P to the introduction of what it means. How is parenteral administration of drugs? The advantages of this method of administration

Arutyunov Eduard 22 group

What is parenteral drug administration? What are the types of parenteral drug administration? You will learn this and much more in this presentation.

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PARENTERAL ADMINISTRATION OF MEDICINES The presentation was prepared by a student of group 22 Arutyunov Eduard

Parenteral drug administration is a route of administration of drugs into the body in which they bypass the gastrointestinal tract, as opposed to the oral route of drug administration. These are primarily injections and inhalation. There are other, more rare, parenteral methods of administration: transdermal, subarachnoid, intraosseous, intranasal, subconjunctival, but these methods of drug penetration into the body are used only in special cases. syringe and hollow needle or high pressure injection (needleless injection). Inhalation (from Lat. Inhalo - I inhale) is a method of administering medicines based on the inhalation of gas, steam or smoke. Inhalation is natural (at seaside resorts, in the forest) and artificial, with the use of special spray devices - inhalers. There are small volume injections (up to 100 ml) and large volume injections, which are called infusions.

Advantages of the parenteral route of administration. Their action occurs faster, which is especially important in emergency cases, when immediate action is necessary.The bioavailability of drugs increases.The effectiveness of drugs does not depend on food intake. , adrenaline) You can use it when swallowing the medicine is impossible - if the patient is unconscious or under anesthesia, with vomiting

Parenteral administration of drugs: a - intradermal; b - subcutaneously; c - intramuscularly; d - intravenously.

There are the following parenteral routes of drug administration: 1. In tissue: intradermally - used for diagnostic purposes (allergic tests by Burne, Mantoux, Casoni, etc.) and for local anesthesia (chipping); subcutaneously - used when a faster action of the drug is required than when administered orally, since the subcutaneous fat layer, where the drug is injected with subcutaneous administration, is well supplied with blood vessels - the drugs introduced in this way are quickly absorbed; intramuscularly - some drugs, if injected under the skin, cause severe irritation, a reaction from adipose tissue, pain; they are slowly absorbed, so they are administered intramuscularly. Due to the abundance of lymphatic and blood vessels in the muscles, absorption is faster, but due to the fact that the extensibility of the tissues is less, the amount of solution for administration is limited. Intramuscularly, insoluble suspensions of drugs, oils, etc. are mainly administered; intraosseous - indications: extensive burns and deformation of the extremities, collapse of the saphenous veins in shock, collapse, terminal conditions, psychomotor agitation or convulsions, the impossibility of intravenous administration of drugs (primarily in pediatric practice).

Intradermal Intradermal injection is used: for diagnostic purposes (allergic tests by Burne, Mantoux, Casoni, etc.) for local anesthesia (chipping). For diagnostic purposes, 0.1-1 ml of the substance is injected using the skin area of ​​the inner surface of the forearm. Burne's test is a method for diagnosing brucellosis, which is an allergic test with intradermal administration of brucellin. Mantoux test is a diagnostic allergic test for detecting tuberculosis with intradermal tuberculin injection. Casoni's test is a diagnostic allergic test for the diagnosis of echinococcosis with intradermal administration of an echinococcal antigen. Required equipment: sterile 1 ml syringe with a needle, sterile tray, ampoule with allergen (serum, toxin) 70% alcohol solution, bix with sterile material (cotton balls, swabs) sterile tweezers tray for used syringes sterile gloves Mask anti-shock medication set.

Subcutaneously Subcutaneous injection is performed at a depth of 15 mm. The maximum effect of a subcutaneously injected drug is achieved on average 30 minutes after injection. The most convenient sites for subcutaneous administration of drugs: the upper third of the outer surface of the shoulder subscapularis anterolateral surface of the thigh lateral surface of the abdominal wall In these areas, the skin is easily captured in a fold, so there is no risk of damage to blood vessels and nerves. Do not inject drugs into places with edematous subcutaneous fatty tissue or into seals from poorly absorbed previous injections.

Intramuscularly Intramuscular injections are carried out only in those places of the body where there is a significant layer of muscle tissue and large vessels and nerve trunks do not pass close to the injection site. The most suitable sites for intramuscular injection are the muscles of the buttocks (gluteus medius and minimus) thigh muscles (vastus lateralis). The sites for intramuscular injection are shaded. Much less often, intramuscular injection is carried out into the deltoid muscle of the shoulder, since there is a danger of damage to the radial or ulnar nerves, brachial artery. For intramuscular injections, use a syringe 8-10 cm long (together with a needle). In the gluteal region, only the upper outer part is used, which is the most distant from the sciatic nerve and large blood vessels.

