Perinatal route of drug administration. What is parenteral administration of drugs. Preparing patients for X-ray

Parenteral route - the introduction of drugs into the body, bypassing the gastrointestinal tract.

There are the following types of parenteral administration of drugs.

Intravenous administration ensures the rapid onset of a therapeutic effect, allows you to immediately stop the development of adverse reactions and carry out accurate dosing of drugs. Intravenously injected drugs that are poorly absorbed from the gastrointestinal tract or have an irritating effect on it.

Methods of intravenous administration of injection solutions:

Bolus administration(from Greek. bolos- lump) - rapid intravenous administration of the drug for 3-6 minutes. The dose of the administered drug is indicated in milligrams of the drug or in milliliters of a solution of a certain concentration.

Infusion administration(usually intravenous, but sometimes intra-arterial or intra-coronary) is given at a certain rate, with the dose calculated quantitatively (for example, ml / min, μg / min, μg / [kg × min]) or less accurately (as the number of drops of a solution introduced in 1 min). For a more accurate long-term infusion, it is preferable, and in some cases, it is strictly necessary (for example, intravenous administration of sodium nitroprusside) to use special dosing syringes, systems for infusion of trace amounts of the drug, special connecting tubes to prevent the loss of drugs in the system due to its adsorption on the walls of the tubes (for example, with the introduction of nitroglycerin).

Combined intravenous administration allows you to quickly achieve a constant therapeutic concentration of the drug in the blood. For example, an intravenous bolus is administered and immediately a maintenance intravenous infusion or regular intramuscular administration of the same drug (for example, lidocaine) is started at regular intervals.

When carrying out intravenous administration, you should make sure that the needle is in the vein: the penetration of drugs into the perivenous space can lead to irritation or tissue necrosis. Some drugs, especially with prolonged use, have an irritating effect on the walls of the veins, which may be accompanied by the development of thrombophlebitis and venous thrombosis. When administered intravenously, there is a risk of infection with hepatitis B, C and HIV viruses.

Medicinal substances, depending on the clinical situation and the characteristics of the FC of the drug, are injected into the vein at different rates. For example, if you need to quickly create a therapeutic concentration of a drug in the blood that is subject to intensive metabolism or protein binding, use a quick (bolus) administration (verapamil, lidocaine, etc.). If there is a risk of overdose with rapid administration and a high risk of developing undesirable and toxic effects (cardiac glycosides, procainamide), the drug is administered slowly and diluted (with isotonic solutions of dextrose or sodium chloride). To create and maintain therapeutic concentrations in the blood for a certain time (several hours), drip administration of drugs is used using systems for blood transfusion (aminophylline, glucocorticoids, etc.).

Intra-arterial administration used to create high concentrations of drugs in the relevant organ (for example, in the liver or limb). Most often this applies to drugs that are rapidly metabolized or bound by tissues. The systemic effect of drugs with this method of administration is practically absent. Arterial thrombosis is considered the most serious complication of intra-arterial administration of drugs.

Intramuscular administration- one of the most common methods of parenteral administration of drugs, providing a rapid onset of effect (within 10-30 minutes). Depot preparations, oily solutions and some drugs are administered intramuscularly, which have a moderate local and irritating effect. Inappropriate

figuratively inject more than 10 ml of the drug once and perform injections near the nerve fibers. Intramuscular administration is accompanied by local pain; quite often abscesses develop at the injection site. Dangerous penetration of the needle into the blood vessel.

Subcutaneous administration. Compared with intramuscular injection, with this method, the therapeutic effect develops more slowly, but lasts longer. It is not advisable to use it in a state of shock, when, due to insufficiency of peripheral circulation, the absorption of drugs is minimal.

Recently, the method of subcutaneous implantation of certain drugs has been very common, providing a long-term therapeutic effect (disulfiram - for the treatment of alcoholism, naltrexone - for the treatment of drug addiction, and some other drugs).

Inhalation administration- method of using drugs produced in the form of aerosols (salbutamol and other β 2 -agonists) and powders (cromoglycic acid). In addition, volatile (ether for anesthesia, chloroform) or gaseous (cyclopropane) anesthetics are used by inhalation. This method of administration provides both local β 2 -adrenergic agonists) and systemic (anesthesia) action. Inhalation do not administer drugs that have irritating properties. It must be remembered that as a result of inhalation, the drug immediately enters through the pulmonary veins into the left parts of the heart, which creates conditions for the development of a cardiotoxic effect.

Inhalation of the drug allows you to accelerate the absorption and ensure the selectivity of the action on the respiratory system.

Achieving one or another result depends on the degree of penetration of drugs into the bronchial tree (bronchi, bronchioles, alveoli). With inhalation, absorption will increase if the particles of the drug penetrate into its most distal sections, i.e. into the alveoli, where absorption occurs through thin walls and over a larger area. For example, nitroglycerin, when administered by inhalation, enters directly into the systemic circulation (as opposed to the enteral route of administration).

To achieve a selective effect of drugs on the respiratory system, for example, in the treatment of asthma, it is necessary to distribute the bulk of the drug in the bronchi of medium and small caliber. The likelihood of systemic effects depends on the amount of the substance that has entered the general circulation.

For inhalation administration, special delivery systems are used:

Metered aerosol inhaler containing propellant gas;

Breath-activated dry powder inhaler (turbuhaler);

Nebulizer.

