urinary catheter. Types of urinary catheters and methods of their introduction

In the article, we will consider how to put a urinary catheter in a woman.

People very often have to get acquainted with a wide arsenal of various medical instruments. And one of them is a urinary catheter for women and men. What is it and why is it generally used?

Main purpose

Why is a urinary catheter required for women and men? In urology, catheters of various shapes and sizes are used to perform certain activities. For each patient, the device is selected individually. At the outlet, such a probe, as a rule, is connected to a drainage bag, that is, directly to a collector designed to collect urine.

The bag is fixed on the patient's leg so that he can move freely and the collector can be used throughout the day. At night, larger containers are used, hanging from the bed.

The indications for the procedure are:

• The need to obtain bladder urine for analysis.
• The presence of inflammatory diseases of the bladder in women.
• The appearance of acute or chronic urinary retention.

Description

The catheter is a tube designed to create a kind of passage between the internal cavities of the body and the external environment. An instrument is used to inject therapeutic solutions, and, in addition, to wash the organ, perform surgical procedures.

A urinary catheter for women and men is required to achieve forced emptying of the organ. For example, catheterization may be required immediately after childbirth, when a woman in labor is unable to urinate on her own for the first time. Sometimes the procedure is performed against the background of damage to the bladder. For example, due to injury, the lumen often closes, and urine is not naturally excreted from the human body. In a number of situations, the use of female urological catheters is required in the process of conducting an examination to make a diagnosis. It is often necessary:

• Determination of the amount of urine present in the bladder.
• Obtaining a sterile portion of urine for analysis.
• Performing radiography of the urethra and bladder by introducing a contrast component into the organs.

Types of catheters

There are many types of urinary catheters available today. The type of medical instrument chosen directly depends on the specific case, for example:

• A device called the "Foley catheter" is applicable for long-term catheterization (when patients are in a coma). It is also suitable for short-term manipulation. It is used for the purpose of washing, eliminating blood clots, diverting urine, and so on.
• "Nelaton's catheter" is designed for periodic catheterization in situations where the patient cannot independently carry out the process of urination. Until the invention of the Foley catheter, this device was intended for permanent use.
• A device called the "Pezzer catheter" is well suited for maintaining continuous catheterization and drainage of urine through a cystostomy. This tool, unfortunately, has quite a few shortcomings, in connection with this, they work with it only in the absence of other possibilities.

Which ones are used more often?

Urinary catheters are currently predominantly flexible. Metal models are rarely used. The fact is that they are less comfortable for the patient and not very convenient to use. Catheters are necessarily fixed after insertion, the doctor chooses the technique for this and is guided by the characteristics of a particular situation.

The difference between female and male models

The difference between the female and male urological catheter is determined by the anatomical feature of the body. Although the purpose of the devices can be said to be the same, they still differ in structure:

• Male models are intended for insertion into narrow and curved urethra, because the tube is made thin and long.
• The urinary catheter for women is made with the expectation of a short, wide and straight urethra, so that such an instrument is endowed with the appropriate characteristics, that is, a relatively large diameter, small length and the complete absence of any bends.

Today, urological catheters are available in most medical stores. Usually, in the description for each such product, it is indicated for which gender of the patient this or that instrument is designed. The approximate cost of the product is from nine to two and a half thousand rubles. The price largely depends on the type of catheter, and at the same time on the place of purchase and the material of manufacture.

How is a urinary catheter placed in a woman?

Installation Features

By itself, such a procedure is not at all difficult, since the female body is very convenient for inserting a tube. For example, in a man, in order to be able to get to the bladder, it will be necessary to overcome the genital organ. But in women, the urethra is located directly behind the labia.

Let's take a closer look at how a catheter is placed in the bladder of a woman.

Before the catheterization procedure, the patient should take a shower, wash thoroughly and come to the room for manipulation. In the event that the procedure is carried out to collect urine, then at first the doctor or nurse may try to do without inserting an instrument into the urethra. For this:

• The patient needs to lie down on the couch, on which a diaper or oilcloth is preliminarily spread.
• Next, the bent legs must be spread apart so that a vessel can be placed between them in order to accumulate urine.
• A warm heating pad is placed on the lower abdomen of the patients. It helps stimulate reflex urination. For similar purposes, the genitals can be watered with slightly heated water.