Divide the buttock mentally into four parts (quadrants). The injection is carried out into the upper external quadrant in its upper external part approximately 5-8 cm below the level of the iliac crest. Accidental needle injury to the sciatic nerve when injecting into the non-upper outer quadrant of the buttock can cause partial or complete paralysis of the limb. In no case should the patient stand during the intramuscular injection, since in this position the needle may break and detach from the sleeve. The patient should lie on his stomach, while the muscles of the body should be completely relaxed. The maximum volume of intramuscularly administered medicinal substance should not exceed 10 ml.

2. Into the vessels: intravenously - used for the introduction of large volumes of medicinal substances, blood transfusion, bloodletting, blood tests; intraarterially - used for terminal conditions caused by shock, blood loss, asphyxia, electrical injury, intoxication, infectious disease; into the lymphatic vessels - used to prevent the passage of the drug through the liver and kidneys (prevents the rapid metabolism of the substance), for a more accurate entry of the drug to the focus of the disease, infection, tumor, etc.

Intravenous administration of drugs Intravenous injection or blood sampling is performed only by trained medical personnel (who have a thorough knowledge of the algorithm for intravenous injection). Venipuncture - percutaneous introduction of a hollow needle into the lumen of a vein for the purpose of: intravenous administration of drugs, blood transfusion and blood substitutes, blood extraction (for taking blood for analysis, as well as bloodletting - removing 200-400 ml according to indications. Most often, punctured elbow vein, and, if necessary, other veins, for example veins on the dorsum of the hand (veins of the lower extremities should not be used because of the risk of thrombophlebitis.) The patient can sit or lie down. A tourniquet is applied to the shoulder, 10 cm above the elbow, and a tourniquet is applied tightly enough to the patient's sleeve to squeeze the veins. , therefore, the pulse on the radial artery should be well palpated. the patient should be asked to "work with his fist" - clench and unclench his fist several times.

Intra-arterial drug administration Drugs are injected into the arteries, which quickly disintegrate in the body. At the same time, a high concentration of the drug is created only in the corresponding organ, and the general effect on the body can be avoided. Intra-arterial drugs are administered in the treatment of certain diseases (liver, limbs, heart). For example, the introduction of thrombolytics into the coronary artery can reduce the size of the thrombus (up to its resorption) and thereby relieve the inflammatory process. X-ray contrast agents are also injected intraarterially, which makes it possible to accurately determine the localization of the tumor, thrombus, vasoconstriction, and aneurysm. For example, the introduction of a radio-opaque substance based on the isotope of iodine makes it possible to determine the localization of the stone in the urinary system and, on the basis of this, use one or another type of treatment.

3. In the cavity: in the pleural cavity; into the abdominal cavity; intracardiac; into the articular cavity The pleural cavity is the slit-like space between the parietal and visceral pleural layers that surround each lung. The pleura is a smooth serous membrane. The parietal (outer) pleura lines the walls of the chest cavity and the outer surfaces of the mediastinum, the visceral (inner) layer covers the lung and its anatomical structures (vessels, bronchi and nerves). Normally, the pleural cavities contain a small amount of serous fluid. The abdominal cavity (lat.cavitas abdominis) is a space located in the trunk below the diaphragm and completely filled with abdominal organs. It is divided into the actual abdominal cavity and the pelvic cavity (lat.cavitas pelvis). The cavity is lined with a serous membrane - the peritoneum, which separates the peritoneal cavity (abdominal cavity in a narrow sense) from the retroperitoneal space.

To excite the activity of the heart, a solution of adrenaline 1: 1000 is most often used at a dose of 0.5 - 1.0 ml, for children there are as many drops of adrenaline as the child is, plus 1 more drop. Adrenaline is injected into the heart cavity by mixing with 10 ml of isotonic sodium chloride solution, heated to 40 °, slowly. At the end, the needle is immediately withdrawn. If there is no effect, the injection can be repeated. Other medicines include solutions of 0.1% atropine and 5% calcium chloride. Intracardiac Drug Administration - Indications: sudden cardiac arrest of various origins. Intracardiac injections can be effective if carried out immediately after cardoplegia, at least after 3 to 7 minutes. The method is one of the components of the resuscitation complex. The articular cavity is a slit-like hermetically sealed space bounded by the synovial membrane and articular surfaces. In the articular cavity of the knee joint there are menisci.

