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 administration of medicinal substances are the upper third of the outer surface of the shoulder, the subscapular space, the anterior side surface hips, lateral surface of the abdominal wall. In these areas, the skin is easily captured in a fold,
therefore, 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.
Required equipment: a sterile syringe tray, a disposable syringe, an ampoule with a drug solution, a 70% alcohol solution, a mix with sterile material (cotton balls, swabs), sterile tweezers, a tray for used syringes, a sterile mask, gloves, an anti-shock kit, a container with a disinfectant solution.
Rice. U-b. Subcutaneous Injection Technique: a-~ the formation of a skin sweetness and injection of a syringe needle into its base; b- drug administration.
The order of the procedure:
1. Invite the patient to take a comfortable position and free the injection site from clothing (if necessary, help the patient in this).
2. Wash your hands thoroughly with warm soapy water. running water; without wiping with a towel, so as not to violate the relative sterility, wipe your hands well with alcohol; put on sterile gloves and also treat them with a sterile cotton ball dipped in 70% alcohol solution.
3. Prepare the syringe with the drug (see section “Preparing the syringe with the drug for injection” above).
4. Treat the injection site with two sterile cotton balls soaked in a 70% alcohol solution, widely, in one direction: first a large area, then the second ball directly to the injection site.
5. Remove the remaining air bubbles from the syringe, take the syringe in your right hand, index finger holding the needle sleeve, and the cylinder with the thumb and other fingers.
6. Form a fold of skin at the injection site, capturing the skin with the thumb and forefinger of the left hand so that a triangle is formed (Fig. 11-6, a).
7. Insert the needle with a quick movement at an angle of 30-45 ° with a cut up into the base of the fold to a depth of 15 mm; while holding the needle sleeve with the index finger (Fig. 11-6, a).
8. Release the crease; make sure that the needle does not enter the vessel, for which purpose the piston is slightly pulled towards itself (there should be no blood in the syringe); if there is blood in the syringe, repeat the injection of the needle.
9. Transfer your left hand to the piston and, pressing on it, slowly inject the medicinal substance (Fig. 11-6, b).
10. Press the injection site with a sterile cotton ball soaked in 70% alcohol solution and remove the needle with a quick movement.
11. Put the used syringe, needles into the tray; Place used cotton balls in a container with a disinfectant solution.
Preliminary preparation for the manipulation:
- wash your hands thoroughly twice with soap and running water, dry with a clean individual towel or sterile disposable napkin. Treat with 70% ethyl alcohol solution, put on a gauze mask, sterile rubber gloves;
- remove the disposable syringe and needle from the package;
- draw up the dose of the medicinal product, which is indicated in the prescription sheet, from the ampoule or vial into the syringe;
- put the syringe with the collected drug on a sterile tray;
- put 3 sterile cotton balls soaked in 70% ethanol solution on this tray;
- in case of drug administration on the outer surface of the shoulder offer the patient to sit comfortably on a chair, free the injection site from clothing; the arm should be slightly bent at the elbow joint;
in the subscapular region offer the patient to sit on a chair, straighten his back, press his left or right side against the back of the chair; the arm on the side of the injection should be lowered and pulled back a little, while with the left hand it will be easier for the nurse to grab the skin with subcutaneous tissue into a fold;
- in case of drug administration in the anterior outer thigh or in lateral areas of the abdomen offer the patient to lie on his back, relax;
- Patients with labile nervous system, predisposed to dizziness, regardless of the chosen injection site, the manipulation should be performed lying down.
The main stages of the manipulation:
1. Mark the injection site (external surface of the upper arm, subscapularis, anterior external thigh, lateral surfaces of the abdomen) where the skin and subcutaneous layer are well folded and there is no risk of damage to blood vessels, nerves and periosteum.
2. Palpate the chosen place. The injection should not be performed in places of edema or seals (infiltration), which remained from previous injections.