The penetration of drugs into the body depends on the particle size of the drug, inhalation technique and inhalation volumetric rate. When using most aerosol inhalers, no more than 20-30% of the total dose of the drug substance (respirable fraction) enters the respiratory system. The rest of the drug is retained in the oral cavity and pharynx, and then swallowed by the patient, causing the development of systemic effects (often undesirable).

The creation of inhalation delivery forms - powder inhalers - allows increasing the respirable fraction of the drug up to 30-50%. Such inhalers are based on the formation of turbulent air flows, which crush large particles of a dry medicinal substance, as a result of which drugs reach the distal respiratory tract better. The advantage of powder inhalers is the absence of a propellant gas that has a negative impact on the environment. Inhalers for the administration of a dry powdery substance are divided according to the methods of using the drug: it is either built into the inhaler or attached to it in the form of a special dosage form.

Breath-activated inhalers (turbuhalers) facilitate the entry of drugs into the respiratory tract, as they do not require coordination of inspiration and pressing the inhaler canister. The drug enters the respiratory tract with less effort to inhale, which increases the effect of the treatment.

Another way to increase the respirable fraction when using inhalers is through the use of assistive devices such as spacers and nebulizers.

Spacers are used in conjunction with metered-dose aerosol inhalers. They help to increase the distance between the latter and the oral cavity of the patient. As a result, the time interval between the release of drugs from the canister and its entry into the oral cavity increases. Due to this, the particles have time to lose excessive speed, and the propellant gas evaporates, leaving

more drug particles of the desired size suspended in the spacer. As the speed of the aerosol jet decreases, the impact on the posterior pharyngeal wall also decreases. Patients feel the cold effect of freon to a lesser extent, and they rarely experience a reflex cough. The main characteristics of the spacer are the volume and the presence of valves. The greatest effect is achieved when using spacers of a larger volume; valves prevent loss of aerosol.

Nebulizers are devices that operate by passing a powerful jet of air or oxygen under pressure through a drug solution, or by ultrasonic vibration of the latter. In both cases, a fine aerosol suspension of drug particles is formed, and the patient inhales it through the mouthpiece or face mask. The dose of the drug is delivered within 10-15 minutes, while the patient is breathing normally. Nebulizers provide the maximum therapeutic effect with the best ratio of local and systemic effects. The drug enters the respiratory tract as much as possible, no additional effort is required to inhale. It is possible to administer drugs to children from the first days of life and to patients with varying degrees of severity of the disease. In addition, nebulizers can be used both in hospitals and at home.

Irritating drugs should not be administered by inhalation. When using gaseous substances, the cessation of inhalation leads to a rapid cessation of their action.

Local application- application of drugs to the surface of the skin or mucous membranes to obtain effects at the site of application. When applied to the mucous membranes of the nose, eyes and skin (for example, patches containing nitroglycerin), the active components of many drugs are absorbed and have a systemic effect. In this case, the effects can be desirable (prevention of angina attacks using nitroglycerin patches) and undesirable (side effects of inhaled glucocorticoids).

Other routes of administration. Sometimes, for a direct effect on the central nervous system, drugs are injected into the subarachnoid space. This is how spinal anesthesia is performed, antibacterial drugs are administered for meningitis. To transfer drugs from the surface of the skin to deep tissues, the method of electro- or phonophoresis is used.

Any drug purchased at a pharmacy is accompanied by a special instruction for use. Meanwhile, compliance (non-compliance) with the rules of admission can have a great, and sometimes decisive, impact on the effect of the drug. For example, when taken orally, food, gastric juice, digestive enzymes and bile that are released during digestion can interact with the drug and change its properties. That is why the connection between taking the medicine and eating is important: on an empty stomach, during or after a meal.

4 hours after or 30 minutes before the next meal (on an empty stomach), the stomach is empty, the amount of digestive juice in it is minimal (several tablespoons). Gastric juice (a product secreted by the glands of the stomach during digestion) at this time contains little hydrochloric acid. With the approach of breakfast, lunch or dinner, the amount of gastric juice and hydrochloric acid in it increases, and with the first portions of food, their release becomes especially plentiful. As food enters the stomach, the acidity of gastric juice decreases as a result of neutralization by food (especially when eating eggs or milk). Within 1-2 hours after eating, it increases again, since the stomach is freed from food by this time, and the secretion of juice is still ongoing. Especially pronounced secondary acidity is found after eating fatty fried meat or black bread. In addition, when fatty foods are taken, its exit from the stomach is delayed and sometimes the pancreatic juice produced by the pancreas is thrown from the intestines into the stomach (reflux).

Food mixed with gastric juice passes into the initial section of the small intestine - the duodenum. Bile, produced by the liver, and pancreatic juice, secreted by the pancreas, also begin to flow there. Due to the content of a large number of digestive enzymes in the pancreatic juice and biologically active substances in the bile, an active process of digestion of food begins. Unlike pancreatic juice, bile is constantly secreted (including between meals). Its excess amount enters the gallbladder, where a reserve is created for the needs of the body.

If there are no instructions in the doctor's instructions or prescriptions, it is better to take drugs on an empty stomach (30 minutes before a meal), since interaction with food and digestive juices can disrupt the absorption mechanism or lead to a change in the properties of the drug.