Stages of catheterization

How to insert a urinary catheter in a woman, what are the steps of the procedure? In cases where urination could not be provoked, doctors proceed to the catheterization procedure. It includes the following main steps:

• Disinfection of the urethra.
• Careful insertion of the catheter into the urethra at a distance of five to seven centimeters. In this case, the doctor will need to keep the patient's labia divorced.
• Collection of urine that flows through the tube into a container prepared for this.
• Then, if necessary, the following procedure is performed (that is, the bladder is washed, drugs are administered, etc.).

How to put a catheter in the bladder of a woman, every specialist with the appropriate qualifications knows.

What are the inconveniences?

Despite the fact that catheterization is much less unpleasant for women than for men, nevertheless, manipulation of this kind is quite stressful. Many patients do not experience much pain or any other physical discomfort, but they absolutely always have to experience obvious psychological discomfort. A good doctor manages to create a trusting, but at the same time calm atmosphere in which women feel relaxed. It is very important that the patient is not afraid and not shy, then the procedure will be very easy, painless and fast enough.

In simple situations, catheterization can be performed by a nurse, for example, when a diagnosis needs to be confirmed. In the event that the manipulation is performed for medicinal purposes, then only a qualified doctor should work. Catheterization is important to be done very carefully, as a sharp or too fast movement can damage the urethra, provoking an inflammatory process (like cystitis or urethritis).

The female urinary catheter is one of the achievements of medicine, whose importance is very great, and it is difficult to overestimate it. Thanks to this simple device, diseases of the urinary system simply cease to be difficult for people: they are easier to recognize and treat. It would be superfluous to remind about patients suffering from severe brain or back injuries, when the use of a catheter is one of the main conditions for providing full-fledged patient care. How to insert a catheter into the bladder of a woman is now clear.

What pathologies require catheterization?

So, catheterization of such an organ as the bladder in women is a procedure necessary in some cases with the development of pathologies of this organ. The procedure itself involves the introduction of a catheter in the form of a flexible latex tube, which can also be made of silicone or Teflon. Such a tube is able to pass through the urethra directly to the bladder.

Often, the need for the described event in women arises in the postoperative periods against the background of gynecological or diseases. Catheterization is performed to control the amount of urine produced. In addition, it can contribute to the healing of postoperative wounds.

In some situations, the procedure is required by patients for washing in case of bleeding, administration of medications, detection of general obstruction, urine output due to neurological pathologies (paralysis), incontinence or delay in a number of certain diseases.

For cancer

Bladder cancer, which is often diagnosed in women, often requires the insertion of a catheter. Typically, such a disease can develop against the background of papillomas. In this case, as a rule, in the urine of patients there is an excessive amount of blood, which is very easily detected in them even with the ordinary naked eye.

Often, cancer is diagnosed in smokers and those who work with aniline dyes. Often, such a pathology is also formed against the background of chronic inflammation of this organ, after irradiation, and in those who often do not urinate on demand. Various sweeteners and a number of medicines also have an effect.

We looked at how to put a urinary catheter in a woman. This procedure is very useful, necessary for carrying out in the presence of pathologies of the bladder.

Catheterization is the procedure of inserting a catheter (for men and women) into the bladder through the urethral canal. Catheterization is used quite often and is used for the purpose of diagnosis and therapy.

Rules for installing a catheter

The catheter can be installed for a short period of time, for example, a short-term installation of a catheter is necessary for surgical intervention, and for a long time, if the patient has difficulty urinating. The latter can be caused by certain diseases.

The male can be affected by various pathological processes resulting from infection, trauma, and neoplastic syndrome. Violation of urination can provoke the development of such unpleasant consequences as kidney failure and infertility. In this article, we will consider in detail the algorithm for bladder catheterization in men.

Indications for the procedure

The catheter may be inserted for diagnostic purposes:

1. To obtain samples of urine in the cavity of the bladder. The samples are further used in laboratory research, for example, to determine the microflora of the bladder.
2. In order to determine the volume of urine that is excreted, to observe its organoleptic characteristics.
3. To determine the level of patency of the urinary tract.

During treatment

In addition, catheterization can be performed in the treatment of:

1. When restoring the urethra after surgery.
2. In the presence of decompression of the bladder.
3. In the presence of an acute urinary retention, which may occur against the background of urethritis, a pathological change that affects the prostate gland.
4. In order to treat the walls of the bladder with medicinal solutions.
5. With chronic obstruction, which can be caused by hydronephrosis.
6. For the purpose of excreting urine, if the patient is not able to perform the act of urination. For example, if the patient is in a coma.