3. Wipe the injection site twice with sterile cotton balls soaked in 70% ethanol.
4. Dip used cotton balls into a 5% solution of chloramine in a container marked "For used cotton balls" for 1 hour.
5. Take the syringe filled with drugs with your right hand so that the second finger holds the needle sleeve, the last fingertips hold the syringe barrel. In this case, point the needle section upwards (Fig. 7.8).
6. With the index and thumb of the left hand in the corresponding area, grab the skin with subcutaneous tissue into a fold.
7. At the base of the formed fold at an acute angle (40-45 °), with a quick movement, insert the needle with a cut up to 2/3 of its length, that is, to a depth of 1-2 cm. In this case, the needle enters the subcutaneous layer. It is necessary to ensure that the needle is not fully inserted and that a part of the needle with a length of at least 0.5 cm remains above the skin (Fig. 7.8).
Rice. 7.9. Performing a subcutaneous injection:
a) insertion of a needle into the formed fold; b) the introduction of drugs under the skin.
8. After puncturing the skin, release the fold, press the piston handle with the first or second finger of the left hand and completely inject the medicine under the skin.
9. With your left hand, apply a sterile cotton ball soaked in 70% ethanol solution to the injection site and pull the needle out with a quick movement. With the same cotton ball, make a light massage of the injection site of the drug so that it is better distributed under the skin, and also to prevent the occurrence of hemorrhage if the vessel wall is damaged by the needle. After the introduction of insulin, massage is not necessary.
10. Dip the spent cotton ball into a 5% solution of chloramine in a container marked "For used cotton balls" for 1 hour.
11. Disinfect the syringe and needle after use.
Due to the fact that the subcutaneous fat layer is richly supplied with blood vessels, subcutaneous injections are used for faster action of the drug.
Usually solutions of drugs are administered, which are quickly absorbed by loose subcutaneous tissue and do not affect it. harmful action. Subcutaneously, you can enter liquids from a small amount to 2 liters.
When conducting subcutaneous injections, the proximity of large vessels and nerve trunks should be avoided. The most convenient sites for injections are the outer surface of the shoulder or the radial edge of the forearm, the subscapular space, the anterolateral surface of the thigh, the lateral surface of the abdominal wall and Bottom part axillary area. In these areas, the skin is easily captured in the fold and there is no danger of damage to blood vessels, nerves and subcutaneous fat.
With subcutaneous administration, the absorption of medicinal substances, and therefore in the manifestation of a therapeutic effect, is slower than with intramuscular and intravenous administration. However, they act in this case for a longer time. In case of insufficiency of peripheral circulation, subcutaneously administered substances are poorly absorbed.
Immediately before injection from the syringe, holding it vertically with the needle up, displace the air. If the air bubbles in the solution are small, you need to pull the piston so that they merge into one large one, and then free yourself from it by moving the piston.
The surface of the skin where the injection is going to be done is wiped twice with sterile cotton balls soaked in alcohol. The first time they wash the A section 10 × 10 cm, with the second cotton ball - directly the puncture site 5 × 5 cm. Then this place is smeared with an alcohol solution of iodine. If the skin is very dirty, it must first be treated with ether.
For injections of aqueous solutions, a thin needle is taken, for injections of oils - a thicker needle, for subcutaneous injections - a needle 90 mm long with a lumen of 1 mm. With the left hand, the skin at the injection site is grasped into a fold, into the base of which a needle is inserted with a quick movement. There are two ways to hold the syringe and puncture the skin.
In the first method, the syringe barrel is clamped between the first and second or third fingers, the fourth and fifth fingers, and the piston is held. An injection is made at the base of the skin fold from the bottom up (the patient is standing) at an angle of 30 ° to the surface of the shoulder. When piercing the skin, the lumen of the needle should always point upwards.
