution.

Preparing for the procedure
19. Explain to the patient the essence and course of the upcoming procedure and obtain his consent.
20. Shield the patient with a screen.
21. Place an absorbent diaper (or oilcloth and diaper) under the patient's pelvis.
22. Help the patient to take the necessary position: lying on his back with legs apart, bent at the knee joints.
23. Wash and dry your hands. Wear clean gloves.
24. Carry out hygienic processing of the external genital organs. Remove gloves.
25. Treat hands with an antiseptic.
26. Put sterile napkins large and medium into the tray using tweezers). Moisten medium-sized wipes with an antiseptic solution.
27. Put on gloves.
28. Treat the glans penis with a napkin dipped in an antiseptic solution (hold it with your right hand).
29. Wrap the penis with sterile napkins (large)
30. Take off the gloves and place them in a container with dez. solution.
31. Treat hands with an antiseptic.
32. Place a clean tray between your legs.
33. Open the syringe and fill it with sterile saline or water 10 - 30 ml.
34. Open the bottle with glycerin.
35. Open the package of the catheter, put the sterile catheter in the tray.
36. Put on sterile gloves.

Procedure execution
37. Take the catheter at a distance of 5–6 cm from the side hole and hold it at the beginning with 1 and 2 fingers, the outer end with 4 and 5 fingers.
38. Lubricate the catheter with glycerin.
39. Insert the catheter into the urethra and gradually, intercepting the catheter, move it deeper into the urethra, and "pull" the penis upward, as if pulling it onto the catheter, applying a slight even force until urine appears (urine is sent to the tray).
40. Drain urine into a tray.
41. Fill the Foley catheter balloon 10 - 30 ml with sterile saline or sterile water.

Completion of the procedure
42. Connect the catheter to the urine collection container (urine bag).
43. Attach the bag to your thigh or to the edge of the bed.
44. Make sure that the tubes connecting the catheter and the container are not kinked.
45. Remove the waterproof diaper (oilcloth and diaper).
46. Help the patient to lie down comfortably and remove the screen.
47. Place the used material in a container with dez. With a solution.
48. Remove gloves and place them in a disinfectant solution.
49. Wash and dry your hands.
50. Make a record of the procedure performed.

Cleansing enema

Equipment
1. Esmarch's mug.
2. Water 1-1.5 liters.
3. Sterile handpiece.
4. Vaseline.
5. Spatula.
6. Apron.
7. The pelvis.
8. Absorbent diaper.
9. Gloves.
10. Tripod.
11. Water thermometer.
12. Container with disinfectants.

Preparing for the procedure
10. Explain to the patient the essence and course of the upcoming procedure. Obtain the consent of the patient for the procedure.
11. Wash and dry your hands.
12. Put on an apron and gloves.
13. Open the package, remove the tip, attach the tip to the Esmarch mug.
14. Close the valve on the Esmarch mug, pour into it 1 liter of water at room temperature (with spastic constipation, the water temperature is 40–42 degrees, with atonic constipation - 12–18 degrees).
15. Fix the mug on a tripod at a height of 1 meter from the couch level.
16. Open the valve and drain some water through the handpiece.
17. Lubricate the tip with Vaseline with a spatula.
18. Place the absorbent diaper at an angle hanging down into the basin on the couch.

20. Remind the patient to retain water in the intestine for 5-10 minutes.

Procedure execution
21. Move the buttocks 1 and 2 with the fingers of the left hand, carefully insert the tip into the anus with the right hand, moving it into the rectum towards the navel (3-4 cm), and then parallel to the spine to a depth of 8-10 cm.
22. Open the valve slightly so that the water slowly flows into the intestines.
24. Suggest the patient to breathe deeply in the abdomen.
24. After all the water has been injected into the intestines, close the valve and carefully remove the tip.
25. Help the patient get off the couch and walk to the toilet.

Completion of the procedure
26. Disconnect the tip from the Esmarch mug.
27. Place used equipment in disinfectant solution.
28. Remove gloves and place in a disinfectant solution with subsequent disposal. Remove apron and send for recycling.
29. Wash and dry your hands.
30. Make sure that the procedure was effective.
31. Make a record of the procedure and the patient's response.

Siphon bowel lavage

Equipment

3. Gloves.
4. Container with disinfectant solution.
5. Tank for taking wash water for research.
6. Capacity (bucket) with water 10 -12 liters (T - 20 - 25 * C).
7. Tank (basin) for flushing water discharge for 10 - 12 liters.
8. Two waterproof aprons.
9. Absorbent diaper.
10. A mug or jug of 0.5 - 1 liter.
11. Vaseline.
12. Spatula.
13. Napkins, toilet paper.

Preparing for the procedure
14. Clarify the patient's understanding of the purpose and course of the upcoming procedure. Obtain consent to carry out the manipulation.
15. Wash and dry your hands.
16. Prepare equipment.
17. Put on gloves, an apron.
18. Place an absorbent diaper on the couch, corner down.
19. Help the patient to lie on the left side. The patient's legs should be bent at the knees and slightly brought to the abdomen.

Procedure execution
20. Remove the system from the packaging. Lubricate the blind end of the probe with Vaseline.
21. Spread the buttocks 1 and II with the fingers of the left hand, with the right hand insert the rounded end of the probe into the intestine and push it to a depth of 30–40 cm: the first 3–4 cm towards the navel, then parallel to the spine.
22. Attach a funnel to the free end of the probe. Keep the funnel slightly oblique, at the level of the patient's buttocks. Pour 1 liter of water into it from a jug along the side wall.
23. Invite the patient to breathe deeply. Raise the funnel to a height of 1 m. As soon as the water reaches the mouth of the funnel, lower it over the basin for rinsing water below the level of the patient's buttocks, without pouring water out of it, until the funnel is completely filled.
24. Drain the water into the prepared container (basin for rinsing water). Note: The first washings can be collected in a test vessel.
25. Fill the funnel with the next portion and raise it up to a height of 1 m. As soon as the water level reaches the mouth of the funnel, lower it down. Wait until it is filled with rinsing water and drain it into a basin. Repeat the procedure several times to clean wash water, using all 10 liters of water.
26. Disconnect the funnel from the probe at the end of the procedure, leave the probe in the intestine for 10 minutes.
27. Remove the probe from the intestine with slow progressive movements, passing it through a napkin.
28. Immerse the probe and funnel in a container with disinfectant.
29. Wipe the skin in the anal area with toilet paper (in women, away from the genitals) or wash the patient in case of helplessness.

Completion of the procedure
30. Ask the patient about the state of health. Make sure he feels normal.
31. Ensure safe transportation to the ward.
32. Pour the rinsing water down the drain; if indicated, carry out preliminary disinfection.
33. Carry out disinfection of used instruments with subsequent disposal of disposable ones.
34. Remove gloves. Wash and dry hands.
35. Make a note in the patient's medical record about the performed procedure and about the reaction to it.

Hypertensive enema

Equipment

3. Spatula.
4. Vaseline.
5.10% sodium chloride solution or 25% magnesium sulfate
6. Gloves.
7. Toilet paper.
8. Absorbent diaper.
9. Tray.
10. Tank with water T - 60 ° C for heating the hypertonic solution.
11. Thermometer (water).
12. Measuring glass.
13. Container with disinfectant

Preparing for the procedure

15. Before setting a hypertensive enema, warn that during the manipulation along the intestines, pain is possible.
16. Wash and dry hands.
17. Heat the hypertonic solution to 38 ° C in a water bath, check the temperature of the drug.
18. Draw the hypertonic solution into a pear-shaped balloon or into Janet's syringe.
19. Put on gloves.

Procedure execution

26. Warn the patient that the onset of the effect of a hypertensive enema occurs in 30 minutes.

Completion of the procedure

28. Place used equipment in a disinfectant solution.
29. Remove gloves and place them in disinfectant solution.
30. Wash and dry your hands.
31. Help the patient get to the toilet.
32. Make sure that the procedure was effective.
33. Make a record of the procedure and the patient's response.

Oil enema

Equipment
1. Pear-shaped balloon or Janet's syringe.
2. Sterile gas outlet tube.
3. Spatula.
4. Vaseline.
5. Oil (vaseline, vegetable) from 100 - 200 ml (as prescribed by a doctor).
b. Gloves.
7. Toilet paper.
8. Absorbent diaper.
9. Screen (if the procedure is performed in the ward).
10. Tray.
11. Tank for heating oil with water T - 60 ° C.
12. Thermometer (water).
13. Measuring glass.

Preparing for the procedure
14. Tell the patient the necessary information about the procedure and obtain his consent to the procedure.
15. Place the screen.
16. Wash and dry hands.
17. Heat the oil to 38 ° C in a water bath, check the oil temperature.
18. Pour warm oil into a pear-shaped bottle or into Janet's syringe.
19. Put on gloves.