The algorithm for catheterization of the bladder in men is quite complicated, but patients should not cause fear for their health, since experienced specialists are trusted to carry out this procedure.

Contraindications for catheterization

Despite the fact that there are many indications, catheterization can not always be performed. There are some contraindications:

• The presence of blood in the scrotum.
• The presence of bruising in the perineum.
• presence in the blood.
• Injured condition of the bladder.
• Injured condition of the urethra.
• Prostatitis in acute form.
• Anuria.
• Some diseases of the genitourinary system, for example, gonorrhea.
• Spasm of the urethral sphincter.
• Acute inflammatory processes occurring in the bladder or urethra.
• Fracture of the penis.

Features of catheterization in men

Due to the anatomical features of the urethra in men, only experienced specialists should perform the catheterization procedure. Difficulties in conducting catheterization arise due to the fact that the male urethra has a relatively large length, about 25 centimeters. In addition, there are two physiological constrictions in the urethra that prevent the free insertion of the catheter. Also, it is very narrow.

The greatest care must be taken if the procedure is performed using a metal catheter. If excessive force is applied during the manipulation, then the walls of the urinary system can be damaged, as a result of which the occurrence of false passages is not excluded.

The algorithm for catheterization of the bladder in men must be strictly observed.

Instruments used in catheterization

For the catheterization procedure, you will need the following tools:

Algorithm for bladder catheterization in men

If the procedure is performed using a soft catheter, then the specialist should perform the following steps:

1. The health worker must first prepare their hands, wash them thoroughly, and treat with a disinfectant solution.
2. The patient is laid on his back, his legs are slightly pushed apart, while the knees should be bent. A tray is required between the legs, and a diaper is placed under the pelvic area.
3. The medical worker should put on sterile gloves, clasp the penis below the head with a sterile napkin. This will open the external opening of the urethra.
4. Next, you need to treat the head with a cotton swab, previously moistened with furacilin. Processing should be carried out in the direction from the urethra to the edge of the head.
5. By squeezing the glans penis, it is necessary to open the external urethral opening. After the hole has opened, a few drops of sterile glycerin are poured into it.

With the help of tweezers, the catheter is captured, and its rounded hole is moistened with vaseline oil or glycerin. The catheter is then inserted into the open urethral opening. With the help of sterile forceps, the first five centimeters of the catheter are inserted, while holding the head.

Immersion of the catheter

It is necessary to immerse the catheter into the urethra slowly, intercepting it with tweezers. In this case, the penis must be pushed onto the catheter with the free hand. This technique will allow you to move the catheter through the urethra with greater ease. In the area at the junction of the membranous part and the spongy part, slight resistance may occur. If it occurs, then it is necessary to pause for two to three minutes to wait for the muscle spasm to disappear, and then continue inserting the catheter.

Physiological narrowing is also present at the entrance of the urethra to the bladder. In this area, the occurrence of re-introduction of the catheter is not excluded.

After the first portion of urine appears, the opposite tip of the catheter must be lowered into the urinal.

Before the end of urination, the bladder must be washed. After that, observing safety measures, the catheter is carefully removed.

After the end of urine output, a Janet syringe filled with a furatsilin solution is attached to the catheter, which is poured into the bladder cavity very slowly. The volume of the injected solution should be about 150 milliliters. After that, the catheter is directed into the tray to remove the liquid. The washing procedure should be carried out until the contents of the bladder become clear.

After flushing is completed, the catheter is removed from the urethra by performing gentle rotational movements. After that, the external opening of the urethra is re-treated with a cotton ball, pre-moistened in a solution of furacilin. At the end of the catheterization procedure, all instruments should be placed in a disinfectant solution.

If the use of a soft catheter does not allow the procedure, then the use of a metal catheter will be required. A similar procedure for introducing a urinary catheter should be carried out exclusively by a qualified doctor, because the technique is very complex, requiring special care and attention.

The patient is placed on his back, the opening of the urethra is treated. I turn the catheter down with the “beak” and advance it along the urethra until it reaches the bladder. To overcome the sphincter area, the penis should be directed along the midline. The catheter is inserted further, slowly moving the urethra in the direction of the instrument.

If the procedure is performed correctly, then there is a discharge into the urine container, while the patient does not experience pain. Due to the fact that catheterization with a metal catheter is quite painful and traumatic, it is rarely performed.

