Complications with intramuscular injections. Thrombophlebitis on the arm after injection

Complications can occur after any type of injection. The reason may be an incorrectly delivered injection, lack of hygiene during the procedure, individual intolerance to the body. How to prevent complications after an injection? What should be done at the first signs of complications from injections, we will describe in detail in this article.

Complications with intramuscular injection

Complications with intramuscular injection are more common than after subcutaneous injection. Among the main complications are the following:

• An abscess is a collection of pus in muscle tissue.
• Infiltration - the formation of a seal.
• Redness, burning and other skin reactions.

The patient may have a fever and general malaise. These may be signs of sepsis.

Stand out possible reasons, for which complications arise after intramuscular injection:

• The injection was made with a too short needle and the medication got under the skin, and not intramuscularly.
• The syringe or hands were not sterile enough and bacteria got into the muscle.
• The medicine was injected too quickly.
• The medication was made for a long time. The result is a seal.
• Allergic reaction of the body to the medication.

If a patient has a seal after an intramuscular injection and the muscle hurts, you can try to alleviate the condition with the help of ointments: Traxevasin, Traxerutin. At night, you can make a mesh with iodine or lotions from alcohol. ethnoscience recommends using flour and honey cakes. To do this, honey is mixed with flour and a small cake is sculpted. It is applied to the sore muscle and covered with a film overnight.

You can cure an abscess with the help of compresses with ointments: Vishnevsky or Heparin. But if there is an increase in temperature, it is better to see a doctor if you feel unwell. The fact is that an abscess can tear inside the muscle and infection will occur. In difficult cases, surgery may be necessary.

If redness appears, it is worth contacting an allergist or your doctor. The drug that is injected is likely to cause allergies. It is necessary to change the medication to a less allergenic analogue.

Complications after a subcutaneous injection

Subcutaneous injection rarely causes complications. The fact is that they make mistakes with subcutaneous administration less often.

From possible complications stand out:

• Allergic reactions at the injection site.
• The formation of abscesses.
• Air embolism - the entry of air under the skin.
• The formation of a hematoma at the site of the needle entry.
• Lipodystrophy is the formation of pits under the skin. It is associated with the breakdown of the fatty layer due to the frequent administration of a drug, for example, insulin.

Complications can have the following reasons:

• Erroneous administration of the wrong drug.
• Air entering the syringe along with the medicine.
• Bacteria penetration into the skin.
• Using a blunt needle to prick.

For any of the complications that appear, you need to consult a specialist. You may need to intervene with surgeons or change the drug.

When an abscess forms, you should not lubricate the lesion with iodine or brilliant green. It will be difficult for the doctor to see the sore spot and determine the cause.

Complications after an injection into a vein

Intravenous injections are given in the hospital; they are rarely given at home. Complications with a well-placed intravenous injection occur in single cases.

Of the possible, stand out:

• Thrombophlebitis - damage to the vessel and inflammation of the vein, the formation of a blood clot.
• Oily embolism - an oil-based compound was accidentally injected into a vein. Together with the blood, it enters the vessels of the lungs and the patient suffocates. In 90% it ends in death.

First aid can be provided only within the walls of the hospital, since mistakes when injecting into a vein are dangerous.

It is easier to prevent than to cure

Complications after intramuscular or subcutaneous injection can be prevented in simple ways:

1. Make intramuscular injection it is possible only with a needle from a syringe for 5 or more cubes. The needle from a two-cube syringe is suitable for subcutaneous injection of the drug.
2. All injections are done with a sharp needle. If it is necessary to draw the drug into a syringe from a vial with a rubber cap, then the puncture is carried out with a separate needle.
3. Shake the syringe and release the air bubbles before injection. Discharge some of the drug through the needle, there may also be air.
4. The procedure is performed only under sterile conditions. The place where the needle is inserted is pretreated with a sleeping bag.
5. It is better to use disposable syringes for injections.
6. Before any injection, the doctor must test the prescribed drug.

Among the worst complications are HIV infection, hepatitis, or sepsis. And what drugs and where to inject correctly in order to avoid mistakes, they tell in the video.

With intramuscular injections, the following complications are possible:

If the needle enters a blood vessel, which may cause to embolism if introduced oil solutions or suspensions that should not enter directly into the bloodstream. When applying similar drugs after inserting the needle into the muscle, the piston is pulled back and it is made sure that there is no blood in the syringe.