On an empty stomach take:

All tinctures, infusions, decoctions and similar preparations made from plant materials, as they contain active substances, some of which, under the action of hydrochloric acid of the stomach, can be digested and converted into inactive forms; in addition, in the presence of food, the absorption of individual components of such drugs may be impaired and, as a result, an insufficient or distorted effect may occur;

All calcium preparations (for example, calcium chloride), which have a pronounced irritant effect; calcium, binding with fatty and other acids, forms insoluble compounds; in order to avoid irritating effects, it is better to drink such drugs with milk, jelly or rice water;

Drugs that are absorbed with food, but for some reason have an adverse effect on digestion or relax smooth muscles (for example, drotaverine is a remedy that eliminates or weakens spasms of smooth muscles);

Tetracycline (you can not drink it and other tetracycline antibiotics with milk, as the drugs bind to calcium).

During a meal or immediately after it, take all multivitamin preparations. After eating, it is better to take drugs that irritate the gastric mucosa (indomethacin, acetylsalicylic acid, hormonal agents, metronidazole, reserpine, etc.).

A special group consists of drugs that should act directly on the stomach or the process of digestion. So, drugs that reduce the acidity of gastric juice (antacids), as well as drugs that reduce the irritating effect of food on a sick stomach and prevent abundant secretion of gastric juice, are usually taken 30 minutes before a meal. 10-15 minutes before meals, it is recommended to take drugs that stimulate the secretion of digestive glands (bitterness), and choleretic drugs.

Gastric juice substitutes are taken with meals, and bile substitutes (for example, allochol ♠) are taken at the end or immediately after meals. Preparations containing digestive enzymes that aid in the digestion of food (eg, pancreatin) are usually taken before, during, or immediately after a meal. Medications that suppress the secretion of hydrochloric acid (for example, cimetidine) should be taken immediately or shortly after a meal, otherwise they block digestion at a very early stage.

Not only the presence of food masses in the stomach and intestines affects the absorption of drugs. The composition of food can also change this process. For example, when eating food rich in fats, the concentration of vitamin A in the blood increases (the speed and completeness of its absorption in the intestine increases). Milk enhances the absorption of vitamin D, the excess of which is dangerous, primarily for the central nervous system. With a predominantly protein diet or the use of pickled, sour and salty foods, the absorption of the anti-tuberculosis drug isoniazid worsens, and with a protein-free diet, on the contrary, it improves.

Absorption

Absorption or absorption of drugs - the process of receipt of a substance from the injection site into the systemic circulation. The drug must pass through several membranes before it reaches a specific receptor. Through cell membranes containing lipoproteins, drugs penetrate through diffusion, filtration or active transport (Fig. 5).

Diffusion- passive passage of drugs through water channels in the membrane or by dissolving in it. Such a mechanism is inherent in non-ionized non-polar, lipid-soluble and polar (i.e. represented by an electric dipole) chemical compounds. Most drugs are weak organic acids and bases, so their ionization in aqueous solutions depends on the pH of the medium. In the stomach, pH is about 1.0, in the upper intestine - about 6.8, in the lower part of the small intestine - about 7.6, in the oral mucosa - 6.2-7.2,

in the blood - 7.4? 0.04, in urine - 4.6-8.2. That is why the diffusion mechanism is most important for drug absorption.

Filtration- penetration of drugs through the pores in the cell membrane as a result of the difference in hydrostatic or osmotic pressure on both sides of it. Such an absorption mechanism is characteristic of many water-soluble polar and non-polar chemical compounds. However, due to the small diameter of pores in cell membranes (from 0.4 nm in erythrocyte membranes)

rocytes and intestinal epithelium up to 4 nm in the capillary endothelium) this mechanism of drug absorption is of little importance (important only for the passage of drugs through the renal glomeruli).

active transport. Unlike diffusion, this mechanism of drug absorption requires active energy consumption, since the drug must overcome the chemical or electrochemical gradient with the help of a carrier (membrane component) that forms a specific complex with them. The carrier provides selective transport and saturation of the drug cell even at a low concentration of the latter outside the cell.

pinocytosis- absorption of extracellular material by membranes with the formation of vesicles. This process is especially typical for drugs with a polypeptide structure with a molecular weight of more than 1000 kilodaltons.

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 administration of drugs 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 determine the dosage for each substance with high accuracy, to establish the time of entry and exit, as well as the concentration.

As preparations 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, so the peculiarities of parenteral administration of drugs have long interested doctors. Parenteral administration of drugs, what does it mean?

Kinds

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

Intravenous (most appropriate to administer drugs through the central veins);
Intraosseous (very rarely used)

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

Advantages and disadvantages

There are advantages and disadvantages of parenteral administration of drugs 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 entry into 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 developing complications, for example:

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

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 drug must be used according to the instructions and follow the algorithm for parenteral administration of drugs:

you can not administer a medicine intended for intramuscular injection (for example, oil preparations - intravenously);
you need to follow the rules of antiseptics: wash your hands, use sterile instruments, treat the injection site;
with intravenous injections, you need to be careful not to get air into the vein;
before administering the drug, it is necessary to check the expiration date, dosage;
before prescribing a medicine, one must take into account individual intolerance, allergies in patients;
with the development of complications, it is necessary to immediately provide assistance to the patient.