Parenteral administration of drugs and solutions is carried out:

• ? in tissue (intradermal, subcutaneous, intramuscular, painful focus, bone tissue);
• ? vessels (intravenous, intra-arterial, lymphatic vessels - performed by a doctor);
• ? cavities (abdominal, pleural, intracardiac, in the spinal canal), procedures are performed by a doctor;
• ? intraosseous (primarily for children under the age of one year or more, as well as in severe conditions, convulsions, when intravenous administration is impossible). Performed by a physician;
• ? into the subarachnoid space through the meninges, under the arachnoid into the cerebrospinal fluid (sub - under; arachnoidea - arachnoid). Performed by a physician. It is important that the drugs are not irritating.

To avoid mistakes when using injectable dosage forms, it is necessary to follow the rule of triple control: first, the nurse reads the doctor's prescription (first stage), then the label on the package (second stage) and, finally, the name of the drug on the ampoule (third stage). Only if all three names match can the injection be given.

Intradermal administration more often used for intradermal tests - Mantoux reaction, allergic test, pain relief and other tests. Injection solutions are injected under the epidermis, into the stratum corneum of the skin.

Subcutaneously more often drugs are administered for a faster effect than oral administration. The disadvantages of subcutaneous administration are the introduction of a small volume of the drug and the rate of absorption (resorption). Resorption depends both on local (the degree of development of subcutaneous fat, which is well supplied with blood vessels, seals due to tissue sclerosis), and general factors (the state of the vessels of the circulatory system, their sclerosis). Injection solutions are injected into the subcutaneous fat.

Intramuscularly drugs are injected that are slowly absorbed and to a lesser extent cause irritation of the subcutaneous fat, pain, therefore, antibiotic solutions, poorly soluble suspensions (bicillin), oil solutions, etc. are mainly administered.

Intravenous administration in the form of a puncture of a vein or its catheterization requires practical experience of introduction. Intravenous administration of the drug is performed by venipuncture or venesection (dissection of access to a vein and vein, performed by a doctor). Large volumes of medicinal solutions are injected intravenously for blood loss, blood preparations for blood transfusions. In this case, the rate of administration of solutions parenterally has clinical significance. When administered intravenously, medicinal solutions achieve the highest bioavailability. A blood sample is taken from a vein for laboratory research and bloodletting.

Intra-arterial a small amount of medicinal solutions that have a vasodilating effect in terminal conditions (shock, electrical injury, asphyxia and other emergency conditions) are introduced. The introduction is performed by a physician.

Currently, there are new non-standard methods of introducing a drug into the body. These include microcapsules, prolonged-release drugs, targeted dosage forms, etc.

The advantages of the parenteral route of administration are:

• ? speed of action;
• ? dosage accuracy;
• ? the entry of the drug into the blood unchanged, bypassing the liver.

Disadvantages:

• ? mandatory participation of trained medical personnel;
• ? the presence of a sterile injection device;
• ? compliance with asepsis and antiseptics, since infection is possible during administration;
• ? difficulty or inability to administer the drug with bleeding;
• ? damage to the skin at the injection site.

Knowledge of the technology and features of parenteral administration is the key to the successful professional activity of a medical worker. The inalienable requirements for the professional activity of a paramedical worker when using medicines are:

• ? compliance with labor safety requirements (compliance with regulatory documents, hand washing standards, use of gloves and overalls, etc.);
• ? compliance with the conditions for performing procedures (inpatient, emergency care at home or in conditions of transportation by ambulance, outpatient clinics or sanatoriums);
• ? the ability to use material resources, medicines in accordance with the instructions and prescriptions of a doctor, the use of other consumable materials within the limits indicated by approved standards, technologies for performing simple medical services.

Almost every one of us has come across the method of parenteral administration of a medicine into the body. Parenteral means "bypassing or bypassing the intestines." In other words, the drug in this case does not enter the body orally and is not processed in the gastrointestinal tract to then enter the bloodstream. Any other method can already be considered parenteral, for example, the penetration of the drug through the skin or directly through the bloodstream. Most often, parenteral administration is called:

• injection, which uses conventional injections;
• infusion or with the help of droppers.