· Infiltrates- painful lumps in the thickness of the muscle tissue at the injection site. May occur on the second or third day after the injection. The reasons for their occurrence can be both non-compliance with the rules of asepsis (non-sterile syringe, poorly treated injection site), and repeated administration of drugs to the same place, or increased sensitivity of human tissues to the injected drug (typical for oil solutions and some antibiotics).

· Abscess- manifested by hyperemia and soreness of the skin over the infiltrate, elevated temperature body. Urgent surgical treatment and antibiotic treatment.

· Allergic reactions on the injected drug. To avoid these complications, an anamnesis is taken before the administration of the drug, the presence of allergic reactions to any substances is found out. With any manifestation allergic reaction(regardless of the method of the previous administration), it is advisable to cancel the drug, since the repeated administration of this medicinal product can lead to anaphylactic shock.

Subcutaneous injections

It is used, for example, when administering insulin.

The subcutaneous fat layer has a dense vascular network, so drugs administered subcutaneously have an effect faster than oral administration - they bypass the gastrointestinal tract, entering directly into the bloodstream. Subcutaneous injections are made with a needle of the smallest diameter and up to 2 ml of drugs are injected, which are quickly absorbed into the loose subcutaneous tissue without adversely affecting it.

The most convenient sites for subcutaneous administration are:

· The outer surface of the shoulder;

Subscapularis space;

· The antero-outer surface of the thigh;

· side surface abdominal wall;

· The lower part of the axillary region.

In these places, the skin is easily caught in a fold and the risk of damage is minimal. blood vessels, nerves and periosteum.

In places with edematous subcutaneous fat;

· In seals from poorly absorbed previous injections.

Intramuscular injection technique:
Purpose: therapeutic
Indications: determined by the doctor
Equipment:
1.soap, individual towel
2.gloves
3.Ampoule with a medicinal product
4.file for opening the ampoule
5.sterile tray
6.waste tray
7.Disposable syringe with a volume of 5 - 10 ml
8. cotton balls in 70% alcohol
9.Skin antiseptic (Lisanin, AHD-200 Special)
10. covered with a sterile napkin, a sterile patch with sterile tweezers
11.mask
12. first aid kit "Anti - HIV"
13. containers with disinfectant. solutions (3% solution of chloramine, 5% solution of chloramine)
14. rags
Preparation for manipulation:
1. Explain to the patient the purpose, the course of the upcoming manipulation, get the patient's consent to perform the manipulation.
2. Treat your hands at a hygienic level.
3. Help the patient to get into the desired position.
Intramuscular injection technique:
1. Check the expiration date and the tightness of the syringe package. Open the packaging, collect the syringe and place it in a sterile patch.
2. Check the expiration date, title, physical properties and dosage medicinal product... Check with the assignment sheet.
3. Take 2 cotton balls with alcohol with sterile tweezers, process and open the ampoule.
4. Draw the required amount of the drug into the syringe, release the air and place the syringe in a sterile patch.
5. Put on gloves and treat with a ball in 70% alcohol, discard the balls in a waste tray.
6. Place 3 cotton balls with sterile tweezers.
7. Spread centrifugally (or in the direction from bottom to top) with the first ball in alcohol a large area skin, treat the puncture site directly with the second ball, wait until the skin dries from alcohol.

8. Dump the balls into the waste tray.
9. Insert the needle into the muscle at a 90 degree angle, leaving 2-3 mm of the needle above the skin.

10. Move your left hand to the plunger and inject the drug.
11. Press a sterile ball to the injection site and quickly withdraw the needle.
12. Check with the patient how he is feeling.
13. Take the 3 ball from the patient and guide the patient.

Take measures for infectious safety, treat hands at a hygienic level, dry with an individual towel

Complications

Nurse must clearly understand what complications can be after intramuscular injections and how to avoid them. In the event of complications, the nurse must know the algorithm medical care to the patient.

So, complications after intramuscular injections can be as follows.

Broken needle

Uncommon, but common. The reason is a strong muscle contraction with a fear of the procedure, an unexpected start of the injection, incorrect psychological preparation the patient.

Help: keeping calm, reassure the patient, reassure him that everything will be fine. ! with the 2nd and 2nd fingers of your left hand, press down the fabric on both sides of the broken needle, squeezing it out in this way. Right hand take a pair of tweezers, gently grab the tip of the piece and remove it. The action is repeated several times. In case of unsuccessful attempts, urgently call a doctor through an intermediary, staying with the patient and reassuring him. In the future, follow all the instructions of the doctor.