Without the possibility of injecting drugs, 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 about anesthesia and anesthesia in simple language. If you received an answer to your question and the site was useful to you, I will be glad to support it, it will help to further develop the project and compensate for the costs of its maintenance.

Arutyunov Eduard 22 group

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

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PARENTERAL DRUG INTRODUCTION Presentation prepared by Group 22 student Eduard Arutyunov

Parenteral drug administration is a way of introducing drugs into the body, in which they bypass the gastrointestinal tract, in contrast to the oral route of drug administration. These are primarily injections and inhalations. There are other, rarer, parenteral routes of administration: transdermal, subarachnoid, intraosseous, intranasal, subconjunctival, however, these methods of drug penetration into the body are used only in special cases. Injection is a method of introducing certain solutions (for example, drugs) into the body using syringe and hollow needle or high-pressure injection (needleless injection). Inhalation (from Latin inhalo - I inhale) is a method of administering medicines based on the inhalation of gas, steam or smoke. Inhalation can be natural (at seaside resorts, in the forest) and artificial, using special spray devices - inhalers. There are injections of small volume (up to 100 ml) and large volume, which are called infusions.

Advantages of the parenteral route of administration. They act faster, which is especially important in emergency cases when immediate action is needed Increases the bioavailability of drugs The effectiveness of drugs does not depend on food intake Substances that are poorly absorbed in the gastrointestinal tract (for example, tobramycin) or are destroyed by acid or gastric juice enzymes (insulin) can be used , 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 - intradermally; b - subcutaneously; c - intramuscularly; g - intravenously.

The following parenteral routes of administration of drugs are distinguished: 1. In tissues: intradermally - used for diagnostic purposes (allergic tests of Burne, Mantoux, Kasoni, etc.) and for local anesthesia (chopping); subcutaneously - used when a faster action of the drug is needed than when administered through the mouth, since the subcutaneous fat layer, where the drug is administered subcutaneously, is well supplied with blood vessels - the drugs administered in this way are quickly absorbed; intramuscularly - some drugs, if injected under the skin, cause severe irritation, a reaction from fatty 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 tissues is less here, the amount of solution for administration is limited. Intramuscularly, insoluble suspensions of drugs, oils, etc. are predominantly administered; intraosseous - indications: extensive burns and deformity of the limbs, subcutaneous vein collapse during shock, collapse, terminal conditions, psychomotor agitation or convulsions, impossibility of intravenous administration of drugs (primarily in pediatric practice).

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

Subcutaneous Subcutaneous injection is performed to a depth of 15 mm. The maximum effect of the subcutaneously administered drug is achieved on average 30 minutes after the injection. The most convenient sites for subcutaneous drug administration are: upper third of the outer surface of the shoulder subscapular space 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 danger of damage to blood vessels and nerves. It is impossible to 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 places for intramuscular injection: muscles of the buttocks (middle and small gluteal muscles) thigh muscles (lateral wide muscle). Sites for intramuscular injections are shaded. Much less often, intramuscular injection is carried out in the deltoid muscle of the shoulder, since there is a risk of damage to the radial or ulnar nerves, the brachial artery. For intramuscular injections, a syringe 8-10 cm long is used (together with a needle). In the gluteal region, only its upper outer part is used, the most distant from the sciatic nerve and large blood vessels.

Mentally divide the buttock into four parts (quadrants). The injection is carried out in the upper outer quadrant in its upper outer part approximately 5-8 cm below the level of the iliac crest. Accidental needle trauma to the sciatic nerve during an injection into a non-upper outer quadrant of the buttock can cause partial or complete paralysis of the limb. In no case should the patient stand during an intramuscular injection, since in this position breakage and separation of the needle from the sleeve are possible. 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. In the vessels: intravenously - used for the introduction of large volumes of drugs, blood transfusion, bloodletting, blood tests; intra-arterial - used in terminal conditions caused by shock, blood loss, asphyxia, electrical injury, intoxication, infectious disease; into the lymphatic vessels - is used to prevent the passage of the drug through the liver and kidneys (prevents the rapid metabolism of the substance), for more accurate entry of the drug substance to the focus of the disease, infection, tumor, etc.

Intravenous administration of drugs Intravenous injection or blood sampling is carried out only by trained medical personnel (who knows the algorithm of intravenous injection thoroughly). Venipuncture - percutaneous insertion of a hollow needle into the lumen of a vein for the purpose of: intravenous administration of drugs, transfusion of blood and blood substitutes, blood extraction (for taking blood for analysis, as well as bloodletting - extracting 200-400 ml according to indications. Most often, the vein of the elbow is punctured, and, if necessary, other veins, for example, veins on the back 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.His arm should be maximally extended at the elbow joint, a dense oilcloth is placed under the elbow. pillow or towel.On the shoulder, above the elbow bend by 10 cm, a tourniquet is applied tightly enough on the sleeve of the patient's clothing to compress the veins.Tighten the tourniquet in such a way that its free ends are directed upwards, and the loop is downwards.Arterial blood flow must not be disturbed , so the pulse on the radial artery should be well palpable.To improve the filling of the vein 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 break down in the body. At the same time, a high concentration of the drug is created only in the corresponding organ, and the overall effect on the body can be avoided. Drugs are administered intraarterially 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 remove the inflammatory process. Radiopaque preparations are also administered intra-arterially, which allows you to accurately determine the localization of the tumor, thrombus, vasoconstriction, aneurysm. For example, the introduction of a radiopaque substance based on the isotope of iodine allows you to determine the localization of the stone in the urinary system and, based on this, use one or another type of treatment.