Complications during catheterization

In some cases, some complications may occur, for example:

• Infection of the urinary system. As a result, pyelonephritis, cystitis, urethritis can develop.
• Damage to the urethra, sometimes significant, up to perforation.

Complications may arise due to errors made during the introduction of a catheter, especially a metal one, or due to insufficient preliminary examination of the patient. Most often, complications arise as a result of a violation of asepsis.

This procedure is prescribed for therapeutic and diagnostic purposes. A urinary catheter is introduced to patients with a variety of urogenital pathologies. Learn about the features of this medical manipulation in men and women.

Types of catheterization

Emptying the patient's bladder is carried out using a special tool that looks like a regular tube. In this case, depending on the condition of the patient, his age and the goals of the procedure, permanent or short-term (periodic) catheters are used. Regarding the former, we can say that they are used for continuous urine diversion. Periodic, or intermittent, devices are designed for a single collection of urine.

In addition, there are the following types of catheterization, or epicystostomy:

• sterile - carried out permanently;
• clean epicystostomy of the bladder - carried out at home;
• using soft rubber tubes (set in most cases);
• catheterization involving the use of hard metal instruments;
• epicystostomy of the renal pelvis:
• ureteral catheterization;
• with access through the urethra or stoma (set after surgery);

Bladder catheterization technique

A nurse can insert a tube made of soft materials, while only a doctor can insert a rigid device. The technique of bladder catheterization involves strict adherence to the rules of septic and antiseptic, which is due to a multiple increase in the risk of secondary urogenital infection. Such consequences are very dangerous for a woman during childbearing.

Bladder catheterization algorithm

Epicystostomy in men and women is carried out the same way. At the same time, the bladder catheterization algorithm in patients of different genders still has its own characteristics. Differences are observed only in the technique of introducing the tube. In general, female epicystostomy is considered a simpler option for manipulation. The installation of a urinary catheter in men is carried out using a long tube and requires some patience from the patient. Nevertheless, with strict adherence to the algorithm of actions, the procedure does not cause the patient any pronounced discomfort.

Bladder catheterization in men

Some complexity of the technique of epicystostomy in the stronger sex is due to the long urethra and physiological constrictions that prevent the introduction of the tube. Bladder catheterization in men with a rigid device is performed only if there are special indications (adenoma, stenosis). It is important to say that in order to relax smooth muscles and ensure further advancement of the instrument, doctors often advise patients to take a couple of deep breaths during the procedure.

Urinary catheter for men

Representatives of the stronger sex have some structural features of the urethra. For this reason, the length of the urinary catheter for men reaches 25-40 cm. In addition, curved tubes are selected for the procedure, repeating the physiological characteristics of the patient's urethra. In addition, the male urinary catheter features a small tube lumen diameter. It is important to note that disposable type devices have recently been used for a single excretion of urine.

Insertion of a catheter into the bladder of a man

Before the procedure, the doctor conducts a short conversation with the patient, during which he explains to the patient the features of the manipulation. As a rule, the installation of a catheter in the bladder of a man, as well as its removal, does not cause pain. Nevertheless, the specialist should warn about the possibility of such sensations. In addition, the male catheterization algorithm is briefly explained to the patient, which is as follows:

1. The patient lies on the couch with his knees bent.
2. Before catheterization, an antiseptic is applied to the surface of the patient's glans penis. Sterile glycerin is instilled into the urethral canal, which also processes the end of the tube.
3. A vessel is placed between the patient's legs to collect urine. When performing a permanent epicystostomy, the patient is knowingly explained what care for the catheter in the bladder includes, and at the end of the procedure, a urinal is installed. It is worth saying that often after surgery, patients are offered to remove the stoma.
4. During catheterization, the doctor takes the tube with sterile tweezers at a distance of about 6 cm from the edge and begins to gradually insert into the patient's urethra. To avoid uncontrolled urination, the urologist holds the head of the penis, slightly squeezing it.
5. When the urethral catheter reaches its intended destination, there is a release of urine.
6. After removing the biological fluid, the tube is connected to a special syringe with a solution of furacilin, through which the doctor flushes the organ. As needed, catheterization can be used to treat urogenital infections with antibiotics and other medications.
7. After the doctor has flushed the bladder through the catheter, the device is removed from the urethra. The removed tube is disinfected. To avoid complications after catheterization, removal of the flushing device is carried out only after the removal of air or water from the fixing balloon.
8. Residual moisture in the form of drops of urine and solution is removed from the genitals with a napkin from a sterile individual set. Within an hour after completion of the procedure, the patient should be in a horizontal position.