But not every one of us will guess that rubbing the skin or mucous membranes with gel, ointment and cream, instilling drops in the eyes or nasal passages, we use what is called "parenteral administration."

The advantage of parenteral drug administration

The great advantage of parenteral administration of drugs over enteral (administration through the esophagus or rectum, absorption in the mouth) is that the latter method is accompanied by a complex complex of biochemical interactions that subject the drug, at times, to strong modifications. Factors such as the aggressive environment of the duodenum and stomach, a number of certain chemical reactions, and so on, are capable of so distorting the initial chemical composition of the introduced medicinal substance that it, as a result, can acquire properties that do not always correspond to the full therapeutic focus. In addition, the effect of the drug in this case may not give any result for up to several hours. But, when we inject a drug directly through the bloodstream, a significant acceleration and simplification of its delivery to the desired body systems is achieved. In addition, the dosage of the active substance is reduced, as well as the cost of medicines.

It should also be noted that many drugs (as well as food products) can harm the digestive system: infect the liver, cause stomach ulcers, damage mucous membranes, cause heartburn, and much more. Based on this factor, parenteral administration of the substance can be considered the safest.

In addition, this method significantly expands the contingent of patients who need help and find themselves practically in the unattainable possibility of treatment by other methods. These patients include infants, weakened, unconscious, and so on. In the same cases, parenteral nutrition can also be used, that is, the introduction into the body through the bloodstream of components and vitamins that support metabolism and replace food intake in the usual way. Thus, the patient's body can receive water, proteins, glucose, water-salt solutions, etc.

Disadvantages of parenteral drug administration

But, like any other method or phenomenon, parenteral administration also has some disadvantages. When we introduce a medicinal substance into the body by parenteral infusion or injection, there is a danger that pathogenic bacteria can pass in the same way, infections (for example, life-threatening gangrene) can spread. If the patient can take the pills on his own, then only specialists or persons competent in a similar field need to give injections and put droppers. It is very important to maintain a number of sanitary rules for strict control over the sterility of instruments and solutions, and to handle the area of ​​injection or infusion.

In addition, this method of administration is also traumatic. An inadvertently made injection can lead to rupture of capillaries, hematomas, bruises in the injection area. The properties of some drugs do not allow them to dissolve well enough, which leads to nodule in the injection site.

In many cases, the psychological factor or the emotional sphere of the patient manifests itself. Perhaps there are few who are absolutely not afraid of injections. In addition, this is another factor that interferes with the correct administration of the injection. But the patient's fears may be natural. For example, many patients are not without fear that during the injection, small air bubbles can enter the vein along with the medicine and disrupt the normal function of blood flow. This condition is called embolism. But most often it occurs due to blood clots, blood clots, and so on. Embolism can sometimes be fatal. The qualifications of the doctor, the correct technique of infusion and injection, sufficiently guarantee that these small air bubbles cannot enter the patient's bloodstream.

As a rule, there are no complications with parenteral nutrition, as with the introduction of other drugs through the central veins. It can be accessed through the subclavian or jugular vein into the superior vena cava.

Since this procedure is safe, the technology of parenteral drug administration is widely used in medicine.

What it is

Our body is able to absorb and process substances that enter it through the gastrointestinal tract, skin and mucous membranes. Of course, there are many medicines in the form of tablets, suppositories, ointments, but their use is not always effective, since it is impossible to accurately determine the dosage for each substance, to establish the time of intake and excretion, as well as the concentration.

As drugs for parenteral administration, multivitamins, iron preparations are used:

• Protein hydrolysates;
• Fat emulsions;
• Energy solutions - carbohydrates in the form of a glucose solution, alcohols, fats.

Many drugs are poorly absorbed from the skin or from the intestines, others are destroyed when passing through the liver, therefore, the peculiarities of parenteral administration of drugs have long been of interest to doctors. Parenteral drug administration, what does it mean?

Views

The technique provides for parenteral injection of the drug directly into the tissues, blood vessels, and body cavities. This is done using a syringe, an infusion system. There are several different types of ways in which drugs are introduced into the body:

• Intravenous (it is most advisable to administer drugs through the central veins);
• Intraosseous (used very rarely)

The most commonly used parenteral intravenous or intramuscular method for injecting drugs.