Damage to the periosteum

It can occur when an intramuscular injection is made with a too long needle in a thin patient. Help: referral to a surgeon and fulfillment of his appointments. Prevention: correlate the length of the needle with the size of the patient's subcutaneous fat layer at the site of the intended injection.

- a method of drug administration, in which a drug enters the body by administration injection solution through a syringe into the subcutaneous tissue. When a subcutaneous injection of a drug enters the bloodstream by absorption of the drug into the vessels of the subcutaneous tissue. Usually, most drugs in the form of solutions are well absorbed in the subcutaneous tissue and provide relatively fast (within 15-20 minutes) absorption in big circle blood circulation. Usually, the action of the drug with subcutaneous administration begins more slowly than with intramuscular and intravenous administration, but faster than oral administration. Most often, drugs are injected subcutaneously that do not have a local irritating effect, and are well absorbed in the subcutaneous fatty tissue. Heparin and its derivatives are administered exclusively subcutaneously or intravenously (due to the formation of hematomas at the injection site). Subcutaneous injection is used when it is necessary to inject into the muscle both an aqueous and an oily solution of drugs, or a suspension, in a volume of no more than 10 ml (preferably no more than 5 ml). Vaccinations are also given subcutaneously against infectious diseases by introducing a vaccine into the body.

Application

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

Execution technique

Subcutaneous injection is most often done in outer surface the shoulder, the anterozoal surface of the thigh, the subscapularis, the lateral surface of the anterior abdominal wall and the area around the navel. Before the subcutaneous injection, the medicinal product (especially in the form of an oil solution) must be warmed up to a temperature of 30-37 ° C. Before the injection, the medical worker treats the hands disinfectant solution and puts on rubber gloves. Before the introduction of the drug, the injection site is treated with an antiseptic solution (most often with ethyl alcohol). Before the injection, the skin at the puncture site is taken into a fold, and after that the needle is placed at an acute angle to the skin surface (for adults - up to 90 °, for children and people with a weakly expressed subcutaneous fat layer, the introduction is at an angle of 45 °). After puncturing the skin, the needle of the syringe is inserted into the subcutaneous tissue approximately 2/3 of the length (at least 1-2 cm); to prevent the needle from breaking, it is recommended to leave at least 0.5 cm of the needle above the skin surface. After puncturing the skin, before injecting the drug, it is necessary to pull the syringe plunger back to check that the needle enters the vessel. After checking the correctness of the needle location, the drug is injected under the skin in full. After the end of the administration of the drug, the injection site is re-treated with an antiseptic.

Advantages and disadvantages of subcutaneous drug administration

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

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

Possible complications of subcutaneous injection

Most frequent complication subcutaneous injection is the formation of infiltrates at the injection site. Usually, infiltrates are formed when the drug is injected into the site of induration or edema that formed after previous subcutaneous injections. Infiltrates can also form when oil solutions are injected, they are not warmed up to the optimal temperature, as well as when the maximum volume of subcutaneous injection is exceeded (no more than 5 ml at a time). When infiltrates appear, it is recommended to apply a zigging semi-alcoholic compress or heparin ointment to the site of infiltration formation, apply an iodine mesh to the affected area, and carry out physiotherapeutic procedures.

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

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

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

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

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

When using a needle for injection with a defect, with excessively deep insertion of the needle into the subcutaneous tissue, as well as in violation of the technique of administering the drug, the needle may break. With this complication, it is necessary to try to independently obtain a fragment of the needle from the tissues, and in case of an unsuccessful attempt, the fragment is removed surgically.

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

Varieties of injection complications, signs, causes, prevention, treatment.

Infiltrate.

Signs:
Lump, soreness at the injection site.
Causes:
- Violation of injection technique,
- Introduction of unheated oil solutions,
- Multiple injections in the same places.
Prevention:
Eliminate the causes of complications.
Treatment:
Warming compress, heating pad, iodine mesh in place of infiltration.

Abscess

Purulent inflammation of soft tissues with the formation of a cavity filled with pus and a pyogenic membrane delimited from the surrounding tissues.
Signs:
Pain, induration, hyperemia in the area of ​​the abscess, local or general increase in temperature.
Causes:
To the causes of infiltration, soft tissue infection is added as a result of a violation
rules of asepsis.
Prevention:
Eliminate the causes of infiltrates and abscesses.
Treatment:
Surgical.