With subcutaneous, intramuscular and intravenous injections, the needle is not inserted entirely, but approximately 2/3 of the length, since its fracture can occur only at the junction with the sleeve. Having made a puncture of the skin, the syringe is transferred to left hand, second and third fingers right hand clamp the rim of the cylinder, and press the piston handle with the first finger, injecting the medicine. Then, with the left hand, a fresh cotton ball soaked in alcohol is applied to the injection site and the needle is quickly removed. The injection site of the drug is lightly massaged with a cotton ball so that it is better distributed in the fiber and does not come back.
The puncture site of the skin is lubricated with an alcohol solution of iodine. To avoid burns, a cotton ball moistened with an alcohol solution of iodine should not be kept at the injection site for a long time.
In the second method, the filled syringe is held vertically with the first and third or fourth fingers, with the needle down. Quickly inserting the needle, press the piston handle with the second finger and inject the medicine, after which the needle is removed.
Complications
violation of the rules of asepsis and insufficient sterilization of the solution can lead to local inflammation up to the development of a septic process. Clinically manifested by hyperthermia at the injection site, swelling. Hyperthermia can also be of a general nature;
erroneous administration of a 10% sodium chloride solution (hypertonic solution) instead of 0.85% saline or some other hypertonic solution can lead to local necrosis;
the introduction of too hot a solution (above 40 ° C) can also cause tissue necrosis;
the erroneous administration of drugs that are not prescribed by a doctor or contraindicated in this patient can also lead to death.
The most common (more common) complication is infiltrate - this is "reactive tissue cell reproduction" around the site of mechanical injury (as a result of an injection with a blunt needle) and chemical irritation medicinal substance. especially oil solutions and suspensions; due to ingestion of a microbial agent.
Infiltrate- local compaction and tissue enlargement. The mechanism of infiltrate development in each case will be different, although the initial and final stages may coincide.
With the introduction of poorly soluble medicinal substances, the process of their absorption slows down. To accelerate the resorption of the formed infiltrates, warming compresses and physiotherapy are used.
Abscess- an organic accumulation of pus in the tissues due to their inflammation with tissue melting and the formation of a cavity. Characterized by local common features inflammation (pain, hyperemia, hyperthermia, etc.).
They require either surgical intervention, or (if the patient's condition allows) intensive conservative treatment (antibacterial therapy is required).
An important point is the prevention of infiltrates and abscesses - strict adherence to asepsis rules: the use of disposable syringes with an unexpired shelf life, reliable sterilization of instruments, treatment of the nurse's hands, patient's skin, ampoules of the medicinal substance with ethyl 70% alcohol and sterile material, maintaining the sterility of instruments and medicinal solution.
"Directory nurse» 2004, «Eksmo»
Currently, there are three main methods of parenteral (i.e. bypassing the digestive tract) administration of drugs: subcutaneous, intramuscular and intravenous. The main advantages of these methods include the speed of action and the accuracy of dosage. It is also important that the drug enters the bloodstream unchanged, without being degraded by the enzymes of the stomach and intestines, as well as the liver. Administration of drugs by injection is not always possible due to some mental illnesses accompanied by fear of injection and pain, as well as bleeding, skin changes at the site of the proposed injection (for example, burns, purulent process), skin hypersensitivity, obesity or malnutrition. In order to avoid complications after an injection, you need to choose the right length of the needle. For injections into a vein, needles 4-5 cm long are used, for subcutaneous injections - 3-4 cm, and for intramuscular injections - 7-10 cm. Needles for intravenous injections should have a cut at an angle of 45 °, and for subcutaneous injections, the cut angle should be sharper. It should be remembered that all instruments and injection solutions must be sterile. For injections and intravenous infusions, only disposable syringes, needles, catheters and infusion sets should be used. Before performing the injection, it is necessary to read the doctor's prescription again; carefully check the name of the drug on the package and on the ampoule or vial; check the expiration date of the medicinal product, disposable medical instrument.
Currently used, single use syringe issued in assembled. These plastic syringes are factory sterilized and packaged in individual bags. Each bag contains a syringe with a needle attached to it or with a needle in a separate plastic container.