Advantages and disadvantages

There are advantages and disadvantages of parenteral drug administration compared to other methods:

• the drug quickly enters the body, its intake is not associated with the work of the gastrointestinal tract (absorption, destruction by digestive enzymes);
• the agent does not pass through the hepatic barrier, which ensures dosage accuracy;
• the method of entering the body does not depend on the condition of the patient, which allows it to be used in seriously ill patients and in emergency situations;
• solutions for parenteral administration are easy to dose.

The disadvantages include the possibility of complications, for example:

• formation of infiltrate, abscess, hematoma, tissue necrosis at the injection site;
• air or oil embolism;
• phlebitis or venous thrombosis;
• infection with the development of sepsis, hepatitis, AIDS;
• allergy to the drug with the development of allergic reactions, up to allergic shock;
• lipodystrophy;
• errors in drug injection.

Of course, such complications are possible, but many of them can be avoided if the technology is followed correctly.

How to administer drugs correctly

Each medication must be used according to the instructions and the algorithm for parenteral administration of drugs must be followed:

• you cannot enter a medicine intended for intramuscular administration (for example, oil preparations - intravenously);
• you need to follow the rules of antiseptics: wash your hands, use sterile instruments, process the injection site;
• with intravenous injections, you need to be careful not to get air into the vein;
• before introducing the drug, it is necessary to check the expiration date, dosage;
• before prescribing a medicine, individual intolerance, allergies in patients must be taken into account;
• with the development of complications, you need to immediately help the patient.

Without the possibility of injecting medications, many serious conditions and diseases cannot be cured, but they must be used correctly so as not to cause complications in the patient.

I created this project to tell you in simple language about anesthesia and anesthesia. If you received an answer to your question and the site was useful to you, I will be glad to have support, it will help to further develop the project and compensate for the costs of its maintenance.

Parenteral (bypassing the digestive tract) administration of drugs is carried out by injection.

Injection- the introduction of medicinal substances using a special injection under pressure into various environments of the body. Injections can be performed in tissue (skin, subcutaneous tissue, muscles, bones), in vessels (veins, arteries, lymphatic vessels), in cavities (abdominal, pleural, heart cavity, pericardium, joints), in the subarachnoid space (under the meninges) , into the paraorbital space, spinal (epidural and subarachnoid) administration is also used.

Injections are indispensable in the provision of first aid, when a quick effect is required, while vomiting, difficulty in swallowing, the patient's unwillingness or his unconsciousness do not prevent the administration of the drug.

The speed of action and greater accuracy of dosage, exclusion of the barrier function of the liver and, as a result, the entry of the drug into the blood unchanged, maintaining the required concentration of drugs in the blood - these are the main advantages of the parenteral route of drug administration.

Syringes and needles are used for injections. Injections are performed with syringes of various capacities - 1, 2, 5, 10, 20 milliliters. Currently, single-use syringes made of pyrogen-free plastic and sterilized at the factory are widely used. Also used are the so-called needleless injectors, which allow you to inject intradermally, subcutaneously and intramuscularly a medicinal substance without the use of needles. The action of the needleless injector is based on the ability of a jet of liquid, supplied under a certain pressure, to penetrate the skin. This method is widely used in mass vaccinations.

Injection needles are made of stainless chromium-nickel steel, one end of the needle is cut obliquely and sharpened, and at the other end there is a brass (plastic) cannula, which is tightly put on the needle cone of the syringe. Needles for intradermal, subcutaneous, intramuscular, intravenous injections differ significantly in length, section, sharpening shape and must be used strictly as intended. The needle for intravenous injection has a cut at an angle equal to 45 degrees, since with a more blunt cut it is difficult to puncture the skin, and therefore the vein escapes from the needle, and with a needle with a sharper cut it is easy to immediately pierce both the anterior and posterior walls of the vein. For subcutaneous and intramuscular injections, the cut angle is sharper.

Intradermal injection - the most superficial, used for diagnostic purposes for staging the tuberculin Mantoux reaction, various allergic tests, as well as at the initial stage of local anesthesia. The site of the intradermal injection is the inner surface of the forearm. After disinfection of this area with an antiseptic solution (70% ethyl alcohol, alcohol solution of chlorhexidine bigluconate), the end of the needle is inserted with a cut upwards at an acute angle, almost parallel to the skin, to a shallow depth so that only its lumen is hidden. With the correct technique of its implementation, a tubercle in the form of a "lemon crust" remains at the site of the intradermal injection.