Procedure execution
20. Help the patient to lie on the left side. The patient's legs should be bent at the knees and slightly brought to the abdomen.
21. Lubricate the gas outlet tube with petroleum jelly and insert it 15–20 cm into the rectum.
22. Release air from Janet's pear-shaped balloon or syringe.
23. Attach Janet's bulb or syringe to the gas outlet tube and slowly inject oil.
24. Without unclenching the pear-shaped balloon, disconnect it (Janet's syringe) from the gas outlet tube.
25. Remove the gas outlet tube and place it together with a pear-shaped balloon or Janet's syringe into the tray.
26. If the patient is helpless, wipe the skin in the anal area with toilet paper and explain that the effect will come in 6-10 hours.

Completion of the procedure
27. Remove the absorbent diaper, place in a container for disposal.
28. Remove gloves and place them in a tray for subsequent disinfection.
29. Cover the patient with a blanket, help him to take a comfortable position. Remove the screen.
30. Place used equipment in a disinfectant solution.
31. Wash and dry your hands.
32. Make a record of the procedure and the patient's response.
33. Assess the effectiveness of the procedure in 6-10 hours.

Medicinal enema

Equipment
1. Pear-shaped balloon or Janet's syringe.
2. Sterile gas outlet tube.
3. Spatula.
4. Vaseline.
5. Medicinal product 50 -100 ml (chamomile decoction).
6. Gloves.
7. Toilet paper.
8. Absorbent diaper.
9. Screen.
10. Tray.
11. Tank for heating the medicinal product with water T -60 ° C.
12. Thermometer (water).
13. Measuring glass.

Preparing for the procedure
14. Tell the patient the necessary information about the procedure and obtain his consent to the procedure.
15. Give the patient a cleansing enema 20-30 minutes before setting the medicinal enema
16. Put the screen on.
17. Wash and dry hands. Wear gloves.

Procedure execution
18. Warm up the drug to 38 ° C in a water bath, check the temperature with a water thermometer.
19. Draw up chamomile decoction into a pear-shaped balloon or into a syringe Zhanet.
20. Help the patient to lie on the left side. The patient's legs should be bent at the knees and slightly brought to the abdomen.
21. Lubricate the gas outlet tube with petroleum jelly and insert it 15–20 cm into the rectum.
22. Release air from Janet's pear-shaped balloon or syringe.
23. Attach Janet's pear-shaped balloon or syringe to the gas outlet tube and slowly inject the drug.
24. Without opening the pear-shaped balloon, disconnect it or Janet's syringe from the gas outlet tube.
25. Remove the gas outlet tube and place it together with a pear-shaped balloon or Janet's syringe into the tray.
26. In the event that the patient is helpless, wipe the skin in the anal area with toilet paper.
27. Explain that after the manipulation it is necessary to spend at least 1 hour in bed.

Completion of the procedure
28. Remove the absorbent diaper, place in a container for disposal.
29. Remove gloves and place them in a tray for subsequent disinfection.
30. Cover the patient with a blanket, help him to take a comfortable position. Remove the screen.
31. Place used equipment in a disinfectant solution.
32. Wash and dry hands.
33. After an hour ask the patient how he is feeling.
34. Make a record of the procedure and the patient's response.

Preparing for the procedure
14. Explain to the patient the course and essence of the upcoming procedure and obtain the patient's consent to the procedure.
15. Wash and dry your hands.
16. Prepare the equipment (the probe should be in the freezer for 1.5 hours before the start of the procedure).
17. Determine the distance to which the probe should be inserted (the distance from the tip of the nose to the earlobe and down the anterior abdominal wall so that the last opening of the probe is below the xiphoid process).
18. Help the patient to assume the high Fowler position.
19. Cover the patient's chest with a towel.
20. Wash and dry hands. Wear gloves.

Procedure execution
21. Treat the blind end of the probe liberally with glycerin.
22. Ask the patient to tilt their head back slightly.
23. Insert the probe through the lower nasal passage at a distance of 15-18 cm.
24. Give the patient a glass of water and a drinking straw. Ask to drink in small sips, swallowing the tube. You can add pieces of ice to the water.
25. Help the patient to swallow the probe, moving it into the pharynx during each swallowing movement.
26. Make sure the patient can speak clearly and breathe freely.
27. Gently advance the probe to the desired mark.
28. Make sure of the correct location of the probe in the stomach: attach the syringe to the probe and pull the plunger towards you; the contents of the stomach (water and gastric juice) must flow into the syringe.
29. If necessary, leave the probe for a long time, fix it with a plaster to the nose. Remove the towel.
30. Close the probe with a cap and secure with a safety pin to the patient's clothing on the chest.

Completion of the procedure
31. Remove gloves.
32. Help the patient get into a comfortable position.
33. Place the used material in a disinfectant solution with subsequent disposal.
34. Wash and dry your hands.
35. Make a record of the procedure and the patient's response.

Preparing for the procedure
16. Explain to the patient the course and essence of the upcoming procedure and obtain the patient's consent to the procedure.
17. Wash and dry hands.
18. Prepare the equipment (the probe should be in the freezer for 1.5 hours before the start of the procedure).
19. Determine the distance to which the probe should be inserted (the distance from the tip of the nose to the earlobe and down the anterior abdominal wall so that the last opening of the probe is below the xiphoid process).
20. Help the patient to assume the high Fowler position.
21. Cover the patient's chest with a towel.
22. Wash and dry your hands. Wear gloves.

Procedure execution
23. Treat the blind end of the probe liberally with glycerin.
24. Ask the patient to tilt their head back slightly.
25. Insert the probe through the lower nasal passage at a distance of 15 - 18 cm.
26. Give the patient a glass of water and a drinking straw. Ask to drink in small sips, swallowing the tube. You can add pieces of ice to the water.
27. Help the patient to swallow the probe, moving it into the pharynx during each swallowing movement.
28. Make sure the patient can speak clearly and breathe freely.
29. Gently advance the probe to the desired mark.
30. Make sure the correct location of the probe in the stomach: attach the syringe to the probe and pull the plunger towards you; the contents of the stomach (water and gastric juice) must enter the syringe or air must be injected into the stomach with a syringe under the control of a phonendoscope (characteristic sounds are heard).
31. Disconnect the syringe from the probe and apply a clamp. Place the free end of the probe into the tray.
32. Remove the clamp from the probe, connect Janet's syringe without a plunger and lower it to the level of the stomach. Tilt Janet's syringe slightly and pour the food warmed up to 37–38 ° С. Raise gradually until food reaches the syringe cannula.
33. Lower Janet's syringe to the original level and introduce the next portion of food. The introduction of the required volume of the mixture should be carried out fractionally, in small portions of 30-50 ml, at intervals of 1-3 minutes. After the introduction of each portion, clamp the distal portion of the probe.
34. Rinse the tube with boiled water or saline solution at the end of feeding. Apply a clamp to the end of the probe, disconnect Janet's syringe and close with a plug.
35. If it is necessary to leave the probe for a long time, fix it with a plaster to the nose and attach it with a safety pin to the patient's clothes on the chest.
36. Remove the towel. Help the patient get into a comfortable position.

Completion of the procedure
37. Place the used equipment in a disinfectant solution with subsequent disposal.
38. Remove gloves and place in a disinfectant solution with subsequent disposal.
39. Wash and dry your hands.
40. Make a record of the procedure and the patient's response.

Gastric lavage with a thick gastric tube

Equipment
1. Sterile system of 2 thick gastric tubes connected by a transparent tube.
2. Sterile funnel 0.5 - 1 liter.
3. Gloves.
4. Towel, napkins are average.
5. Container with disinfectant solution.
b. Tank for rinsing water analysis.
7. Capacity with water 10 liters (T - 20 - 25 * C).
8. Tank (basin) for flushing water discharge for 10 - 12 liters.
9. Vaseline oil or glycerin.
10. Two waterproof aprons and an absorbent diaper if rinsing while lying down.
11. A mug or jug for 0.5 - 1 liter.
12. Mouth expander (if necessary).
13. Language holder (if necessary).
14. Phonendoscope.

Preparing for the procedure
15. Explain the purpose and course of the forthcoming procedure. Explain that nausea and vomiting may occur when the tube is inserted, which can be suppressed by breathing deeply. Obtain consent to the procedure. Measure blood pressure, calculate the pulse, if the patient's condition allows it.
16. Prepare equipment.