3. In the cavity: into the pleural cavity; into the abdominal cavity; intracardiac; into the articular cavity The pleural cavity is a slit-like space between the parietal and visceral pleura that surround each lung. The pleura is a smooth serous membrane. The parietal (external) pleura lines the walls of the chest cavity and the outer surfaces of the mediastinum, the visceral (internal) 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 body below the diaphragm and completely filled with abdominal organs. It is divided into the abdominal cavity proper and the pelvic cavity (Latin cavitas pelvis). The cavity is lined with a serous membrane - the peritoneum, which separates the peritoneal cavity (abdominal cavity in the narrow sense) from the retroperitoneal space.

To stimulate the activity of the heart, a 1:1000 solution of adrenaline is most often used at a dose of 0.5 - 1.0 ml, for children as many drops of adrenaline as the child is old, plus 1 more drop. Enter adrenaline into the cavity of the heart, mixing with 10 ml of isotonic sodium chloride solution, heated to a temperature of 40 °, slowly. At the end, the needle is immediately withdrawn. If there is no effect, the injection can be repeated. From other medicines, solutions of 0.1% atropine and 5% calcium chloride can be noted. Intracardiac Administration of Drugs - Indications: sudden cardiac arrest of various origins. Intracardiac injections can be effective if carried out immediately after cardioplegia, in any case not later than 3-7 minutes. The method is one of the components of the resuscitation complex. The articular cavity is a slit-like hermetically sealed space, limited by the synovial membrane and articular surfaces. Menisci are located in the articular cavity of the knee joint.

Parenteral route of administration of drugs (injection) - the introduction of drugs bypassing the digestive tract (see diagram below). Injections are widely used in medical practice.
Advantages of the parenteral route of administration:
- speed of action;
- dosage accuracy;
- the barrier function of the liver is excluded;
- the influence of digestive enzymes on medicines is excluded;
- indispensable in the provision of emergency assistance.
Ethical and deontological aspect of the topic. Often patients experience a feeling of fear before the upcoming injections.
A friendly, calm conversation with the patient, preparing him for the injection, a comfortable position of the patient, a clear implementation of the injection will prevent and reduce pain, a sense of fear. When performing intramuscular injections, the patient should lie down, since in the standing position of the patient, the gluteal muscles are significantly tense, which can cause the needle to break.
Precautionary measures.
1. When opening the ampoule, glass fragments may cause injury, so it is necessary to use a cotton ball. If, nevertheless, an injury has occurred, then it is necessary to remove glass fragments from the wound, wash the wound with hydrogen peroxide, treat the edges of the wound with an antiseptic solution, and apply an aseptic bandage.
2. When checking the patency of the needle, under the pressure of the piston, it can come off the needle cone and injure others. To prevent this from happening, it is necessary to hold the needle by the cannula.

Scheme

Syringes and needles

Syringes and needles are used for injections. At present, in connection with the spread of AIDS, drug addiction, hepatitis and other especially dangerous diseases transmitted by transmissible means (with blood), the whole world has switched to the use of disposable syringes. Russia is no exception. Plastic syringes are supplied either with needles already in place or with needles in a separate plastic container. Disposable syringes and needles are factory sterilized and can only be used once.
In all children's and infectious diseases hospitals, maternity hospitals, city and large district hospitals, reusable glass or combined syringes are practically not used. At the same time, not all hospitals, especially rural ones, remote from big cities and communications, have the opportunity to provide patients with disposable syringes. In such cases, glass syringes and needles should be sterilized by boiling in an electric sterilizer or by autoclaving (pressurized steam sterilization) before use.
For this:
- remove the metal pistons from the glass syringes;
- put syringes, plungers, needles and tweezers into the sterilizer;
- pour a sufficient amount of distilled water into the sterilizer (if there is none, you can use boiled water);
- boil the syringes for at least 20 minutes from the moment the water boils;
- carefully, so as not to burn yourself and break the syringes, drain the water from the sterilizer without opening the lid completely; .
- Wait for the syringes to cool down.

Syringe selection

The capacity of injection syringes is 1.0, 2.0, 5.0, 10.0, 20.0 ml.
Use disposable syringes. The syringe type "Record" is combined with a metal piston, "Luer" - entirely glass. Syringes-tubes, also disposable, are filled with a medicinal substance. Janet's syringe with a capacity of 100 and 200 ml is used for washing cavities.
It is very important for each injection to choose the appropriate syringe and needle (table).

Table. Choosing a syringe for parenteral routes of drug administration

Leak test. The syringe must be airtight, i.e., do not allow air or liquid to pass between the cylinder and the piston. Checking the tightness, close the needle cone with your finger and pull the piston towards you. If it quickly returns to its original position, then the syringe is sealed.

Calculation of the division price.