Subcutaneous injection - deeper, it is performed to a depth of 15 mm. With its help, medicinal substances are injected, which are well absorbed in the loose subcutaneous tissue. The most convenient sites for subcutaneous injections are the outer surface of the shoulder and thigh, the subscapularis, and the anterior abdominal wall (heparin administration). The surface of the skin, where the injection is going to be given, is treated twice with sterile cotton balls with alcohol, at the beginning a large area, and then directly at the injection site. With the left hand, the skin at the injection site is taken into a fold, with the right hand a needle is inserted under the skin into the base of the resulting triangle to a depth of 10-15 mm at an angle of 45 degrees to the skin, with a cut up. After the injection of the drug, the needle is quickly removed, the injection site is again wiped with alcohol and pressed with a cotton ball.

It should be remembered that some solutions (for example, calcium chloride, hypertonic sodium chloride solution), when administered subcutaneously, cause necrosis of subcutaneous adipose tissue.

Intramuscular injection is performed in places where the muscle layer is well developed: in the upper-outer quadrant of the buttock, the antero-outer surface of the thigh, the subscapularis. When administered intramuscularly, the drug quickly enters the bloodstream due to the greater number of vessels and muscle contraction than in the subcutaneous tissue.

The gluteal region is conventionally divided into 4 quadrants. Intramuscular injection is recommended only in the upper outer quadrant, which includes the gluteus maximus, gluteus maximus, and minimus muscles. Injections cannot be made into the upper-inner and lower-outer quadrants, since most of the quadrants are occupied by bone formations (respectively, the sacrum, the head of the femur), and the muscle layer here is insignificant. In the lower-outer quadrant, the neurovascular bundle passes; therefore, intramuscular administration of medicinal substances in this zone is not carried out.

The position of the patient during the injection is lying on his stomach or on his side. The skin is twice treated with a cotton ball moistened with alcohol, at the beginning a large area of ​​the upper-outer quadrant, then directly the injection site. The skin in the injection area is stretched, and a needle 8-10 cm long with a wide lumen perpendicular to its surface is quickly inserted into the muscle to a depth of 70-80 mm. Just before the injection of the drug, it is necessary to slightly pull the syringe plunger towards you and make sure that the needle does not enter the blood vessel. In the absence of blood flow into the syringe, the solution is slowly injected, after which the needle is removed. In order to improve the resorption of the drug, it is recommended to lightly massage the injection site or put a warm heating pad.

Intravenous injection more often used in the provision of emergency medical care. Intravenous injections are most often performed with the help of venipuncture (percutaneous injection of a needle into a vein), less often - with the use of venosection (operative opening of the lumen of the vein). These manipulations are the most responsible, since the concentration of medicinal substances in the blood after intravenous administration increases much faster than when using other methods of administering medications; however, mistakes in intravenous injection can have very serious consequences for the patient.

Venopuncture is carried out with the aim of taking blood for various studies and for bloodletting, for intravenous administration of drugs, blood transfusion and blood substitutes. It is most convenient to perform intravenous injections into the veins of the elbow bend, in some cases superficial veins of the forearm, hand, popliteal zone, temporal region (in children), and sometimes the veins of the leg are used.

When performing an intravenous injection, it is necessary to constantly remember that the drug enters the bloodstream immediately, and any mistake (violation of asepsis, drug overdose, entry of air, an oil preparation into a vein, erroneous administration of a drug) can become fatal for the patient.

The length of the needle for intravenous injection is 40 mm, the inner diameter is 0.8 mm, while the cut of the needle should be at an angle of 45 degrees to minimize the likelihood of injury or puncture of the opposite wall of the vein.

During venipuncture, the patient sits or lies. The arm should have a firm support and lie on the table or couch in the position of maximum extension in the elbow joint, for which an oilcloth pillow is placed under the elbow, and when bloodletting - and a diaper.

Vein preparation is very important for the success of venipuncture. It is easiest to puncture a well-filled vein. To do this, 1-3 minutes before the puncture, a rubber tourniquet is applied in the middle third of the shoulder and the outflow of blood from the vein is blocked, while the pulse on the radial artery should not change. The tourniquet is tied so that its free ends point up and the loop down. If the pulse on the radial artery is weakened, the tourniquet should be slightly loosened. If the ulnar vein is poorly felt, the skin below the tourniquet does not acquire a cyanotic color, the tourniquet should be tightened tighter. For more filling of the veins, the patient is offered to squeeze and unclench the brush several times.