Procedure execution
17. Help the patient to take the position necessary for the procedure: sitting, leaning against the back of the seat and slightly tilting his head forward (or laying on the couch in a lateral position). Remove dentures from the patient, if any.
18. Put on a waterproof apron on yourself and the patient.
19. Wash your hands, wear gloves.
20. Place the pelvis at the patient's feet or at the head end of the couch or bed if the procedure is performed in the supine position.
21. Determine the depth to which the probe should be inserted: height minus 100 cm or measure the distance from the lower incisors to the earlobe and to the xiphoid process. Place a mark on the probe.
22. Remove the system from the packaging, moisten the blind end with Vaseline.
23. Place the blind end of the probe on the root of the tongue and ask the patient to swallow.
24. Insert the probe to the desired mark. Assess the patient's condition after swallowing the probe (if the patient coughed, remove the probe and repeat the probe insertion after the patient is resting).
25. Make sure that the probe is in the stomach: draw 50 ml of air into Janet's syringe and attach it to the probe. Introduce air into the stomach under the control of a phonendoscope (characteristic sounds are heard).
26. Attach a funnel to the probe and lower it below the level of the patient's stomach. Fill the funnel completely with water, holding it at an angle.
27. Slowly raise the funnel up to 1 m and control the passage of water.
28. As soon as the water reaches the mouth of the funnel, slowly lower the funnel to the level of the patient's knees, drain the rinsing water into a basin for rinsing water. Note: The first washings can be collected in a test vessel.
29. Repeat the washing several times until the appearance of clean wash water, using the entire amount of water, collecting the wash water in a basin. Make sure that the amount of the injected portion of the liquid corresponds to the amount of rinsing water released.

End of procedure
30. Remove the funnel, remove the probe, passing it through a napkin.
31. Place the used equipment in a container with a disinfectant solution. Drain the rinsing water into the sewer, first disinfect them in case of poisoning.
32. Remove the aprons from yourself and the patient and place them in a container for disposal.
33. Remove gloves. Place them in a disinfectant solution.
34. Wash and dry your hands.
35. Give the patient the opportunity to rinse the mouth and escort (deliver) to the ward. Cover warmly, observe the condition.
36. Make a mark on the procedure.

Dilution of the antibiotic in a vial and intramuscular injection

Equipment
1. A disposable syringe with a volume of 5.0 to 10.0, an additional sterile needle.
2. A bottle with benzylpenicillin sodium salt, 500,000 U, sterile water for injection.

5. Skin antiseptic.
6. Gloves.
7. Sterile tweezers.
8. Non-sterile tweezers for opening the bottle.
9. Containers with a disinfectant solution for the disinfection of used equipment

Preparing for the procedure
10. Clarify the patient's knowledge of the medicinal product and his consent to the injection.
11. Help the patient to take a comfortable supine position.
12. Wash and dry hands.
13. Put on gloves.
14. Check: - syringe and needles - tightness, expiration date; - medicinal product - name, expiration date on the vial and ampoule; - packing with tweezers - expiration date; - packaging with soft material - expiration date.
15. Remove the sterile tray from the packaging.
16. Collect the disposable syringe, check the patency of the needle.
17. Open the aluminum cap on the vial with non-sterile tweezers and file the ampoule with the solvent.
18. Prepare cotton balls, moisten them with a skin antiseptic.
19. Treat the bottle cap with a cotton ball moistened with alcohol and an ampoule with a solvent, open the ampoule.
20. Draw up the required amount of solvent for dilution of the antibiotic into the syringe (in 1 ml of the dissolved antibiotic - 200,000 U).
21. Pierce the bottle cap with a needle of a syringe with solvent, | enter the solvent into the bottle.
22. Shaking the bottle, achieve complete dissolution of the powder, draw the required dose into the syringe.
23. Change the needle, expel air from the syringe.
24. Place the syringe in a sterile tray.

Procedure execution
25. Determine the site of the intended injection, palpate it.
26. Treat the injection site twice with a tissue or cotton ball with a skin antiseptic.
27. Stretch the skin at the injection site with two fingers or make a fold.
28. Take a syringe, insert the needle into the muscle at an angle of 90 degrees, two-thirds of the length, holding the cannula with your little finger.
29. Release the skin fold and with the fingers of this hand pull the syringe plunger towards you.
30. Press down on the plunger, slowly inject the drug.

End of procedure
31. Remove the needle, pressing the injection site with a tissue or a cotton ball with a skin antiseptic.
32. Give a light massage without removing the napkin or cotton ball from the injection site (depending on the medication) and help to stand up.
33. Disinfect the used material and equipment with subsequent disposal.
34. Take off gloves, throw into a container with a disinfectant.
35. Wash and dry your hands.
36. Ask the patient about his state of health after the injection.
37. Make a record of the performed procedure in the patient's medical record.

Intradermal injection

Equipment
1. Disposable syringe 1.0 ml, additional sterile needle.
2. Medicinal product.
3. The tray is clean and sterile.
4. Sterile balls (cotton or gauze) 3 pcs.
5. Skin antiseptic.
6. Gloves.
7. Sterile tweezers.

Preparing for the procedure

10. Help the patient to take a comfortable position (sitting).
11. Wash and dry your hands.
12. Put on gloves.

16. Prepare 3 cotton balls, moisten 2 balls with a skin antiseptic, leave one dry.

Procedure execution
21. Determine the site of the proposed injection (the middle inner part of the forearm).
22. Treat the injection site with a napkin or cotton ball with a skin antiseptic, then a dry ball.
23. Stretch the skin at the injection site.
24. Take the syringe, insert the needle into the cut of the needle, holding the cannula with the index finger.
25. Press down on the plunger, slowly inject the drug with the hand that was used to stretch the skin.

End of procedure
26. Remove the needle without cleaning the injection site.

29. Wash and dry your hands.

Subcutaneous injection

Equipment
1. Disposable syringe with a volume of 2.0, an additional sterile needle.
2. Medicinal product.
3. The tray is clean and sterile.
4. Sterile balls (cotton or gauze) at least 5 pcs.
5. Skin antiseptic.
6. Gloves.
7. Sterile tweezers.
8. Containers with a disinfectant solution for the disinfection of used equipment

Preparing for the procedure
9. Clarify the patient's knowledge of the medicinal product and obtain his consent to the injection.

11. Wash and dry your hands.
12. Put on gloves.
13. Check: - syringe and needles - tightness, expiration date; - medicinal product - name, expiration date on the package and ampoule; - packing with tweezers - expiration date; - packaging with soft material - expiration date.
14. Remove the sterile tray from the packaging.
15. Collect the disposable syringe, check the patency of the needle.

17. Open the ampoule with the medicinal product.
18. Collect the medicine.
19. Change the needle, expel air from the syringe.
20. Place the syringe in a sterile tray.

Procedure execution

23. Take the skin at the injection site into the fold.
24. Take a syringe, insert the needle under the skin (at an angle of 45 degrees) two thirds of the length of the needle.
25. Release the skin fold and press the piston with the fingers of this hand, slowly inject the drug.

End of procedure
26. Remove the needle, pressing the injection site with a tissue or cotton ball with a skin antiseptic.
27. Disinfect the used material and equipment with subsequent disposal.
28. Take off gloves, throw into a container with a disinfectant.
29. Wash and dry your hands.
30. Ask the patient about his state of health after the injection.
31. Make a record of the performed procedure in the patient's medical record.

Intramuscular injection

Equipment
1. Disposable syringe with a volume of 2.0 to 5.0, an additional sterile needle.
2. Medicinal product.
3. The tray is clean and sterile.
4. Sterile balls (cotton or gauze) at least 5 pcs.
5. Skin antiseptic.
b. Gloves.
7. Sterile tweezers.
8. Containers with a disinfectant solution for the disinfection of used equipment

Preparing for the procedure
9. Clarify the patient's knowledge of the medicinal product and obtain his consent to the injection.
10. Help the patient to get into a comfortable supine position.
11. Wash and dry your hands.
12. Put on gloves.
13. Check: - syringe and needles - tightness, expiration date; - medicinal product - name, expiration date on the package and ampoule; - packing with tweezers - expiration date; - packaging with soft material - expiration date.
14. Remove the sterile tray from the packaging.
15. Collect the disposable syringe, check the patency of the needle.
16. Prepare cotton balls, moisten them with a skin antiseptic.
17. Open the ampoule with the medicinal product.
18. Collect the medicine.
19. Change the needle, expel air from the syringe.
20. Place the syringe in a sterile tray.

Procedure execution
21. Determine the site of the intended injection, palpate it.
22. Treat the injection site twice with a tissue or cotton ball with a skin antiseptic.
23. Stretch the skin at the injection site with two fingers.
24. Take a syringe, insert the needle into the muscle at an angle of 90 degrees, two-thirds of the length, holding the cannula with your little finger.
25. Pull the syringe plunger towards you.
26. Press down on the plunger, slowly inject the drug.

End of procedure
27. Remove the needle; pressing the injection site with a napkin or cotton ball with a skin antiseptic.
28. Give a light massage without removing the napkin or cotton ball from the injection site (depending on the medication) and help to stand up.
29. Used material, equipment should be disinfected with subsequent disposal.
30. Take off gloves, throw into a container with a disinfectant.
31. Wash and dry your hands.
32. Ask the patient about his state of health after the injection.
33. Make a record of the performed procedure in the patient's medical record.

