HOW TO PUT AN INJECTION
In case of urgency the need to administer by intramuscular injection may arise, a drug whose elementary principles it is convenient to know.
Injections represent the method of introduction into the body of drug substances by a route other than the digestive route.
The advantage of such a method lies in the possibility of obtaining a rapidly effective therapeutic action.
The injections can be: intramuscular, subcutaneous, intradermal and intravenous
The syringe. It consists of a cylindrical body, called a shirt, through which a plunger runs. The end ends in a funnel to which the needle cone fits.
The gradation (in cubic centimeters) is on the body of the syringe.
For injection, the syringe should be:
sterile; Proportional to the volume to be injected: the gradation allows an exact dosage; Hermetic: to avoid losses during handling.
The needle. One end has a cone that fits the syringe funnel; The other is cut short or long. There are different diameter and lengths.
The use of single-use needles and syringes tends to be generalized, to the undoubted benefit of the patient, in that it reduces the risk of infection and avoids the task of sterilization.
Injectable drugs have two forms of presentation: in solution: aqueous, oily; powdered.
The products are sterile and present in ampoules or closed vials with a rubber stopper fixed with a metal cap.
If the drug is present in solution, it is necessary to: mount the syringe, adapt a large-caliber needle to the syringe and cause all the liquid to reach the body of the ampoule by shaking it lightly. Disinfect the neck of the blister and lime, saw it and break it, keeping it resting on cotton to protect the fingers. In case of pre-filled blisters, disinfect and break directly;
Hold the ampoule between the forefinger and thumb of the left hand and insert the needle, without supporting it on the outside and holding the syringe between the thumb and the ring of the right hand; Pulling the plunger by lever over the projection of the shirt: the liquid will pass into the syringe; If the needle does not reach the bottom of the blister, tilt it and continue sucking; Mount the needle most suitable for injection; In the case of solutions contained in vials with a rubber stopper it is necessary to jump the metal protection and disinfect the rubber with alcohol; After having aspirated with the sterilized syringe both air and liquid to be injected, the rubber is pierced with the needle, the air is injected into the vial and the medication is aspirated.
If the drug is in the form of a powder, it is necessary to extract as necessary the required volume of physiological solution or double distilled water; Disinfect the cap with a strong antiseptic (iodized alcohol type) and insert a large gauge needle; Introduce the liquid: if the dilution is immediate, allow the liquid to flow back into the syringe or separate from the needle and shake the vial until complete dilution; Introduce air into the syringe, inject it into the vial and let the plunger retract; Mount the needle most suitable for the injection: first expel the air from the syringe and the needle, leaving a drop of liquid.
It is the introduction of the drug solution into muscle tissue.
Choice of injection point.
Choose muscular masses deep, away from the course of nerves and vessels. The choice points are the muscles of the thighs and glutes.
In the buttocks: to avoid puncture of the sciatic nerve, perform the injection in the upper outer quadrant. To delineate it, draw a horizontal line from the top of the groove of the buttocks to the iliac crest and then a vertical line that divides the anterior line in two.
In thighs: The injection is applied to the outer side of the thigh, at an equidistant point between the major trochanter and the knee.
Subspinous region of the scapula (diseased plaster).
Arm deltoid region.
Depending on the point of injection, place the patient on the side (knee flexed) or on the belly.
Disinfect the hands and disinfect the patient’s skin.
Tighten the skin with two fingers, insert three-quarters of the needle with a dry blow, aspirate with the plunger to check that the needle has not been inserted into a vessel and gently inject the liquid.
Press the skin near the needle with a cotton swab soaked in a disinfectant and withdraw the needle and syringe at the same time.
Maintain the compression for a few minutes, checking that there is no loss of blood, in which case it should be compressed for a certain time to avoid the appearance of hematome.
Note the assistance provided. Control. It is mainly done in function of the therapeutic activity, the inconveniences and the accidents attributable exclusively or mainly to the drugs. To check the possible access, check the thermal curve. The most common local complications are: hematomas: a complication that constitutes a contraindication to intramuscular injections when the prothrombin value is too low; Hard nodules due to poor absorption of the liquid; Septic abscesses due to errors in disinfection and sterilization.
Consists of the introduction of a drug solution into the subcutaneous or hypodermic tissue. Volume to be injected. 5 cm3 is the maximum for a single injection.
Choice of injection point
. Halfway between the patella and the groin. External side of the thigh (avoid inguinal area). External arm face; Subspinous or supraspinous area of the scapula. Abdominal wall (left only). In case of repeated injections, it is advisable to change the inoculation point every day to facilitate the correct absorption of the injected liquid.
Correctly position the patient according to the injection site. Disinfect your hands carefully and also disinfect the patient’s skin. Take a pinch of skin to form a thick fold, insert the needle (mounted on the syringe) with firm gesture at the base of the fold. Relax your fingers, make sure the needle can move, suction to check that no glass has been drilled. Inject the liquid slowly.
Remove the needle and syringe at the same time, holding cotton with disinfectant on the skin at the injection site. Control. The reader is referred to local and general measurements of intramuscular injections.
It is the introduction of the drug into the thickness of the dermis. Injection point. Inner side of the forearm. Injection technique. The patient’s forearm should be firmly supported on some surface. Disinfect the hands and skin of the patient. Grasp the forearm by stretching the skin with the thumb; Place the needle superficially under the skin, with the needle hole facing up.
As soon as it has disappeared under the skin, introduce the liquid. The injection must form a papule, which remains after withdrawing the needle. Remove the needle and syringe with a quick gesture. Control. Locally the injection provokes an itchy reaction, sometimes even of a very intense nature: to warn the patient that he should not scratch and not to clean the area, because it would falsify the reading of the test.
Special subcutaneous injections
Delayed heparin is injected with an already prepared syringe containing the exact amount of the product to be injected (Calciparin: 0.2, 0.3, 0.5, 0.8, 1 ml). The needle must be inserted perpendicularly (as in intramuscular injections, but without giving a dry blow) in a raised skin fold with two fingers (thickness of the base of the fold: 4 cm).
- Inject and maneuver smoothly to avoid causing bruising. Insulin is injected with a needle of 12 mm in length and 4/10 gauge. Needles already prepared on “insulin syringes” are usually too thick and too long (5/10 and 16 mm). They are therefore used to extract the drug from the vial and are then replaced by more suitable ones.
The injection is done as in the case of heparin, perpendicularly (as in intramuscular injections), lifting a wide skin fold. The correct injection: should not cause pain; Should not bleed; You should not leave a bubble; Should not cause bruising. It is necessary to change the injection point every time.
Special subcutaneous injections Delayed heparin is injected with an already prepared syringe containing the exact amount of the product to be injected (Calciparin: 0.2, 0.3, 0.5, 0.8, 1 ml).
The needle must be inserted perpendicularly (as in intramuscular injections, but without giving a dry blow) in a raised skin fold with two fingers (thickness of the base of the fold: 4 cm). Inject and maneuver smoothly to avoid causing bruising. Insulin is injected with a needle of 12 mm in length and 4/10 gauge.
Needles already prepared on “insulin syringes” are usually too thick and too long (5/10 and 16 mm). They are therefore used to extract the drug from the vial and are then replaced by more suitable ones.
The injection is done as in the case of heparin, perpendicularly (as in intramuscular injections), lifting a wide skin fold. The correct injection: should not cause pain; Should not bleed; You should not leave a bubble; Should not cause bruising. It is necessary to change the point of iny each time