In order to correctly draw a dose of a medicinal substance into a syringe, you need to know the "division price" of the syringe, i.e., the amount of solution between the next two divisions of the syringe. Find on the cylinder the number closest to the needle cone indicating the number of milliliters, then count the number of divisions on the cylinder between this number and the needle cone, divide this figure by the number of divisions - you will find the price of the syringe division.
There are syringes for special purposes, which, with a small capacity, have a narrowed and elongated cylinder, due to which divisions corresponding to 0.01 and 0.02 ml can be applied at a large distance from each other. This allows for a more accurate dosage when administering potent agents, sera, and vaccines. To administer insulin, a special insulin syringe with a capacity of 1.0-2.0 ml is used. On the cylinder of such a syringe, milliliters (ml) and units (UNITS) are indicated, since insulin is dosed in UNITS.

Preparing for an injection

Injections are performed in the treatment room, and for seriously ill patients - in bed.
In the treatment room there is a sterile table covered with sterile sheets, between the layers of which sterile syringes, needles, and trays are laid out. Special clips are attached to the free edges of the sheet. You can open the sterile table only for them.
On the nurse's desk are: iodine, alcohol, nail files for opening ampoules, bix with sterile material, sterile tweezers. The syringe is collected on a sterile table with sterile forceps.
For an injection, two needles are needed: one is used to collect the drug, the other is injected. Two needles ensure sterility. The neck of the ampoule is also treated with alcohol before opening. Oil solutions are heated to a temperature of 38 "C, lowering the ampoule into warm water.
To perform an injection in a seriously ill patient, a kraft bag (sterile syringe) and sterile balls moistened with alcohol are placed in a sterile tray, covered with a sterile napkin.
Hand treatment:
- open the faucet and adjust the temperature and water jet;
- wash your forearms with soap;
- wash with soap successively the left and right hands and interdigital spaces;
- thoroughly rinse the nail phalanxes;
- turn off the faucet with your right or left elbow;
- dry your left and right hand (if possible, use napkins);
- treat your hands with two cotton balls moistened with alcohol: with one ball, wipe the palmar surface, interdigital spaces and the back of the hand in succession. With another ball, also process the second hand.
Assembling a syringe from a kraft bag:
- open the craft package and take out the syringe;
- insert the plunger, taking it by the handle, into the syringe barrel;
- take the needle for the drug set by the cannula and put it on the under-needle cone without touching the tip of the needle with your hands;
- fix the cannula of the needle by rubbing it to the under-needle cone;
- release the air from the syringe;
- put the assembled prepared syringe on the inner (sterile) surface of the kraft bag.
The syringe for single use is produced in assembled form. To prepare the syringe for injection, open the package from the side where the plunger is felt (if the package is opaque).
Assembly of the reusable glass syringe:
- open the sterile table by the claws that are attached to the free ends of the sheet covering the table:
- remove the sterile tweezers from the chlorhexidine solution with your right hand and take one kidney-shaped tray from the sterile table, placing it upside down on the palm of your left hand;
- with sterile tweezers, put the plunger, cylinder and 2 needles into the tray;
- put the tray with the syringe on the desktop, put the tweezers in the chlorhexidine solution;
- close the sterile table with a sheet for linen claws;
- with sterile tweezers in your right hand, take the cylinder and "intercept" it with your left hand;
- use the same tweezers to take the piston and insert it into the cylinder, secure the removable cover;
- take the needle by the cannula with sterile tweezers and put it on the needle cone to collect the solution;
- fix the needle on the needle cone;
- put the tweezers in a container with a solution of chlorhexidine, and put the syringe with the needle in the tray.
The syringe is prepared for a set of medicines.
Medicines intended for injection are supplied in vials closed with rubber caps or in glass ampoules (Fig.).

Rice. Containers with liquid dosage forms (ampoules and vials) for the parenteral route of drug administration

The labels always indicate the name of the medicine and its quantity. Carefully read everything that is written on the labels, using a magnifying glass if necessary. If the name of the medicine is missing or impossible to read, then the vial or ampoule must be discarded. A colored belt can be applied around the neck of the ampoule, along which the top of the ampoule can be broken off without splinters. The rubber stopper of the vials is rolled up with a metal cap, in the middle of which there is a detachable tab. This petal should be torn off immediately before using the medicine.
If there are several doses of the medicine in the vial, then the rubber stopper should be wiped with a swab moistened with alcohol.

Ampoule solution kit

Before opening the ampoule or vial with the drug, read its name, dose, expiration date. Preheat the ampoule with the oil solution in a water bath to a temperature of 38 * C;
- before. how to open the ampoule, lightly tap the neck with your finger so that the entire solution is in its wide part;
- file the ampoule with a nail file along the neck and treat it with a cotton ball moistened with alcohol, break off the narrow (upper) end of the ampoule;
- take the ampoule in the left hand, holding it between the index and middle fingers, and in the right hand - the syringe, and carefully inserting the needle into it, draw up the required amount of the medicinal substance (Fig., a);

Rice. Parenteral route of drug administration, preparation for injection.

A - the ampoule is open; filling the syringe with the liquid contents of the ampoule; b - removing air from the syringe until the first drop appears from the needle.

Remove the needle with which the solution was drawn and put on the injection needle;
- fix the needle, lift the syringe up and, holding the syringe vertically at eye level, let out air and a little (first drop) of the medicinal substance: this is how you check the patency of the needle (Fig., b).
The syringe is prepared for injection.