1. As a parenteral irritant during gastric intubation

use:

a) cabbage broth

b) 33% magnesium sulfate

c) 40% glucose

d) + 0.1% histamine

2. Gastric intubation is performed with the aim of:

a) removal of stomach contents

b) + studies of the secretory function of the stomach

c) determining the shape and size of the stomach

d) prevention of flatulence

3. When conducting gastric intubation, the parenteral stimulus

injected with a syringe with a capacity (ml.):

4.In order to open the sphincter of Oddi, a solution is injected through the duodenal probe:

a) 0.025% pentagastrin

b) + 33% magnesium sulfate

c) 0.05% proserin

d) 10% calcium chloride

5. When receiving portion "A" of duodenal intubation, bile is taken:

a) hepatic

b) + duodenal

c) gastric juice

d) gallbladder

6. Duodenal bile is obtained from:

a) gallbladder

b) liver

c) + 12 duodenal ulcer

d) stomach

7. Portion "C" with duodenal intubation has the color:

a) green

b) dark olive

c) + golden yellow

d) transparent

8. The contents of the gallbladder are in a portion:

9. After gastric intubation, the test material

sent to:

a) + clinical laboratory

b) bacteriological laboratory

d) biochemical laboratory

10. If blood appears during sounding, it is necessary:

a) pull the probe towards you and continue the manipulation

b) introduce physiological solution into the probe

c) change the position of the patient

d) + stop probing

11. "Blind" sounding is used for the purpose of:

a) obtaining bile for research

b) + emptying the gallbladder

c) assessing the size of the gallbladder

d) determining the patency of the cystic duct

12. Number of tubes for duodenal intubation (pcs.):

13. Limiting point of olive advancement during duodenal intubation:

a) + duodenum

b) stomach

c) hepatic duct

d) gallbladder

14. For duodenal intubation, you need:

a) thick gastric tube

b) thin gastric tube

c) + duodenal probe with metal olive

d) thin gastric tube with glass adapter

15. With duodenal intubation, an irritant is used:

a) + 33% solution of magnesium sulfate

b) cabbage broth

c) 0.1% solution of histamine

d) 5% glucose solution

16. When fractional gastric intubation is used parenteral

stimulus:

a) 40% glucose solution

b) 33% solution of magnesium sulfate

c) + 0.1% solution of histamine

d) 10% calcium chloride

17. Before gastric intubation, the last meal is performed:

a) on the morning of the study day

b) at lunch on the eve of the study

c) + in the evening on the eve of the study, a light dinner

d) afternoon tea

18. For gastric intubation, a probe is used:

a) thick stomach

b) duodenal

c) + thin gastric tube

d) endoscopic

19. As a test breakfast for gastric intubation, you can

use:

a) + meat broth, 200 ml

b) magnesium sulfate solution 25% -50ml

c) apple juice 200 ml

d) 0.9% sodium chloride solution 200 ml

20. With duodenal intubation receive:

a) + 3 - 5 portions of bile

b) 7-9 servings of bile

c) not divided into portions

d) as many tubes as the nurse prepares

21. To obtain the 2nd portion of bile, an irritant is introduced:

a) 0.9 yo sodium chloride solution 50 ml

b) 0.01% solution of potassium permanganate 50 ml

c) + 33% magnesium sulfate solution 40 ml

d) 4% sodium bicarbonate solution 50 ml

22. The purpose of vomiting assistance is:

a) + prevention of asphyxia

b) emptying the stomach from food

c) emptying the intestines from food

d) support the patient physically

23. After duodenal intubation, the patient may have unpleasant

consequences:

a) + lowering blood pressure

b) hypertension

c) increased appetite

Probe manipulations

The student should know:

the purpose of probing the digestive tract;

the technique of introducing a gastric tube through the nose or mouth;

the technique of introducing a thick gastric tube through the mouth;

indications and contraindications for gastric lavage;

methods of taking gastric contents to determine secretion;

the purpose of duodenal sounding;

universal precautions when working with the received samples;

methods for decontamination of probes, funnels, syringes.

The student should be able to:

insert a thin tube into the stomach through the nose and through the mouth;

insert a thick tube into the stomach;

flush the stomach;

take wash water for research;

explain to the patient the course of the upcoming examination of gastric contents and contents of the duodenum and gallbladder;

Self-study questions :

goals, indications, contraindications of probe procedures;

deontological support of probe procedures;

equipping probe manipulations;

Algorithm of fractional sensing action by the Leporsky method;

algorithm for the action of fractional sensing with a parenteral stimulus;

algorithm of action of duodenal sounding;

algorithm of action of gastric lavage;

positive and negative aspects of the application of methods for the study of gastric contents according to the Leporsky method and with a parenteral stimulus.

tactics of the nurse in the event of a patient's reaction to the administration of histamine;

tactics of the nurse in the absence of one of the portions during duodenal intubation (two possible reasons for this);

the use of probeless methods, their positive and negative sides;

carrying out gastric lavage in case of unconsciousness of the patient;

vomiting and vomiting relief.

glossary

term

explanation

Atony

Weakening of tone, i.e. tension, excitability of tissues and organs

Hypokinesia

Insufficient movement

Intubation

Introduction of a special tube into the larynx

Cardia

The section of the stomach after the esophagus

Regurgitation

Reverse flow (liquid)

pH meter

Determination of the pH of the contents of various parts of the stomach and duodenum.

Stenosis

Narrowing of the lumen

Subcardinal department

Part of the stomach belowardia

Theoretical part

Ethical and deontological support

Many patients do not tolerate tube insertion well. The reason for this is cough or vomiting reflexes, high sensitivity of the mucous membrane of the pharynx and esophagus. In most cases, poor tolerance of probe manipulations is caused by the patient's negative psychological attitude towards the probing process, and there is a "fear of research". To eliminate the "fear of research", the patient should be explained the purpose of the research, its benefits, talk politely, calmly, kindly from the beginning to the end of the procedure.

Approximate content of a conversation between a healthcare professional and a patient during the insertion of the probe:

“Now we will start the procedure. Your well-being will largely depend on your behavior during probing. The first and basic rule is not to make sudden movements. Otherwise, nausea and coughing may occur. You should relax and breathe slowly and deeply. Please open your mouth a little, keep your hands on your knees. Breathe slowly and deeply. Take a deep breath and swallow the tip of the probe. If you find it difficult to breathe through your nose, breathe through your mouth and gently advance the tube as you inhale. If you feel dizzy, breathe normally, shallowly for a few minutes, then resume deep breathing. You swallow very well. It would be nice if other patients swallowed the tube just as easily.

Safety rules

Attention !

If during any probe manipulation there is blood in the material obtained, stop probing and call a doctor!

If, when the probe is inserted, the patient begins to cough, suffocate, his face becomes cyanotic, the probe should be removed immediately, since it has entered the larynx or trachea, and not into the esophagus.

In the case of an increased gag reflex in a patient, treat the root of the tongue with an aerosol 10% solution of lidocaine.

Contraindications for all probe manipulations: gastric bleeding, varicose veins of the esophagus, tumors, bronchial asthma, severe heart disease.

Probing of the digestive tract is carried out for both therapeutic and diagnostic purposes. With the help of probing, you can get the contents of the stomach with its subsequent examination, and rinse the stomach. In case of acute expansion (atony) of the stomach, especially in the early postoperative period, with high intestinal obstruction, the contents are removed with the help of an inserted probe, including gases. With the help of a probe inserted into the stomach, one of the methods of artificial feeding of the patient becomes possible. Medicines can be administered through a tube inserted into the digestive tract.

Fractional gastric intubation with parenteral stimulus

Algorithm for introducing a gastric tube through the mouth

Purpose: examination of gastric juice, gastric lavage .

Contraindications: contraindications for all probe manipulations: gastric bleeding, esophageal varicose veins, tumors, bronchial asthma, severe heart disease.

Equipment : Sterile gastric tube - rubber tube with a diameter of 3 - 10 mm. with lateral oval holes at the blind (inner) end. There are three marks on the probe: 1) 50-55cm (distance from the incisors to the entrance to the stomach); 2) 60-65cm (distance from the incisors to the stomach cavity); 3) 70-75cm (distance from the incisors to the exit from the stomach). Gloves, towel, glycerin.

Explain to the patient the procedure for the procedure, obtain consent.

Open the package with a sterile probe. Remove it with sterile tweezers and place in a sterile tray. Take the probe from the tray with your right hand closer to the blind (inner) end, and with the left hand support the free end.

Explain to the patient, if possible, that:

with the introduction of the probe, nausea and vomiting are possible, which can be suppressed by breathing deeply through the nose;
Do not squeeze the lumen of the probe with your teeth and pull it out.

Note : in case of inadequate patient behavior, this procedure must be performed with the help of an assistant: means of fixing the arms and legs should be used, the assistant fixes the head with his hand. A mouth dilator is used to hold the patient's mouth.

Height - 100cm.
Distance from the earlobe to the tip of the nose and to the navel.
Up to 2 or 3 marks.