The order of the procedure:
1. Open the package of a disposable syringe, with tweezers in your right hand, take the needle by the sleeve, put it on the syringe.
2. Check the patency of the needle by passing air or a sterile solution through it, holding the sleeve with your index finger; put the prepared syringe into a sterile tray.
3. Before opening the ampoule or vial, carefully read the name of the medicine to make sure it matches the doctor's prescription, clarify the dosage and expiration date.
4. Lightly tap the neck of the ampoule with your finger so that all the solution is in the wide part of the ampoule.
5. File the ampoule with a nail file in the area of its neck and treat it with a cotton ball dipped in a 70% alcohol solution; when collecting the solution from the vial, remove the aluminum cap from it with non-sterile tweezers and wipe the rubber stopper with a sterile cotton ball with alcohol.
6. With a cotton ball, which was used to wipe the ampoule, break off the upper (narrow) end of the ampoule. To open the ampoule, it is necessary to use a cotton ball to avoid injury by glass fragments.
7. Take the ampoule in your left hand, holding it with your thumb, forefinger and middle fingers, and in your right hand - a syringe.
8. Carefully insert the needle put on the syringe into the ampoule, and, pulling, gradually draw into the syringe right amount the contents of the ampoule, tilting it as necessary;
9. When taking the solution from the vial, pierce the rubber stopper with a needle, put the needle with the vial on the needle cone of the syringe, lift the vial upside down and draw the required amount of contents into the syringe, disconnect the vial, change the needle before injection.
10. Remove air bubbles present in the syringe: turn the syringe with the needle up and, holding it vertically at eye level, release air and the first drop of the drug by pressing on the piston.
intradermal injection
1. Draw the prescribed amount of the drug solution into the syringe.
2. Ask the patient to take a comfortable position (sit down or lie down) and free the injection site from clothing.
3. Treat the injection site with a sterile cotton ball soaked in a 70% alcohol solution, making movements in one direction from top to bottom; wait until the skin at the injection site is dry.
4. Grab the patient's forearm with the left hand from the outside and fix the skin (do not pull!).
5. With the right hand, lead the needle into the skin with a cut upwards in the direction from bottom to top at an angle of 15 ° to the skin surface for the length of only the cut of the needle so that the cut is visible through the skin.
6. Without removing the needle, slightly lifting the skin with the cut of the needle (forming a “tent”), move your left hand to the syringe plunger and, pressing the plunger, inject the medicinal substance.
7. Remove the needle with a quick movement.
8. Put the used syringe, needles into the tray; Place used cotton balls in a container with a disinfectant solution.
Due to the fact that the subcutaneous fat layer is well supplied with blood vessels, subcutaneous injections are used for faster action of the drug. Subcutaneously administered medicinal substances have a faster effect than when administered through the mouth. Subcutaneous injections are made with a needle of the smallest diameter to a depth of 15 mm and up to 2 ml of drugs are injected, which are quickly absorbed from loose subcutaneous tissue and do not have a harmful effect on it. The most convenient sites for subcutaneous injection are: the outer surface of the shoulder; subscapular space; anterior surface of the thigh; lateral surface of the abdominal wall; lower armpit.
In these places, the skin is easily captured in the fold and there is no danger of damage to blood vessels, nerves and periosteum. It is not recommended to inject into places with edematous subcutaneous fat, into seals from poorly absorbed previous injections.
Technique:
wash your hands (put on gloves);
Treat the injection site successively with two cotton balls with alcohol: first a large area, then the injection site itself;
Place the third ball with alcohol under the 5th finger of the left hand;
Take the syringe in your right hand (with the 2nd finger of the right hand hold the cannula of the needle, with the 5th finger - the plunger of the syringe, with 3-4 fingers hold the cylinder from below, and with the 1st finger - from above);
· 
fold the skin with your left hand triangular shape, base down;
Insert the needle at an angle of 45 ° into the base of the skin fold to a depth of 1-2 cm (2/3 of the length of the needle), hold the cannula of the needle with your index finger;
Move your left hand to the plunger and inject the drug (do not transfer the syringe from one hand to the other).