Bladder catheterization in women

Epicystostomy in women is considered a simpler option for manipulation, which is due to the presence of a shorter urethral canal compared to the male. In addition, the procedure takes much less time. Bladder catheterization in women in most cases passes without any complications. It is worth noting that when working with ladies it is especially important to create a trusting environment.

Urinary catheter for women

The procedure for the fairer sex is carried out using a short (up to 15 cm) direct device and a syringe, through which the doctor flushes the excretory organ. At the same time, the urinary catheter for women is wider in diameter. In fact, the type of epicystostomy, as well as the nature of the flush, are determined taking into account the age and concomitant diseases of the patient. If the doctor ignores individual characteristics, a variety of complications can occur: from kidney disease to rupture of the urethral canal with subsequent blood poisoning.

Placement of a catheter in the bladder of a woman

Before the procedure, a brief briefing is carried out, during which the doctor tells the patient about the main points of the upcoming manipulation. If the patient's condition requires the doctor to insert a tube for a long period, then it is additionally explained how to use the catheter independently. For diagnostic purposes, the doctor can also pre-percuss the abdomen (suprapubic part) of the patient. The installation of a catheter in the bladder of a woman almost completely repeats a similar procedure in men, with the exception of the type and depth of the tube.

Video: Foley catheter placement algorithm

In order to combat urological diseases, a urinary catheter is used - a system of rubber tubes that is inserted into the bladder through the urethra to control the amount of urine produced or to diagnose its composition. It is also intended for the implementation of the act of urination, if a person has urea dysfunction.

General information

Diseases such as cancer of the genitourinary system, prostate adenoma, urinary retention and kidney ailments entail problems with urine output. One of the methods of their therapy is the introduction of a catheter into the urethra. This is done to drain the bladder and make it easier to urinate. The conductor can be latex or rubber (soft) or plastic, metal (hard). It looks like a straight or curved tube with holes at both ends. At the same time, soft ones have an oblique cut, and hard ones have a handle, a beak and a rod.

Types and sizes

The classification is made depending on the material from which the devices are made, the time spent in the body. The number of channels and organs into which the device is inserted are taken into account. The length of the tube depends on the physiological characteristics of the organism. Female catheters are usually shorter. The optimal length for women is 12-15 cm, for men - about 30 cm.

According to the material of manufacture, they distinguish:

• elastic (rubber);
• soft (made of latex or silicone);
• hard (plastic or metal).

Depending on the length of stay in the ureter:

• permanent (introduced for a long term);
• disposable.

Taking into account the organ of administration, there are:

• urethral;
• ureteral;
• tools for the pelvis of the kidney;
• bladder stents.

By location there are:

• internal (completely located inside the body);
• external (one end goes out).

By the number of channels, there are options:

• single-channel;
• dual channel;
• three-channel stent.

The most common types

Different types of catheters are used to catheterize the bladder. Their choice depends on the function they will perform. The quality of the device is also important, since in some cases it leads to irritation or allergic reactions. Including the above factors, the most common are:

• Foley urethral catheter. Considered an indwelling urinary catheter. It has a blind end and two holes. At the end there is a rubber reservoir, to which a thin channel is connected. Used to flush the bladder, remove blood clots or urine.
• Nelaton catheterization device. Straight, elastic, with rounded ends. It has a smaller diameter than Foley. Not used permanently. Inserted into the urinary canal for drainage.
• Tiemann stent. It has one channel for drainage and 2 holes near the tip. Used in diseases of the prostate gland.
• Pizza fixture. Rubber conductor with 2-3 holes and cup-shaped tip. Set as permanent for draining the kidneys when their main function fails.
• Melekote is identical to the Pizzer pattern.
• Poisson's stent is a rubber smooth thread with three holes and a spiral end. Enter using a metal probe, which then must be removed. Rarely used for the treatment of the genitourinary system.

Each of the examples of catheterization devices has advantages and disadvantages in use. If the introduction of the catheter is provided for a short time, the best disposable Nelaton catheter. The Foley stand is more suitable not only for excretion of urine, but also for the administration of drugs. If the patient is unable to urinate, the Pizzer variant is most suitable.

How are they set?

To put a catheter into the urethra, you must follow some rules. First, the placement of the catheter must be sterile. To do this, in order to avoid sepsis, the instrument and genitals are treated with antiseptic disinfectants. Secondly, patients who have undergone the procedure claim that it hurts. To relieve such sensations, Lidochlor gel or other approved painkillers are used.