Moisten the inner end of the probe with boiled water or glycerin.

Stand to the right of the patient (if you are "right-handed")

Invite the patient to open their mouth.

Place the end of the probe on the root of the tongue and invite the patient to swallow, breathe deeply and slowly through the nose (preferably).

Inject slowly and evenly up to the desired mark.

Algorithm for obtaining material for research

(fractional sensing)

Equipment :

Sterile gastric tube - rubber tube with a diameter of 3 - 10 mm. with lateral oval holes at the blind (inner) end. There are three marks on the probe: 1) - 50-55cm (distance from the incisors to the entrance to the stomach); 2) - 60-65cm (distance from the incisors to the stomach cavity); 3) - 70-75cm (distance from the incisors to the exit from the stomach).

branch ______________ ward number ____

Referral to a clinical laboratory

gastric juice obtained with a parenteral stimulus (pentagastrin)

9 servings

Patient: full name __________________________

Date ___________ Nurse Signature ________

Glycerin is sterile.

Dishes: 9 clean jars or tubes with labels.

Sterile syringe - 20.0 ml for extraction.

Sterile syringe - 2.0 ml for the introduction of the irritant.

Irritant: 0.1% histamine solution or 0.025% pentagastrin solution.

Alcohol balls (alcohol - 70 °).

Note: after each extraction of gastric contents, the stomach must remain empty!

Fractional sounding by the Leporsky method

Purpose: study of gastric juice .

Contraindications : contraindications for all probe manipulations: gastric bleeding, tumors, bronchial asthma, severe heart disease.

Equipment :

Sterile thin probe - rubber tube with a diameter of 3 - 5 mm. with lateral oval holes at the blind (inner) end. There are three marks on the probe: 1) - 50-55cm (distance from the incisors to the entrance to the stomach); 2) - 60-65cm (distance from the incisors to the stomach cavity); 3) - 70-75cm (distance from the incisors to the exit from the stomach).

Glycerin is sterile.

Dishes: 7 clean jars or tubes with labels.

Sterile syringe - 20.0 ml or vacuum extraction unit.

Gloves, towel, sterile tray, direction:

branch ________ ward No. ___

Sending to the clinical laboratory gastric juice obtained by the Leporsky method (cabbage broth)

1, 4, 5, 6 and 7 servings

Patient: full name ______________

Date_____

Signaturem / s ________

Enteral irritant - cabbage broth 200 ml, heated to 38 ° C.

Note : enteric irritants can serve, in addition to cabbage broth: meat broth, caffeine solution, etc.

Algorithm for taking gastric juice according to the Leporsky method

Explain to the patient the procedure for the procedure, warn in the evening that probing is done on an empty stomach, so that in the morning the patient does not eat, drink, or smoke(if probing is done in the office, then warn the patient not to forget to take a clean towel with him).

Correctly seat the patient: leaning on the back of a chair, tilting his head forward, if the patient is in bed, then Fowler's high position. If the patient cannot be brought into a sitting or reclining position, he can lie on his side without a pillow.

Wash your hands, put on gloves.

Put a towel on the patient's neck and chest; if there are removable dentures, remove them.

Insert the tube (see the algorithm for introducing the gastric tube through the mouth).

With the help of a 20.0 ml syringe, extract the contents of the stomach on an empty stomach -the first a portion

Using a cylinder from a 20.0 ml syringe (using it as a funnel, attaching it to the outer end of the probe), inject 200 ml of cabbage broth heated to 38 ° C.

After 10 minutes, extract 10 ml of gastric contents -second a portion.

After 15 minutes, extract the entire contents of the stomach -third serving, the stomach should remain empty.

Within an hour, every 15 minutes, using a 20.0 ml syringe, extract 4 more portions of stomach contents -fourth, fifth, sixth and seventh portions.

Carefully remove the probe with a towel or large napkin and place it in disinfectant solution.

Wipe the patient's mouth and help him get into a comfortable position.

Remove gloves, place them in disinfectant solution, wash your hands.

Send to laboratory1, 4, 5, 6 and 7 portions along with direction.

Upon receipt of a response from the laboratory, immediately glue it into the patient record.

Remember ! With any technique, you need to extract the content as completely and continuously as possible! If a significant admixture of blood appears, stop the extraction, call a doctor, show the contents and follow his instructions.

additional information

Equipment of probe procedures for each patient individually.

Fractional research according to the Leporsky method is currently rarely used due to technical inconvenience and less reliable research results.

Fractional study using parenteral stimuli:

parenteral stimuli are physiological, but they act stronger than enteral ones, they are accurately dosed and when applied, we get pure gastric juice. With the introduction of histamine, side effects may occur in the form of dizziness, fever, decreased A / D, nausea, difficulty breathing, etc. With these phenomena, you should urgently call a doctor and prepare one of the antihistamines for parenteral administration: diphenhydramine, suprastin, pipolfen ... Sometimes, in order to prevent allergic reactions when using histamine, 30 minutes before its administration, a solution of diphenhydramine 1% - 1 ml is injected subcutaneously.
in case of collapse and anaphylactic shock - see algorithms for help with collapse and anaphylactic shock. Pentagastrin almost does not cause side effects. It is administered subcutaneously at a dose of 6 μg (0.006 mg) per 1 kg of the patient's weight.
The study is carried out in the morning on an empty stomach. In the evening on the eve, the patient should not eat coarse, spicy food, in the morning before the examination, do not eat, drink, or smoke.
In some cases, for easier insertion of the probe into the stomach, 1.5 hours before the procedure, the probe is placed in the freezer.
After each extraction of gastric contents, a clamp is applied to the outer end of the probe, or it is bent and the patient holds the probe in his hand (if he is able), or tied in a knot.
After use, the probes are disinfected by boiling in distilled water for 30 minutes from the moment of boiling at full immersion. Then they undergo pre-sterilization treatment, just like syringes (only they cannot be cleaned with brushes), and then hanging dry with the blind end up, individual packaging and sterilization with a steam method, a gentle mode or in 6% hydrogen peroxide (then they are not packaged).Order No. 345.

Can be disinfected in 3% Samarovka solution for 1 hour.

The probes must not be disinfected with chlorine-containing preparations, since it is very difficult to remove the chlorine smell from rubber.

All extracted portions of gastric contents are sent to the laboratory, where the amount, color, consistency, smell, and the presence of impurities (bile, mucus, etc.) are determined. By titrating gastric juice with 0.1N sodium hydroxide solution, the free and total acidity in each portion is determined, and then the basal and stimulated production (flow rate) of hydrochloric acid is calculated using the formula.

Unfortunately, in practice, one often has to deal with erroneous results of fractional probing. To avoid them, two circumstances must be taken into account. First, after insertion into the stomach, the probe may take an incorrect position (roll up, be in the upper part of the stomach, etc.). Therefore, if a small amount of gastric contents is obtained during suction, the doctor should be informed about this. In this case, X-ray examination can be used to check the position of the probe in the stomach. Secondly, the still recommended weak stimulants of gastric secretion (for example, cabbage broth, meat broth, caffeine, etc.) do not objectively reflect the state of gastric acid secretion. Use histamine or (if contraindicated) pentagastrin as a stimulant.

Probeless methods for examining gastric contents

Intracavitary Ph -metry

One of the modern methods of studying the acid-forming and acid-neutralizing functions of the stomachis the intracavitary Ph -metry - definition Phcontents of various parts of the stomach and duodenum by measuring the electromotive force generated by hydrogen ions. For this study, a specialPh-metric probe. Normal indicatorsPh usually 1.3 - 1.7.

In recent years, both in our country and abroad, this method of intracavitary (24 - hour) continuous monitoringPhbecame widespread in specialized medical institutions. According to experts, the method is multipurpose. P measurementhin the lumen of the stomach, esophagus or duodenum, carried out during the day, taking into account the interdigestive and nocturnal acid secretion - the most dangerous in peptic ulcer disease - puts this method among the most informative, accurate, physiologically justified.

Radio telemetry method

R hgastric contents are sometimes determined with the help of special "pills" (radio capsules) equipped with a miniature radio sensor. After swallowing such a radio capsule, the sensor transmits information aboutPh, temperature and hydrostatic pressure in the lumen of the stomach and duodenum, which is recorded by the receiving device.

In the morning on an empty stomach, the patient swallows a radio capsule, fixed on a thin silk thread or on a probe, to keep the capsule in the desired part of the digestive tract. Then a belt is put on the patient, into which a flexible antenna is preliminarily mounted to receive signals from the radio capsule, and the tape drive mechanism is turned on.

The radiotelemetric method of research is the most physiological in the study of the secretory and motor functions of the stomach.

"Acidotest"

The use of ion exchange resins for the study of gastric secretion is based on the ability of resins to exchange ions in an acidic environment. This principle is used in the Acidotest method. The method is based on the detection in the urine of a dye formed in the stomach during the interaction of the ingested ion-exchange resin (yellow pellets) with free hydrochloric acid. The enteric irritant is caffeine (white tablets). The intensity of the color is determined by a standard (color scale) in the laboratory.