Broken needle.

Signs: no.
Causes:
- Insertion of the needle up to the cannula itself,
- Using old, worn out needles,
- Sharp muscle contraction.
Prevention:
- Insert the needle 2/3 of its length,
- Do not use old needles,
- Do the injections while the patient is lying down.
Treatment:
Remove the piece of needle with tweezers or surgically.

Oil embolism.

Signs:
The oil trapped in the vein - an embolus, enters the pulmonary vessels with the blood stream. There is an attack of suffocation, cyanosis. This complication often ends in the death of the patient.
Causes:
- Accidental hit of the end of the needle into the lumen of the vessel during subcutaneous or intramuscular injections,
- Erroneous administration of oil solutions intravenously.
Prevention:
Inject oil solutions in a two-step manner.
Treatment:
As prescribed by a doctor.

Air embolism.

Signs:
See "oil embolism", but it manifests itself very quickly in time.
Causes:
The ingress of air into the syringe and its introduction through the needle during the injection into the vessel.
Prevention:
Thoroughly expel air from the syringe before injection.
Treatment:
As prescribed by a doctor.

Incorrect administration of the drug.

Signs:
They can be different: from a painful reaction to anaphylactic shock.
Causes: -
Prevention:
Before injection, carefully read the publication of the drug, dosage, expiry date.
Treatment:
- Inject 0.9% sodium chloride solution into the injection site,
- Put an ice pack on the injection site,
- If the injection is made on the limb - apply a tourniquet above,
- Further treatment as prescribed by a doctor.

Damage to the nerve trunks.

Signs:
They can be different: from neuritis to paralysis.
Causes:
- Mechanical damage with a needle if the injection site is incorrectly selected,
- Chemical damage when a drug depot is created close to the nerve.
Prevention:
Choose the correct injection site.
Treatment:
As prescribed by a doctor.

Thrombophlebitis (inflammation of a vein with the formation of a blood clot in it).

Signs:
Pain, hyperemia, infiltration along the vein, fever.
Causes:
- Frequent venipuncture of the same vein,
- Use of blunt needles.
Prevention:
- Alternate veins when performing injections,
- Use sharp needles.
Treatment:
as prescribed by a doctor.

Necrosis (tissue necrosis).

Signs:
Increasing pain in the injection area, edema, hyperemia with cyanosis, blistering, ulceration and tissue death.
Causes:
Incorrect introduction of an irritating substance under the skin (for example, 10% calcium chloride solution).
Prevention:
Follow the injection technique.
Treatment:
- Stop administering the solution,
- Suck out the injected medicine with a syringe as much as possible,
- Cut the injection site with 0.5% novocaine solution,
- Place an ice pack on the injection site.

Hematoma (bleeding under the skin).

Signs:
Bruising under the skin in the form of a purple spot.
Causes:
- Inaccurate intravenous injection (puncture of the vessel wall),
- Use of blunt needles.
Prevention:
- Compliance with technique intravenous injection;
- Use of sharp needles.
Treatment:
- Stop injection;
- Apply cotton wool with alcohol to the vein;
- Apply a semi-alcohol compress to the area of ​​the hematoma.

Lipodystrophy.

Signs:
Pits are formed under the skin at the insulin injection sites due to the resorption of adipose tissue.
Causes:
Regular injections of insulin at the same place.
Prevention:
Alternating the site of insulin injection.
Treatment: -

Sepsis, AIDS, viral hepatitis.

Signs:
Long-term complications, manifest as common disease organism.
Causes:
Gross violation of the rules of asepsis, pre-sterilization cleaning and sterilization of instruments.
Prevention:
Exclusion of the cause of these complications.
Treatment: -

Allergic reactions.

Signs:
Itching, rash, acute runny nose, etc. Anaphylactic shock.
Causes:
Individual intolerance to the drug.
Prevention:
- Before the first injection, you should ask the patient about their tolerance of this drug;
-On title page history can be data on intolerance to any medicinal substances,
- Before the first injection of antibiotics, test for sensitivity to this drug.
Treatment:
- Stop administering the drug,
- Suck out the injected substance as much as possible with a syringe,
- Cut the injection site with a 0.5% solution of novocaine,
- Put on an ice pack.