Before the venipuncture, the nurse performs hygienic hand disinfection. She carefully treats the skin of the patient's elbow bend with sterile cotton wool moistened with alcohol, until slight hyperemia appears, with movements from the periphery to the center, determining the filling of blood vessels and choosing the most filled and superficially located vein. It is better to choose the injection site in the zones of bifurcation branches, since in this zone the vein is most fixed, especially for elderly patients with processes of sclerosis of the vascular bed.

A vein puncture can be performed in two stages or simultaneously. It is better for beginners to use the two-step method. Holding the needle with the right hand with a cut upwards parallel to the intended vein and at an acute angle to the skin, only the skin is pierced - the needle will lie next to the vein and parallel to it, then the vein itself is pierced from the side; this creates the feeling of falling into emptiness. When the needle is in the vein, droplets of blood will appear from the cannula, then the tourniquet is removed, and the needle is advanced a few millimeters forward along the vessel. Attach a syringe to the needle and slowly inject the medicinal solution, leaving 1-2 ml in the syringe. If the needle is already connected to the syringe, to control its position, pull the syringe plunger towards yourself several times, while the appearance of blood in the syringe will confirm the correct position of the needle. The one-step method of venipuncture requires a lot of skill. In this case, the skin is pierced over the vein and simultaneously with it. The angle between the needle and the skin, sharp at the beginning of the puncture, decreases during the insertion of the needle, and its advance into the vein after it enters the vein is accomplished when the needle moves almost parallel to the skin. Pulling the plunger on the appearance of blood in the syringe, make sure that it is in the vein, and, removing the tourniquet, inject a medicinal substance.

After the completion of the administration of the drug, the needle is quickly removed, the skin of the injection site is re-treated with alcohol and a sterile cotton ball is pressed against it for 2-3 minutes or a pressure bandage is applied to this area.

BIOLOGICAL SAMPLING TECHNIQUES

MATERIAL

When instructing a patient about the procedure for taking biological material for research, it is necessary to give instructions clearly, intelligibly and slowly. If the patient finds it difficult to repeat them, you should make short memorial notes for him on a sheet of paper. It is necessary to convince the patient that only careful, scrupulous adherence to the rules for collecting material for analysis is the key to a correct diagnosis.

When collecting biological material, precautions should be taken. Direct contact with biological material must be avoided. You need to work only with rubber gloves, try not to break laboratory glassware and not injure yourself with glass shards. Patient excretions must be decontaminated before being discharged into the sewer system. Laboratory glassware, vessel and urinals, stool loops, etc. should be thoroughly disinfected.

If the patient's secretions get on their bare hands, it is necessary to perform their hygienic disinfection using one of the methods used in this medical institution. Compliance with these rules will prevent the transmission of various infectious agents from patients, including HIV infection.

In general, the algorithm for the collection, labeling and transportation of biological materials can be presented as follows:

Prepare the place of work in compliance with the rules of asepsis;

Perform hygienic hand disinfection, wear sterile gloves;

Take a sufficient amount of biological material in compliance with the rules of asepsis, while it is not recommended to talk, sneeze, cough;

Place biological material in a sterile container;

Attach a label indicating the name of the patient, diagnosis, department, ward, date and time of receipt of the material, the purpose of the study;

Correctly store and timely transport biological material to the laboratory.

1. Taking blood for clinical, biochemical, bacteriological, immunological tests, as well as for sugar is done in the morning on an empty stomach. The test tube must be dry, chemically clean, and have a ground-in rubber cap. It is forbidden to draw blood without a syringe using only one needle.

2. General analysis of urine: the morning average portion of urine is used in the amount of 100-200 ml after a preliminary thorough toilet of the external genital organs. If it is necessary to establish the source of possible changes in the urine, a two- or three-glass test is used (the patient urinates in sequence in three vessels in the morning).

3. Kakovsky-Addis test: the day before the patient urinates for the last time in the evening, and the next day at 8.00 all urine is collected (in women by a catheter) and immediately sent to the laboratory.

4. Nechiporenko's test: only an average one-time portion of freshly released urine is used.

5. Zimnitsky's test: it is used to assess the concentration function of the kidneys during normal eating and drinking. Urine is collected every 3 hours in a separate dish, and the daily (from 6.00 to 18.00) and night (from 18.00 to 6.00) diuresis are taken into account separately.

6. Urine analysis for 17-ketosteroids: taken from a daily amount of 200 ml of urine in a 500 ml sterile jar with a plastic lid. The direction indicates the daily amount of urine.