Attention!If there is a small air bubble in the syringe, inject the medicine slowly and do not release all the solution under the skin, leave a small amount with the air bubble in the syringe:
Remove the needle by holding it by the cannula;
Press the injection site with a cotton ball with alcohol;
Make a light massage of the injection site without removing the cotton wool from the skin;
Put a cap on a disposable needle, discard the syringe into a trash can.
Intramuscular injections
Some subcutaneous drugs cause pain and are poorly absorbed, leading to the formation of infiltrates. When using such drugs, as well as in cases where they want to get a faster effect, subcutaneous administration is replaced by intramuscular. Muscles have a wide network of blood and lymphatic vessels, which creates conditions for the rapid and complete absorption of drugs. With intramuscular injection, a depot is created, from which the drug is slowly absorbed into the bloodstream, and this maintains the required concentration in the body, which is especially important in relation to antibiotics. Intramuscular injections should be made in certain places of the body where there is a significant layer of muscle tissue and large vessels and nerve trunks do not come close. The length of the needle depends on the thickness of the layer of subcutaneous fat, since it is necessary that when inserted, the needle passes through the subcutaneous tissue and enters the thickness of the muscles. So, with an excessive subcutaneous fat layer, the length of the needle is 60 mm, with a moderate one - 40 mm. Most suitable places for intramuscular injections are the muscles of the buttocks, shoulder, thigh.
For intramuscular injections in the gluteal region use only the upper part of it. It should be remembered that accidentally hitting the sciatic nerve with a needle can cause partial or complete paralysis of the limb. In addition, there is a bone (sacrum) and large vessels nearby. In patients with flabby muscles, this place is localized with difficulty.
Lay the patient either on their stomach (toes turned in) or on their side (the leg that will be on top is bent at the hip and knee to relax
gluteal muscle). Palpate the following anatomical structures: superior posterior iliac spine and greater trochanter femur. Draw one line perpendicular down from the middle
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Intramuscular injection into the vastus lateralis muscle carried out in the middle third. Place the right hand 1-2 cm below the trochanter of the femur, the left hand 1-2 cm above the patella, the thumbs of both hands should be on the same line. Locate the injection site, which is located in the center of the area formed by the index and thumbs of both hands. When injecting young children and malnourished adults, take the skin and muscle into a fold to ensure that medicinal product hit the muscle.
Intramuscular injection can be done and into the deltoid muscle. The brachial artery, veins and nerves run along the shoulder, so this area is used only when other injection sites are not available or when several intramuscular injections are performed daily. Release the patient's shoulder and shoulder blade from clothing. Ask the patient to relax the arm and bend it at the elbow joint. Feel the edge of the acromial process of the scapula, which is the base of the triangle, the apex of which is in the center of the shoulder. Determine the injection site - in the center of the triangle, approximately 2.5-5 cm below the acromial process. The injection site can also be determined in another way by placing four fingers across the deltoid muscle, starting from the acromial process.
Demchenko Alina Gennadievna
Reading time: 4 minutes
For some women, the thought of daily injections for IVF is not only unpleasant, but also associated with difficulties. Many clinics recommend arriving daily at a certain time for the procedure, but this is not always convenient. Therefore, a nurse or doctor carefully advises patients on how to inject in the abdomen or buttock during IVF.
A subcutaneous injection is a shot given into a fatty area under the skin (as opposed to an intravenous injection, which is given directly into the bloodstream). An injection in the abdominal area is mainly prescribed for patients who are in the IVF protocol and who are injecting hormonal drugs.
Prescriptions for drugs are usually accompanied by detailed instructions for correct use.
For any protocol (long, short), drugs are prescribed.