On the eve and on the day of the examination, the patient should not take medications and consume products that stain urine. The study begins in the morning on an empty stomach, no earlier than 8 hours after eating.

Despite the fact that the "Acidotest" technique is not a probe procedure, the authors consider it possible to give it in this chapter.

Teaching the patient the Acidotest technique

(when it is carried out on an outpatient basis)

Equipment: two containers for urine

Clarify the patient's understanding of the course and purpose of the upcoming study and obtain his consent.

Assess the patient's ability to learn.

Explain the Acidotest method:

in the morning on an empty stomach (9 hours after the last meal), the patient empties the bladder (this portion is not collected);
after emptying the bladder, immediately take 2 caffeine tablets;
empty the bladder after 1 hour into a glass container (mark it with a label with the words "Control portion");
take 3 yellow pills with a little water;
empty the bladder after 1.5 hours into the second container (mark it with a label with the words "Experimental portion");
deliver to the laboratory the direction and containers with the control and experimental portions of urine.

Ask the patient to repeat the Acidotest technique. Make sure the training was effective. Give written instructions if necessary.

Duodenal intubation

Probing of the duodenum is carried out to study bile, which helps in the diagnosis of diseases of the biliary tract, gallbladder, pancreas and duodenum. Duodenal intubation is also used for therapeutic purposes (for example, for pumping out bile with reduced motor function of the gallbladder).

Studies are carried out using a special duodenal probe with a diameter of 4 - 5 mm and a length of up to 1.5 m, which has a metal olive with holes at the inner end. Such probes are rubber, but now they are produced from polymeric materials; they have brass fusion at the inner end as olive. All duodenal probes are labeled every 10 cm.

The resulting portions of the duodenal contents are subjected to microscopic examination, which makes it possible to detect inflammation in the gallbladder and biliary tract (leukocytes, epithelial cells), to detect various bacteria and protozoa (for example, lamblia). In addition, you can find: atypical cells, gallstone disease (by the presence of sand in bile), determine the violation of the colloidal composition of bile (a large number of cholesterol crystals), etc.

As a rule, when conducting duodenal intubation, three portions are obtained:

"A" - contents of the duodenum, its composition - duodenal juice + pancreatic juice + bile;

"V" - gallbladder bile;

"WITH" - bile from the intrahepatic bile ducts.

In some cases, the fourth portion appears - "BC", the so-called gallbladder reflex, which usually occurs in children with hypokinesia of the gallbladder, and in adult patients with cholelithiasis.

Remember ! The "BC" portion is the "C" portion against the background of the "B" portion .

Given the important diagnostic value of this portion, the sister performing the duodenalsounding,you need to observe the color of bile when receiving portions "B" and "C". The “BC” portion should be collected in a separate tube and marked accordingly.

In some diseases, for example, when the bile duct is blocked by a stone, it is not possible to get the "B" portion.

Duodenal sounding algorithm

(fractional method)

Target : diagnostic .

Equipment : a sterile duodenal probe in a package, a rack with tubes, a stimulator for contraction of the gallbladder (25 - 40mm 33% magnesium sulfate solution, or 10% alcohol solution of sorbitol or chylecystokinin), a 20.0 ml syringe for aspiration, a syringe for injection (if chylecystokinin is used ), heating pad, roller, gloves, towel, small bench.

Clarify the patient's understanding of the course and purpose of the procedure, obtain his consent to the procedure(if probing is done in the office, then warn the patient not to forget to take a clean towel with him).

Wash your hands, put on gloves.

Invite the patient to sit on a chair or couch.

Place a towel on the patient's chest.

Open the package with a sterile probe, take the inner end of the probe in your right hand at a distance of 10-15 cm, hold the outer end with your left hand.

Determine the distance at which the patient should swallow the probe so that it is in the subcardinal stomach (on average about 45 cm) and in the duodenum: the distance from the lips and down the anterior abdominal wall so that the olive is located 6 cm below the navel.

Offer the patient to open his mouth, put the olive on the root of the tongue, the patient swallows the olive, the nurse helps him to swallow, carefully pushing the probe deeper. The patient continues to swallow. With each swallowing movement, the probe will advance into the stomach to the desired mark (4th or 5th). While the probe is swallowed, the patient can sit or walk.

Check the location of the probe by connecting a syringe to the outer end and aspirating the contents. If a cloudy yellow liquid enters the syringe, the olive is in the stomach; if not, pull the probe towards you and ask him to swallow the probe again.

9. If the probe is in the stomach, place the patient on the right side, placing a roller or blanket under the pelvis, and a warm heating pad under the right hypochondrium. In this position, the patient continues to swallow the probe up to the 7-8 mark. Duration of swallowing from 40 to 60 minutes.

Note : The tube rack is positioned below the couch level. When the olive is in the duodenum, a golden yellow liquid enters the test tube - the duodenal contents - a portion A ... For 20 - 30 minutes, 15 - 40 ml of the contents of the duodenum (2 - 3 tubes) are supplied. If the liquid does not enter the tube, you need to check the location of the probe by introducing air into it with a syringe and listening to the epigastric region with a phonendoscope. If the probe is in the duodenum, then the introduction of the probe is not accompanied by any sounds, if the probe is still in the stomach, then when air is introduced, characteristic bubbling sounds are noted

10. When the probe is swallowed up to the 9th mark (80 - 85 cm.), Lower the outer end into the test tube.

11. After receiving a portion"A" , use a syringe to inject a stimulator of contraction of the gallbladder (25 - 40 ml of a 33% solution of magnesium sulfate, or 10% alcoholic solution of sorbitol, or a choleretic agent of a hormonal nature, for example, cholecystokinin - 75 units / m). Move the probe to the next tube.

12. In 10 - 15 minutes after the introduction of the stimulant, a portion will begin to flow into the test tube.« V" – gallbladder bile. Duration of serving« V" - in 20 - 30 minutes. - 30 - 60 ml of bile (4 - 6 tubes).

Note : for timely identification of portions " Sun " carefully observe the color of the portion « V" . When a light-colored liquid appears, move the probe to another test tube, then, when a dark-colored liquid appears, move the probe again. Mark portion "VS" .

13. After receiving a portion« V" move the probe to the next tube to receive a portion « WITH" - hepatic portion. Duration of serving« WITH" – for 20 - 30 minutes - 15 - 20 ml (one - two tubes).

14. Carefully remove the probe with a towel or napkin in slow forward movements while wiping it.

15. Immerse the probe in disinfectant solution.

16. Wash your hands, remove gloves, place them in a disinfectant solution, wash and dry your hands.

17. Send all portions to the clinical and bacteriological laboratory with directions.

18. Upon receipt of a response from the laboratory, immediately glue it into the patient record.

department _______ ward number ___

Clinical referral

Laboratory

Patient name _______________

department _______ ward number ___

Referral to bacteriological

Laboratory

Bile - portions "A", "B", "C".

Patient name _______________
date ________ signature m / s _____

Bile delivered to the laboratory is examined:

determine the physical properties (color !. transparency, quantity "specific gravity, reaction);

conduct a chemical study (study of the concentration function of the gallbladder, colloidal stability of bile (determination of protein, bilirubin, urobilin, bile acids, cholesterol));

Normal bile does not contain any cellular elements ”sometimes there is a small amount of cholesterol in it.

With pathology, the content appears leukocytesLeukocytes: White blood cells. In a healthy adult, 1 μl of blood contains 5-9 thousand L. The amount of L. can both increase (leukocytosis) and decrease (leukopenia). In an adult, Leukocytes are formed mainly in the bone marrow. Leukocytes have amoeba-like movements, take part in immune reactions. Determine the leukocyte formula: the quantitative ratio between the individual forms of L., revealed during the clinical analysis of blood, is essential in determining the disease. Depending on the structure and functions performed, L. are divided into granulocytes and agranulocytes: granulocytes make up 60% of all L. Their cytoplasm has a granular structure. Granulocytes are divided into three types: basophils (produce heparin, which prevents blood clotting), neutrophils (perform a phagocytic function, accumulating in the area of tissue damage or penetration of microbes into the body), eosinophils (involved in the neutralization and destruction of foreign proteins). Agranulocytes (non-granular leukocytes) are divided into lymphocytes and monocytes. Lymphocytes are produced in the lymph nodes, tonsils, spleen, and bone marrow. Different groups of lymphocytes react differently to a foreign protein, producing either enzymes that destroy protein bodies (microbes, viruses), or specific antibodies that bind and neutralize the foreign protein. Monocytes have amoeboid movements and are characterized by high phagocytic activity, but under conditions other than neutrophils, appearing in the focus of inflammation at the final stage and preparing this site for regeneration.»| mucus, epithelium - signs of inflammation; erythrocytes, crystals of cholesterol, bilirubin - signs of cholelithiasis.