7. Bacteriological examination of urine: a sterile tube is filled with an average portion of freshly released urine in the amount of 10 ml and sent to the bacteriological laboratory.

8. Laboratory examination of feces: feces for examination should be collected in the morning after sleep. The patient empties the intestines into a clean vessel, then puts a small amount of feces with a spatula in a clean, dry glass jar, which is sent to the laboratory. To study feces for eggs of worms, it is necessary to take feces in a warm form from three places.

9. Taking a smear from the pharynx: hold a sterile cotton swab along the arches and palatine tonsils, without touching the mucous membrane of the mouth and tongue. Then carefully insert a sterile swab into the tube, without touching its walls, label the tube.

10. Taking a swab from the nose: with light translational-rotational movements, successively insert a sterile cotton swab into the lower nasal passage from one side and then from the other side. Next, place the swab in a test tube and mark it. The tube should be immediately taken to the bacteriological laboratory.

11. Collection of sputum for general analysis: sputum is collected in the morning on an empty stomach. Before collecting it, the patient needs to brush his teeth and rinse the mouth with boiled water. It is necessary to collect sputum after a cough push into the spittoon, close the lid and deliver it to the laboratory no later than 1 hour after collection.

PREPARATION OF PATIENTS FOR X-RAY,

ENDOSCOPIC AND ULTRASONIC

RESEARCH

The reliability and effectiveness of the results of additional research methods to a large extent depends on the quality of patient preparation for these research methods.

X-ray examination stomach and duodenum plays an important role in the diagnosis of pathology of the upper gastrointestinal tract. Currently, the generally accepted technique is the point of view that patients with normal gastrointestinal tract function do not need special preparation for X-ray examination of the stomach, which is performed on an empty stomach. Only if the patient has organic stenosis of the pyloric stomach, before examination, the stomach should be flushed for 2-3 hours. Preparation for conducting endoscopic examination of the stomach and duodenum . Routine esophagogastroduodenoscopy is performed in the morning on an empty stomach; emergency research is performed at any time of the day, if necessary, before EGDD, gastric lavage is performed to "clean" wash water.

X-ray and endoscopic examination of the colon (respectively, irrigoscopy and colonoscopy) are the leading methods for diagnosing diseases of the colon and rectum and require careful preparation of the distal gastrointestinal tract. The classic way preparation of the colon for the study is the following. On the eve of the study, the patient is given 30 g of castor oil before dinner, and in the evening, a cleansing enema is given twice with an interval of 1 hour. The patient does not eat supper. In the morning, two cleansing enemas are given again.

Currently, the drugs "Duphalac" and "Fortrans" are becoming more and more widely used in order to prepare the colon for research (as well as for surgery).

On the eve of the study, the patient must follow a special "cleansing" slag-free diet. You can not eat meat products, poultry, fish, cereals and cereals, bread and pasta, vegetables and fruits in any form throughout the day; it is allowed to consume only clear liquids during the day - mineral water, tea without sugar, transparent broth.

When using the drug "Duphalac" at 13:00, dilute 100 ml of the drug in 1-2 liters of water, within the next 4 hours, drink this first portion. The patient should develop mild painless diarrhea. At 19-20 hours, dilute 100 ml of the drug "Duphalac" in 1-2 liters of water, also drink this portion. Moderate painless diarrhea will continue, and the washout fluid should gradually become clearer and without additional symptoms.

When using Fortrans, the contents of 4 sachets should be dissolved in 1 liter of water each and stirred until completely dissolved. The resulting solution should be taken in a dosage of 1 liter per 15-20 kg of body weight, which approximately corresponds to 3-4 liters. The solution can be taken once, 4 liters in the afternoon on the eve of the study, or divided into 2 doses (2 liters the night before and 2 liters in the morning), while taking the drug should be finished 3-4 hours before the study.

The amount of liquid drunk by the patient, taking into account the volume of broths or juices drunk, should not be less than 4 liters!

Ultrasound examination (echography) found wide application in the diagnosis of diseases of the abdominal cavity and retroperitoneal space. This study is carried out, as a rule, in the morning on an empty stomach, preparation is usually reduced to combating flatulence, which is achieved by prescribing the above-mentioned diet before the ultrasound examination and using activated carbon or carbolene (0.5-1 g 3-4 times a day).

FIRST AND PRE-MEDICAL CARE