Dilution of the solid in the vial

Some drugs for injection, including antibiotics, are available as crystalline powder in vials.
Before use, it is dissolved in a sterile isotonic sodium chloride solution (0.9% sodium chloride solution), water for injection, 0.5%, 0.25% novocaine solution. In order for 1 ml to contain 100,000 IU of the active substance, 5 ml of solvent should be taken for a vial containing 500,000 IU of the substance.
Act:
- read the inscription on the bottle (name, dose, expiration date);
- remove the aluminum cover with non-sterile tweezers;
- treat the rubber stopper with a ball of alcohol;
- draw the required amount of solvent into the syringe;
- pierce the stopper with a needle and inject the solvent (Fig. below, a);
- remove the vial with the needle from the needle cone and shake the vial until the powder dissolves.

Vial solution kit
- Put the needle with the vial containing the dissolved substance on the needle cone of the syringe;
- lift the vial upside down and draw the contents of the vial (or part of it) into the syringe (Fig., b);
- remove the vial together with the needle from the needle cone of the syringe;
- put on and fix the injection needle on the cone of the syringe;
- check the patency of the needle by passing a little solution through the needle;
- release the air from the syringe and the first drop of the solution at the tip of the needle.
The syringe is prepared for injection.

Calculating the dose of insulin

The introduction of insulin is a responsible procedure. An overdose of the drug can lead to severe hypoglycemic coma due to a sharp decrease in blood sugar levels.
Late introduction or insufficient dose of insulin can aggravate the symptoms of insulin deficiency - hyperglycemia. Therefore, the dose of insulin should be calculated very carefully. Currently, special syringes are widely used to administer insulin.
The peculiarity of insulin syringes is that there are 40 divisions along their entire length, and each division corresponds to one unit of insulin. The milliliters (ml) and units (U) of action in which insulin is dosed are indicated on the barrel of the insulin syringe. In order to correctly draw insulin into a non-insulin syringe with a capacity of 1.0-2.0 ml, you need to calculate the division value of the syringe. It is necessary to count the number of divisions in 1 ml of the syringe. Domestic insulin is produced in vials of 5.0 ml. In 1 ml - 40 IU. Divide 40 units of insulin by the number of divisions obtained in 1 ml of the syringe 40:10 = 4 units - the price of one division, i.e. 0.1 ml = 4 units.
Divide the dose of insulin you need by the price of one notch and you will determine how many notches on the syringe should be filled with medicine.
For example: 72 units: 4 units = 18 divisions.
Insulin is administered subcutaneously 30 minutes before meals. Store the medicine in the refrigerator. 30-40 minutes before the introduction, it is removed from the refrigerator. 30 minutes after the administration of the drug, the patient should eat.
Currently, for the introduction of insulin, "pen-syringes" are used, containing a special reservoir ("cartridge", or "penfill") with insulin, from which, when a button is pressed or turned, insulin enters the subcutaneous tissue. In the syringe pen before the injection, you need to set the required dose. Why the needle is injected under the skin and the entire dose of insulin is injected by pressing the button. Insulin reservoirs/cartridges contain insulin in a concentrated form (1 ml contains 100 units of insulin). There are pen syringes for not only short-acting insulin, but also for long-acting insulin and for a mixture (combination) of insulins. Be sure to carefully read the instructions for using the syringe pen, as different types of pens are arranged and act differently.

There are several ways to administer drugs: outer- through the skin, mucous membranes and respiratory tract; internal (enteral)) - through the mouth or rectum; parenteral - bypassing the gastrointestinal tract, i.e. subcutaneously, intramuscularly, intravenously, etc.

External use of drugs - on the skin and mucous membranes, is designed mainly for their local action. Internal use of medicinal substances is simple and convenient. Patients take drugs by mouth, in the form of powders, tablets, drops, potions, suppositories, and medicinal enemas. The main advantage of the parenteral method of administration is the speed of administration and action.

Injection is the introduction of drugs intradermally (in / c), subcutaneously (s / c), intramuscularly (in / m), intraosseous (in / c), intravenously (in / in), intraarterially (in / a). injections are made with a syringe. A syringe is a tool for dosed injection of liquid medicines into the tissues of the body. The syringe is a manual piston pump, consisting of a cylinder, piston and needles.

Preparing the syringe for injection. The package with a disposable syringe is opened, a needle with a sheath is fixed on the cannula, and the syringe is removed. The ampoule with the required medicine is treated at the site of the proposed incision with cotton wool soaked in alcohol. An ampoule is filed with a special file and broken. Remove the cap from the needle and, without touching the walls of the ampoule, draw the required amount of the drug into the syringe. The syringe is installed vertically with the needle up and, holding the needle sleeve, the air is carefully removed from it. The preparation of a reusable syringe consists in boiling it in a sterilizer for 45 minutes.

subcutaneous injection.

The choice of site for subcutaneous injection depends on the thickness of the subcutaneous tissue. The most successful areas are the subscapular region, the posterior surface of the shoulder in the region of the middle third and the anterior surface of the thigh. The skin at the site of the upcoming injection is carefully treated with ethyl alcohol. The fingers of the left hand (1 and 2) collect the skin and subcutaneous tissue into a fold. With any s / c injection technique, the needle should be cut up and inserted 2/3 of the length.