Portion A is obtained from the duodenum - the pathology in it confirms the pathology in portions B and C or the pathology of the stomach and duodenum.

Portion C - from the intrahepatic bile ducts; disease - cholangitis.

If you cannot get portion B, you can think of a hypertensive form of biliary dyskinesia. If portion B is too plentiful, you can think of a hypotonic form of dyskinesia.

If the simplest lamblia or helminths (opisthorchiasis) are found, this is a possible etiology of the disease.

Gastric lavage

In case of acute poisoning with large doses of drugs taken by mouth, poor quality food, alcohol, mushrooms, etc., the stomach is washed through a thick or thin probe. (At the same time, experts in the field of toxicology consider gastric lavage with a thick probe to be an unsafe procedure.)

Remember ! Gastric lavage to an unconscious patient in the absence of cough and laryngeal reflexes to prevent aspiration of fluid is carried out only after preliminary tracheal intubation, which is carried out by a doctor or paramedic.
If, when the probe is inserted, the patient begins to cough, suffocate, his face becomes cyanotic, the probe should be removed immediately - it has entered the larynx or trachea.

Decontamination of probes is carried out in accordance with the existing regulatory documents. Each probe must be packed in a separate bag. In the same bag, it is cooled in a freezer for 1.5 hours before administration, which greatly facilitates the procedure for introducing the probe.

Algorithm for gastric lavage with a thick probe

Purpose: to cleanse the stomach of poisons and toxins.

Indications :

Contraindications:

Equipment : a system for gastric lavage (2 thick - up to 1 cm in diameter, sterile gastric tubes connected by a glass tube, the blind end at one probe is cut off), a glass funnel with a capacity of 1 - 1.5 liters, a towel, napkins, a sterile container for rinsing water (if you will need to send them to the laboratory), a container with water T ° - 18 ° - 25 ° - 10 liters, a mug, a container for draining rinsing water, gloves, 2 waterproof aprons, glycerin.

Note :

Disconnect the funnel and remove the probe with a towel or napkin. Place contaminated items in a waterproof container. Pour the rinsing water down the drain.

Remove gloves, wash hands.

Gastric lavage with a thin probe

Purpose: to cleanse the stomach of poisons and toxins .

Indications : acute poisoning with large doses of drugs taken by mouth, poor quality food, alcohol, mushrooms, etc.

Contraindications: organic narrowing of the esophagus, acute esophageal and gastric bleeding, severe chemical burns of the mucous membrane of the larynx, esophagus, stomach with strong acids and alkalis (several hours after poisoning), myocardial infarction, cerebrovascular accident, malignant tumors of the stomach, esophagus, pharynx.

Equipment : a thin gastric tube, Janet's syringe, a towel, napkins, a sterile container for rinsing water (if you need to send them to the laboratory), a container with water T ° - 18 ° - 25 ° - 10 l, a container for draining rinsing water, gloves, 2 waterproof apron, glycerin.

Clarify the patient's understanding of the course and purpose of the manipulation (if the patient is conscious) and obtain his consent.

Put on aprons on yourself and the patient.

Wash hands with a hygienic level, put on gloves, treat gloves with a glove antiseptic.

Insert the gastric tube up to the established mark through the mouth or through the nose (see the algorithm for introducing the gastric tube through the mouth or through the nose).

Draw 0.5 liters of water into Janet's syringe, attach it to the probe and introduce water into the stomach.

Pull the plunger towards you while aspirating (extracting) the introduced water from the stomach.

Note : if necessary, take wash water for research (as prescribed by a doctor):

re-enter this portion of liquid into the stomach;

if you suspect poisoning with cauterizing poisons, immediately take the first portion of wash water;

repeat p. 5 - 6 twice and pour the rinsing water into a sterile container, close the lid.

Note : in case of appearance of blood in the rinsing water, immediately inform the doctor without removing the probe, show the rinsing water to the doctor!

Repeat the introduction of water into the stomach and its aspiration to clean wash water (all 10 liters of water must be consumed).

Disconnect Janet's syringe and remove the probe with a towel or napkin. Place contaminated items in a waterproof container. Pour the rinsing water down the drain.

Remove the aprons, immerse them in a waterproof container

To wash the patient, lay him comfortably on his side, cover.

Remove gloves, wash hands.

Write a referral and send the wash water to the laboratory.

Make a record of the manipulation and the patient's response to it in the medical record.

Browse the website:

http://video.yandex.ru/users/nina-shelyakina/collections/?p=1 in the collectionPM 04 films under numbers 192, 193, 194 and repeat all the manipulations on the topic.

From the Internet

DUODENAL SENSING

In what cases is the patient shown duodenal intubation?
Duodenal intubation is performed for diseases of the liver and biliary tract for both diagnostic and therapeutic purposes. At the same time, various stimuli are introduced into the duodenum or parenterally, which stimulate contractions of the gallbladder, relaxation of the sphincter of the common bile duct and the transition of bile from the biliary tract to the duodenum.
What substances are used as irritants introduced into the duodenum during duodenal intubation?
As irritants use 30-50 ml of warm 25% magnesium sulfate solution. 2 ml is administered parenterally. gastrocepin.
What is a duodenal probe?
For duodenal intubation, a sterile disposable probe with a diameter of 3 ml and a length of 1.5 m is used. At its end, inserted into the stomach, a hollow metal olive with a number of holes is fixed. There are 3 marks on the probe: at a distance of 40-45 cm from the olive, 70 cm and 80 cm from the olive. The last mark roughly corresponds to the distance from the front teeth to the large duodenal papilla (Vater nipple).
How is the preparation for the sounding procedure carried out?
In addition to the probe, a clamp for the probe, a rack with test tubes, a 20 ml syringe, sterile inoculum tubes, a tray, medicines (25% magnesium sulfate solution) are prepared for the duodenal intubation procedure.
As a preparation for the study, the patient is prescribed 2 no-shpy tablets the night before. Dinner is light; gas-forming products (black bread, milk, potatoes) are excluded.
How is the duodenal intubation procedure performed?
The study is carried out on an empty stomach. Mark on the probe the distance from the navel to the front teeth of the patient, who is in a standing position. After that, the patient is seated, they give him a tray with a probe. An olive is placed deep behind the root of the patient's tongue, inviting him to swallow and breathe deeply (the olive can be lubricated with glycerin beforehand). In the future, the patient slowly swallows the probe, and when vomiting occurs, he squeezes it with his lips and takes several deep breaths. When the probe reaches the first mark, the olive is presumably in the stomach. The patient is placed on a couch on his right side, under which a roller is placed (at the level of the lower ribs and right hypochondrium) from a rolled blanket or pillow. A hot heating pad wrapped in a towel is placed on top of the roller.
What is portion A for duodenal intubation?
If the olive has entered the intestine, then a golden-yellow transparent liquid begins to stand out - portion A (a mixture of intestinal juice, pancreatic secretion and bile). The liquid flows freely from the outer end of the probe, which is lowered into the test tube, or it is sucked off with a syringe. A test tube with the most transparent content is selected for analysis.
How is portion B collected during duodenal intubation?
One of the stimuli (usually 40-50 ml of warm 25% magnesium sulfate solution) is injected through the probe. The probe is closed with a clamp (or tied in a knot) for 5-10 minutes, then opened, the outer end is lowered into a test tube and concentrated dark olive gallbladder bile is collected (second portion - B). If this does not happen, you can repeat the introduction of magnesium sulfate after 15-20 minutes.
How is portion C collected during duodenal intubation?
After complete emptying of the gallbladder, a golden yellow (lighter than portion A) transparent, uncontaminated portion C begins to flow into the test tubes - a mixture of bile from the intrahepatic bile ducts and duodenal juices. After receiving this portion, the probe is removed.
How is material collected for bacteriological research carried out?
For bacteriological examination, part of the bile from each portion is collected into sterile test tubes. Before and after filling the tubes with bile, their edges are held over the flame of the burner and all other rules of sterility are observed.
The resulting portions of the duodenal contents should be delivered to the laboratory as soon as possible, since the proteolytic enzyme of the pancreas destroys leukocytes. It is difficult to detect lamblia in chilled duodenal contents, since they stop moving. To prevent cooling, the tubes are placed in a glass of hot water (39-40 ° C).
How is the functional state of the biliary system assessed based on the data of duodenal intubation?
The receipt of bile indicates the patency of the biliary tract, and portion B indicates the preservation of the concentration and contractile function of the gallbladder. If within 2 hours it is not possible to advance the olive of the probe into the duodenum, the study is stopped.
What is chromatic duodenal intubation?
For more accurate recognition of gallbladder bile, they resort to chromatic duodenal intubation. To do this, the night before, about 12 hours before the study (at 21.00-22.00, but not earlier than 2 hours after a meal, the subject is given 0.15 g of methylene blue in a gelatin capsule.
In the morning, when the bladder is probed, the bile turns out to be colored blue-green. Determine the time elapsed from the introduction of the stimulus to the appearance of portion B, the volume of bile.
What are the features of duodenal intubation in children?
In children, duodenal intubation is as difficult as extracting gastric juice. A probe with an olive tree is inserted into newborns to a depth of approximately 25 cm, children 6 months old - 30 cm, 1 year old - 35 cm, 2-6 years old - 40-50 cm, older ones - 45-55 cm. Magnesium sulfate is injected into duodenum at the rate of 0.5 ml of 25% solution per 1 kg of body weight. Otherwise, the procedure and technique of probing are the same as in adults.