Insertion of a urinary catheter is much more difficult for men than for women. The problem is that in men, the urethra is narrower and longer than the female.

The technique of inserting a catheter in men is complex. During the procedure, the patient should lie on his back, bending his knees, and relax. The doctor treats the genitals and the apparatus with an antiseptic, and begins to slowly insert the instrument. In this case, the penis should be in a position perpendicular to the body. The signal that the manipulation is taking place correctly is the appearance of liquid in the catheter.

The bladder catheter in men has a length of 20-30 cm with a narrow diameter. This is due to the physiological characteristics of the body. Therefore, you need to use the appropriate instance. At the end of the procedure, the insertion site of the adapter is disinfected with an antiseptic, and the urinal is attached to the inside of the thigh. If the patient is lying - to the bed.

Catheterization in women

Inserting a urethral catheter for women is simple. In this case, the patient lies on her back, spreading her legs, bent at the knees. The labia and the instrument are treated with disinfectants. A urethral catheter is inserted 4-6 cm into the urinary canal, lowering the second edge into a special reservoir. It is attached to the thigh with a tight bandage bandage. During manipulation, blood may appear, but this is not dangerous. If the doctor did everything correctly, the bleeding is insignificant and does not repeat. A urethral catheter can damage the neck and walls of the bladder.

Both cystostomy and urethral catheters have advantages and disadvantages. When installing the urethral option, you can damage the neck and walls of the bladder. Suprapubic is less traumatic for a person. A cystostomy is easier to handle and less likely to cause inflammatory infections. Moreover, an incision in the abdomen heals faster and brings less discomfort than a tube in the genitals. Among other things, if the device becomes clogged, urine flows down it, infecting the genitals. And if such a problem occurs in the suprapubic sample, urine is excreted anyway.

The suprapubic catheter has advantages in diameter. It is much wider than in the urethral. But, cystostomy also has a number of negative aspects. Firstly, it is blocked more often, since it is allowed to install it only for a long time. Secondly, the side effects of its stay in the body are: urinary retention, spasm or stones. Thirdly, it is difficult for overweight patients to place a suprapubic catheter.

Medicines can be introduced into the body in various ways, depending on the indications: enterally (orally) drugs are administered in the form of tablets, powders, solutions, mixtures, capsules; rectally (into the rectum) - in the form of suppositories, enemas; parenterally (bypassing the gastrointestinal tract) - in the form of injections or by applying drugs to the skin, mucous membranes.

This article will discuss the parenteral method of administering drugs under the skin and into the muscle through a syringe, as well as into a vein using an intravenous catheter.

General rules for performing injections

Injection - the introduction of the drug by injecting it under pressure into a particular environment or tissue of the body with a violation of the integrity of the skin. This is one of the most dangerous ways to use medications. As a result of an incorrectly performed injection, nerves, bones, tissues, blood vessels can be damaged, or the body becomes infected with microflora.

The following types of injections are distinguished: intradermal, subcutaneous, intramuscular, intravenous, intraarterial, intraarticular, intraosseous, intracardiac, subdural, subarachnoid (spinal injections), intrapleural, intraperitoneal.

Injections require sterile instruments - a syringe and a needle, intravenous catheters of various sizes, infusion (drip) systems, as well as alcohol balls, injection solutions, tourniquets, etc. When using each element, it is important to adhere to certain rules.

Rice. 1. Syringes of various volumes (from 1 to 50 ml) used in veterinary medicine

syringes. Getting started, it is necessary to check the integrity of the syringe package, then open it sterilely from the side of the piston, take the syringe by the piston and, without removing it from the package, insert it into the needle.

Needles. First of all, check the integrity of the package. Then it is opened sterile from the side of the cannula, the needle is carefully removed from the cap.

Infusion systems. Manipulations are performed in the following order:

1. the package is opened in the direction of the arrow;
2. close the roller clamp;
3. remove the protective cap from the needle for the vial and insert the needle completely into the vial with the infusion solution;
4. hang the bottle with the solution and squeeze the needle container so that it is filled by ½;
5. open the roller clamp and release air from the system;
6. connected to a needle or intravenous catheter;
7. open the roller clamp and adjust the flow rate.