First way. The syringe barrel is held with 1, 3 and 4 fingers, the 2nd finger lies on the needle sleeve, 5 on the piston. The injection is made at the base of the fold from the bottom up, at an angle of 30 ° to the surface of the body. After that, the syringe is intercepted with the left hand, the rim of the cylinder is held with 2 and 3 fingers of the right hand, and the piston handle is pressed with 1 finger. Then, with the right hand, a cotton ball moistened with ethyl alcohol is applied to the injection site and the needle is quickly removed.

The second way. The filled syringe is held vertically with the needle down. 5 finger lies on the needle sleeve, 2 - on the piston, the syringe barrel is held by 1, 3 and 4 fingers. The needle is quickly inserted, the piston handle is pressed with 2 fingers, the medicinal substance is injected, after which the needle is removed.

Intramuscular injection.

To achieve a quick effect with the introduction of medicinal substances, as well as for the introduction of poorly absorbable drugs, intramuscular injections are made. The injection site is chosen in such a way that there is a sufficient muscle layer in this area and there is no accidental injury to large nerves and blood vessels. For example, the gluteal region. The buttock is mentally divided into four parts, the injection is made in the upper outer part (quadrant). Use long needles (6-8 cm) with a diameter of 0.5 - 0.8 mm. The syringe is held in the right hand with the needle down, perpendicular to the surface of the body, while the 2nd finger is located on the piston, and the 5th finger lies on the needle sleeve. The skin is stretched with the fingers of the left hand. The needle is quickly inserted to a depth of 5-6 cm, the piston is pulled up to prevent the needle from entering the vessel, and only after that the drug is slowly injected. Remove the needle quickly, in one motion. The injection site is treated with a cotton ball moistened with ethyl alcohol.

Intravenous injection.

For intravenous injection, one of the veins in the elbow area is most often used. Injections are made in a sitting or lying position, the extended arm is placed on the table, upward with the elbow bend. A tourniquet is applied to the shoulder so as to compress only superficial veins and not block the flow of arterial blood. The pulse on the radial artery with a tourniquet applied should be well defined. To accelerate the swelling of the veins, the patient is asked to vigorously bend the fingers in the hand, while the veins of the forearm are filled and become clearly visible. The skin of the elbow is treated with a cotton ball dipped in ethyl alcohol, then the syringe connected to the needle is taken with the fingers of the right hand (see method one), and the skin is pulled with two fingers of the left hand and the vein is fixed. Holding the needle at an angle of 45 o, cut up, pierce the skin and advance the needle along the vein, then pierce the vein, after which the needle is almost horizontally advanced in the vein somewhat forward. When a needle enters a vein, blood appears in the syringe. If the needle does not enter the vein, then when the piston is pulled towards itself, blood will not flow into the syringe. When taking blood from a vein, the tourniquet is not removed until the end of the procedure. With intravenous injection, the tourniquet is removed and, slowly pressing on the piston, the dissolved medicinal substance is injected into the vein. Constantly monitor that air bubbles do not enter the vein from the syringe and the drug solution does not enter the subcutaneous tissue. At the end of the intravenous injection, the needle is smoothly removed, the puncture site is closed with a cotton ball soaked in ethyl alcohol, and a pressure aseptic bandage is applied to prevent the formation of a hematoma or the arm is bent at the elbow, holding it until the blood in the wound clot.

13. Possible complications during injections and measures for their prevention:

Almost all complications after the injection are associated with a violation of the rules for the administration of medicinal substances. Damage to the nerve columns may occur, either from the needle or from the injected drug. The patient immediately experiences acute pain along the nerve trunk. With intramuscular injections, if the needle is deeply inserted, it can break and its fragment will remain in the tissues. The nurse should carefully examine the needles before using them, especially at the junction with the cannula. If such a complication occurs, the nurse should immediately inform the doctor. A fragment of the needle left in the tissues can change its position under the influence of muscle contractions.

Complications with intravenous administration of drugs:

pyrogenic reactions, which are accompanied by a sharp rise in temperature with a tremendous chill. This occurs when using drugs with an expired shelf life, the introduction of poorly prepared solutions.

Fatty embolism of the pulmonary vessels. Occurs when erroneous injection of oil preparations into a vein. Fat embolism is manifested by sudden pains in the heart, suffocation, coughing, blue face.

Air embolism of the pulmonary vessels. It turns out when air bubbles are not removed in a timely manner from a syringe or blood transfusion system.

Dizziness, collapse, heart rhythm disturbance. May be due to too rapid administration of the drug.

Infiltrate. It is formed when the drug enters the subcutaneous tissue. This occurs in the case of end-to-end perforation of the vein. If this happens, it is recommended to put a wine compress on the elbow area.

Hematomas at the injection site. More often formed in patients with impaired blood clotting or increased vascular permeability. Prevention of this complication is a tight pressing of the injection site.

Sepsis. May occur in violation of the rules of asepsis and antisepsis.

Phlebitis. Inflammation of a vein caused by chemical or physical irritation is often accompanied by thrombosis of the affected vessel.

Allergic reactions. May occur with most drugs. They appear in the form of itching of the skin, skin rashes, Quincke's edema. The most dangerous form of reaction is anaphylactic shock (shortness of breath, nausea, skin itching, lowering blood pressure, loss of consciousness, blue skin). If any of these symptoms appear in a patient, the administration of the drug should be stopped immediately and urgent emergency care should be provided.