Duodenal intubation, target: obtaining duodenal contents for laboratory research.
Indications for duodenal intubation: diseases of the liver, gallbladder, biliary tract.
Contraindications
Equipment... Sterile duodenal probe with an olive at the end; sterile syringe with a capacity of 20 ml; soft roller; warm heating pad; towel; tray; 50 ml of a 25% solution of magnesium sulfate heated to +40 ... + 42 ° С; a rack with laboratory test tubes (at least three test tubes, each test tube indicates a portion of bile A, B, C); referral to the laboratory; clean dry jar; hard trestle bed without a pillow; bench; set of linen; a glass of boiled water (pink potassium permanganate solution, 2% sodium bicarbonate solution or slightly saline solution).

1. Explain to the patient the necessity of the procedure and its sequence.
2. The night before, they warn that the upcoming study is carried out on an empty stomach, and the dinner before the study must be no later than 18.00.
3. The patient is invited to the probe room, comfortably seated on a chair with a back, slightly tilted his head forward.
4. A towel is placed on the patient's neck and chest and asked to remove the dentures, if any. Give a saliva tray in your hands.
5. Remove the sterile probe from the bix, moisten the end of the probe with the olive with boiled water. Take it with the right hand at a distance of 10-15 cm from the olive, and support the free end with the left hand.
6. Standing to the right of the patient, offer him to open his mouth. They put an olive on the root of the tongue and ask to swallow. During swallowing, the tube is advanced into the esophagus.
7. Ask the patient to breathe deeply through the nose. Free deep breathing confirms the presence of the probe in the esophagus and relieves the gag reflex from irritation of the posterior pharyngeal wall with the probe.
8. With each swallowing of the patient, the probe is inserted deeper to the fourth mark, and then another 10 - 15 cm to advance the probe inside the stomach.
9. Attach a syringe to the probe and pull the plunger towards you. If a cloudy liquid enters the syringe, then the probe is in the stomach.
10. Suggest the patient to swallow the probe up to the seventh mark. If his condition permits, it is better to do this while walking slowly.
11. The patient is placed on the trestle bed on the right side. A soft roller is placed under the pelvis, and a warm heating pad under the right hypochondrium. In this position, it is easier to move the olive to the gatekeeper.
12. In the supine position on the right side, the patient is offered to swallow the probe up to the ninth mark. The probe moves into the duodenum.
13. The free end of the probe is lowered into the jar. The jar and tube rack are placed on a low bench at the patient's head.
14. As soon as a yellow transparent liquid begins to flow from the probe into the jar, the free end of the probe is immersed in a test tube A (the duodenal bile of portion A has a light yellow color). For 20 - 30 minutes, 15 - 40 ml of bile is supplied - an amount sufficient for research.
15. Using a syringe like a funnel, 30-50 ml of a 25% solution of magnesium sulfate heated to +40 ... + 42 ° C is injected into the duodenum. A clamp is applied to the probe for 5-10 minutes or the free end is tied with a light knot.
16. After 5-10 minutes, remove the clamp. Dip the free end of the probe into the jar. When thick bile of a dark olive color begins to flow, the end of the probe is lowered into test tube B (portion B from the gallbladder). For 20 - 30 minutes, 50 - 60 ml of bile is released.
17. As soon as from the probe, along with the gallbladder bile, bright yellow bile flows, its free end is lowered into a jar until clear bright yellow hepatic bile is released.
18. Dip the probe into test tube C and collect 10-20 ml of hepatic bile (portion C).
19. Carefully and slowly seat the patient. Remove the probe. The patient is allowed to rinse the mouth with a prepared liquid (water or antiseptic).
20. Taking an interest in the patient's well-being, they take him to the ward, put him to bed, and provide peace. He is advised to lie down, as magnesium sulfate can lower blood pressure.
21. Tubes with directions are delivered to the laboratory.
22. After the test, the probe is soaked in a 3% solution of chloramine for 1 hour, then it is treated according to OST 42-21-2-85.
23. The result of the study is glued into the history of the disease.

Notes (edit)... The patient should be left with breakfast in the department (the sentinel nurse should inform the distributor in advance about the diet number and the number of servings). Control the patient's well-being, blood pressure readings. They warn him that magnesium sulfate has a laxative effect and he may have loose stools. To test for lamblia, portion B bile should be delivered to the laboratory warm.

Fractional duodenal intubation.

Target... Receiving duodenal contents for laboratory research; study of the dynamics of bile secretion.
Indications... Diseases of the liver, gallbladder, biliary tract.
Contraindications... Acute cholecystitis; exacerbation of chronic cholecystitis; varicose veins of the esophagus; coronary insufficiency.
Equipment... Sterile duodenal probe with an olive at the end; sterile syringe with a capacity of 20 ml; soft roller; warm heating pad; towel; tray; 50 ml of a 25% solution of magnesium sulfate, heated to +40 ... + 42 ° С; a rack with laboratory test tubes (at least three test tubes, each test tube contains a portion of bile: A, B, C); referral to the laboratory; clean dry jar; hard trestle bed without a pillow; bench; set of linen; a glass of boiled water (pink potassium permanganate solution, 2% sodium bicarbonate solution or slightly saline solution).

Technique for performing fractional duodenal intubation.

The technique of the study is similar to the technique of performing duodenal intubation..
Fractional duodenal intubation consists of five phases or stages.
In the first phase get the first portion of bile from the common bile duct - clear light yellow bile. The phase lasts 20 minutes. Usually 15-40 ml of bile is released during this time. Receiving more than 45 ml indicates hypersecretion or expansion of the common bile duct. Less bile means hyposecretion of bile or a decrease in the capacity of the common bile duct. After 20 minutes from the beginning of receiving bile, an irritant is injected - a 25% solution of magnesium sulfate, heated to +40 ... + 42 ° C. At the end of the first phase, a clamp is applied to the probe.
At the beginning of the second phase fractional duodenal intubation remove the clamp, lower the free end of the probe into the jar and wait for the beginning of the flow of bile. Normally, the phase lasts 2 - 6 minutes. The lengthening of the phase indicates hypertonicity of the common bile duct or the presence of an obstacle in it.
Third phase- this is the time before the appearance of gallbladder bile. Normally, it lasts 2 - 4 minutes. During this time, 3 - 5 ml of light yellow bile is released - the remainder of bile from the common bile duct. The lengthening of the phase indicates an increase in the tone of the sphincter. The bile obtained during the first and third phases constitutes portion A of the classical duodenal intubation.
Fourth phase- This is a registration of the duration of emptying of the gallbladder and the volume of gallbladder bile. Normally, 30 - 70 ml of bile of a dark olive color is released in 30 minutes - this is a classic portion of B. The rate of secretion of gallbladder bile is 2 - 4 ml / min. The rate of excretion of gallbladder bile within 10 minutes less than this indicator is characteristic of the hypomotor function of the gallbladder, and more - for the hypermotor function.
Fifth phase of duodenal intubation- obtaining liver bile (portion C). Normally, 15-30 ml of golden bile (hepatic bile) is released in 20 minutes.
Notes (edit)... The patient should be left with breakfast in the department (the sentinel nurse should inform the distributor in advance about the diet number and the number of servings).
Gastric and duodenal intubation is performed by personnel trained to work in the probing room.

Manipulation “Technique of intravenous injection. Algorithms for performing nursing manipulations Contraindications for performing probe procedures

Patient Eye Care

Study of the arterial pulse on the radial artery

Blood pressure measurement technique

Determination of the frequency, depth and rhythm of breathing

Measuring the temperature in the armpit

Algorithm for measuring height, body weight and BMI

Setting the warming compress

Statement of mustard plasters

Using a heating pad

Setting the ice bladder

Care of the external genitals and perineum of a woman

Catheterization of a woman's bladder with a Foley catheter

Catheterization of the male urinary bladder with a Foley catheter

Cleansing enema

Siphon bowel lavage

Hypertensive enema

Oil enema

Medicinal enema

Nasogastric tube insertion

Feeding with a nasogastric tube

Gastric lavage with a thick gastric tube

Dilution of the antibiotic in a vial and intramuscular injection

Intradermal injection

Subcutaneous injection

Intramuscular injection

Fractional duodenal intubation.

Technique for performing fractional duodenal intubation.