A set of medicinal product in a syringe from an ampoule
First of all, you need to familiarize yourself with the information placed on the ampoule: the name of the drug, its concentration, expiration date.
Make sure that the medicinal product is suitable for use: there is no sediment, the color does not differ from the standard.
Tap on the narrow part of the ampoule so that all the drug is in its wide part.
Before sawing off the neck of the ampoule, you need to treat it with a cotton ball with a disinfectant solution. Cover the ampoule with a tissue to protect yourself from splinters. With a confident movement, break off the neck of the ampoule.
Insert a needle into it and collect the required amount of the drug. Wide bore ampoules should not be inverted (Fig. 2). It is necessary to ensure that when dialing the drug, the needle is always in the solution: in this case, air will not enter the syringe.
Make sure there is no air in the syringe. If there are air bubbles on the walls, you should slightly pull the syringe plunger, “turn” the syringe several times in a horizontal plane and squeeze out the air.

Rice. 2. Ampoules with a wide "neck" should not be turned over to avoid leakage of the drug

A set of medicines in a syringe from a vial closed with an aluminum cap
As in the case of an ampoule, first of all you need to read the name of the drug, concentration, expiration date on the vial; make sure that the color does not differ from the standard.
Vials with solutions are checked for safety of packaging and contamination.
Then, with non-sterile tweezers (scissors, etc.), a part of the vial cap covering the rubber stopper is bent.
Wipe the rubber stopper with a cotton / gauze ball moistened with an antiseptic.
Insert the needle at an angle of 90° into the vial and withdraw the required amount of the drug from the vial into the syringe.
Separate sterile needles and syringes are used each time the contents of the vial are taken.
Opened multi-dose vials are stored in the refrigerator for no more than 6 hours, unless otherwise indicated in the instructions.

Rice. 3. A set of the drug from a bottle with a rubber stopper rolled up with an aluminum cap

Injection technique

When performing injections, it is very important to follow certain rules.

Subcutaneous injections. In this method, the drug substance is injected directly into the subcutaneous tissue, preferably in an area that is well supplied with blood. Subcutaneous injections are less painful than intramuscular injections. The inguinal fold and withers are the most suitable sites for subcutaneous injections. Before injection, the skin is collected in a fold to determine the thickness of the subcutaneous tissue. Having captured the skin with the thumb and forefinger, an injection is made into the resulting triangle. To correctly administer the drug, it is necessary to accurately calculate the length of the fold and the thickness of the subcutaneous tissue. The needle is inserted at an angle of 45° to 90° to the skin surface.

Intramuscular injections. In this way, those medicinal substances are administered that, when injected subcutaneously, give severe irritation (for example, magnesium sulfate) or are slowly absorbed. The drug is injected into the posterior femoral muscle group or into the muscles of the shoulder.

Intravenous injections. They are carried out both with a syringe and a needle, and by pre-installation of an intravenous catheter. In veterinary medicine, due to the mobility of patients, it is optimal to use catheters. When choosing a catheterization site, it is necessary to take into account the ease of access to the puncture site and the suitability of the vessel for catheterization. There are practically no complications if the basic rules are followed. The catheter must be properly cared for.

Rules for venous catheterization

Indications for venous catheterization. A peripheral intravenous catheter is an instrument inserted into a peripheral vein and provides access to the bloodstream.

Rice. 4. Intravenous catheters

Indications for the use of an intravenous catheter:

• emergency conditions that require quick access to the bloodstream (for example, if you need to urgently and quickly administer drugs);
• prescribed parenteral nutrition;
• hyperhydration or hydration of the body;
• transfusion of blood products (whole blood, red blood cells);
• the need for rapid and accurate administration of the drug at an effective concentration (especially when the drug can change its properties when taken orally).

A well-chosen venous access largely ensures the success of intravenous therapy.

Vein and catheter selection criteria. With intravenous injections, the advantage remains with the peripheral veins. The veins should be soft and elastic, without seals and knots. It is better to inject drugs into large veins, in a straight section corresponding to the length of the catheter.

When choosing a catheter (Fig. 4), it is necessary to focus on the following criteria:

• diameter of the vein (the diameter of the catheter should be less than the diameter of the vein);
• the required rate of administration of the solution (the larger the size of the catheter, the higher the rate of administration of the solution);
• potential time of the catheter in the vein (no more than 5 days).

When catheterizing veins, preference should be given to modern Teflon and polyurethane catheters. Their use significantly reduces the frequency of complications and, with high-quality care, their service life is much longer.
The most common cause of failures and complications during peripheral vein catheterization is the lack of practical skills of the staff, violation of the technique of placing a venous catheter and caring for it. This is largely due to the lack of generally accepted standards for peripheral venous catheterization and catheter care in veterinary medicine.

The standard set for catheterization of a peripheral vein (Fig. 5) includes a sterile tray, sterile wipes moistened with disinfectant, adhesive tape, peripheral IV catheters of several sizes, tourniquet, sterile gloves, scissors, gauze or self-locking elastic bandage.

Rice. 5. Standard kit for peripheral venous catheterization

Placement of a peripheral catheter. They begin by providing good lighting for the manipulation site. Then the hands are thoroughly washed and dried. Assemble a standard set for vein catheterization, while the set should contain several catheters of different diameters.
A tourniquet is applied 10-15 cm above the intended catheterization zone. A vein is selected by palpation.
The catheter of the optimal size is selected, taking into account the size of the vein, the required rate of insertion, and the schedule of intravenous therapy.
They put on gloves.
The catheterization site is treated with a skin antiseptic for 30-60 seconds and allowed to dry.
Having fixed the vein (it is pressed with a finger below the intended site of the catheter), the catheter of the selected diameter is taken and the protective cover is removed from it. If there is an additional plug on the case, the case is not thrown away, but held between the fingers of the free hand.
The catheter is inserted on the needle at an angle of 15° to the skin, observing the indicator chamber. When blood appears in it, the angle of inclination of the stylet needle is reduced and the needle is inserted into the vein by a few millimeters (Fig. 6). After fixing the stylet needle, slowly move the cannula from the needle into the vein to the end (the stylet needle is not completely removed from the catheter yet). They take off the tourniquet.
Do not insert the needle all the way into the catheter after it has been displaced from the needle into the vein! This will lead to injury to the walls of the vessel.
The vein is clamped to reduce bleeding, and the needle is finally removed from the catheter.
The needle is disposed of in accordance with safety rules.
Remove the plug from the protective cover and close the catheter or attach the infusion set.
The catheter is fixed on the limb with adhesive tape (Fig. 7).

Rice. 6. Installation of an intravenous catheter in a cat. The assistant clamps the vein above the catheter with the thumb. The catheter tube is in the vein, the stylet needle is half out.

Rice. 7. The installed catheter is fixed on the paw with adhesive tape.

Rules for the care of the catheter
Each catheter connection is a gateway for infection to enter. Repeated touching of the instruments with hands should be avoided. It is recommended to change sterile plugs more often, never use plugs, the inner surface of which could be infected.

Immediately after the introduction of antibiotics, concentrated glucose solutions, blood products, the catheter is washed with a small amount of saline.

To prevent thrombosis and prolong the life of the catheter in a vein, it is recommended to rinse the catheter with saline additionally - during the day, between infusions.

Complications after venous catheterization are divided into mechanical (5-9%), thrombotic (5-26%), infectious (2-26%).

It is necessary to monitor the condition of the fixing bandage and change it if necessary, as well as regularly inspect the puncture site in order to detect complications as early as possible. If edema appears (Fig. 7), redness, local temperature rise, catheter obstruction, leakage, as well as pain in the animal that is injected with the drug, the catheter should be removed and a new one installed.

Rice. 7. Swelling of the limb in an animal with improper fixation of the catheter (the paw is very tightly constricted with a plaster)

When changing the adhesive bandage, it is forbidden to use scissors, because. you can cut the catheter, as a result of which it will enter the bloodstream. The place of catheterization is recommended to be changed every 48-72 hours. To remove the venous catheter, you need a tray, a ball moistened with a disinfectant solution, a bandage, and scissors.

Conclusion

Despite the fact that peripheral vein catheterization is a much less dangerous procedure than central venous catheterization, if the rules are violated, it can cause a complex of complications, like any procedure that violates the integrity of the skin. Most complications can be avoided with good manipulative technique of the staff, strict adherence to the rules of asepsis and antisepsis, and proper care of the catheter.

Literature

1. Handbook for the nurse of the treatment room. - St. Petersburg: "Printing house" Beresta ", 2007.
2. Mitin V.N. First aid for small pets. - M.: KolosS, 2005.
3. Handbook for nurses of the intensive care unit // Ed. AND I. Grinenko. - St. Petersburg: Health Committee of the Leningrad Region, Association of Nurses, 2007.

S. V. Panfilova, veterinary clinic "Biocontrol"
at the Russian Cancer Research Center. N.N. Blokhin (Moscow)