No one is safe from injections, not even the most healthy man Moreover, vaccinations are needed to keep us healthy. That is why the syringe is not only a symbol of fear, but also a symbol of health. As doctors say, the injection itself is not as dangerous as a low-quality syringe. Today, an injection can be made as painless as possible; the main thing is to choose the ideal device for this procedure.

In the mid-20th century, the most common medical syringes were made of glass and chrome-plated metal. The first disposable medical syringe made of plastic was invented by veterinarian Murdoch, but over time, this invention was appreciated not only by animals, but also by people: the medicine quickly reached any target, instantly absorbed into the blood. After some time, the medical syringe also acquired a seal for the piston: most often in the pharmacy you can find just such a device for injections. Today, medical syringes can be bought in a wide variety of sizes and designs. The main thing is to understand the patient’s needs and choose the highest quality medical devices.

Syringes: what are they?

Medical syringes are divided into several categories and according to several parameters.

• Position of the cone tip. A needle is attached to this cone on the syringe barrel. This situation could be:

a) Concentric or coaxial. In this case, the tip is located directly in the middle of the cylinder of the injection device. Typically, this position occurs with small-volume syringes for injection under the skin or into muscles.

b) Displaced or eccentric. The cone is located on the side of the cylinder. These are needed for blood collection.

• Needle fastening.

a) Integrated into the cylinder. There are also medical syringes, the volume of which is no more than one milliliter.

b) Luer. One of the most popular types of fastening. In this case, the needle is put on the part of the cylinder that protrudes. Characteristic for medical syringes of even the largest volumes.

c) Luer-lock. With it, a needle is “screwed” into a syringe. It is used in droppers, perfusers and infusion pumps, but is not very suitable for ordinary injections. But this is an ideal option for introducing drugs into hard tissues of cartilage or periosteum.

d) Catheter type. Suitable, for example, for feeding, drainage, rinsing abscesses, as well as for administering any medicine through a catheter.

• Design.

A) Two-component. They consist only of a piston and a cylinder, so the injection can be very prickly and painful.

B) Three-component. In order to remove maximum pain during the injection, it was enough to place a rubber seal on the piston. Because of this, the piston began to move more smoothly, and the parts of the medical syringe stopped rubbing against each other. All this helped relieve pain during and after the injection. For the same purposes, by the way, an atraumatic needle was created, which has a tip of three edges and is better polished. Thanks to this design, the muscle fibers do not tear, but only move apart and there is no pain. BogMark medical syringes are equipped with such a needle.

Advice: if you want to give an injection to a person for whom you want only the best, look at the quality of the syringe and its manufacturer. In order to avoid pain and children's tears, choose a three-component syringe from the best manufacturers, including, for example, the already mentioned BogMark, Plastipak, Omnifix. Make sure that the device is sterile. And be sure to pay attention to the volume of the syringe: the capabilities of this simple device and its purpose depend on it. For a child, you should also choose a needle with the smallest diameter.

What types of syringes are there by volume?

The volume of a medical syringe refers to the volume of its cylinder. The cylinder volume is small, standard and large. They all have their own purpose; they are unlikely to be capable of anything else.

We need to talk about the purpose of medical syringes of different sizes first of all, because otherwise you can make a mistake with the “capacity”.

• Syringes with the smallest volume. These include syringes with volumes such as 1 ml, 0.3, and ½ ml. They are needed, for example, in such branches of medicine as endocrinology (insulin syringe), phthisiology (medical tuberculin syringes), neonatology (for the little ones). Also, such miniature devices are used to conduct intradermal allergy testing and for vaccinations.
• Syringes with standard volume. These include all devices with a volume from two milliliters to 22. They are used in any branch of medicine and are used for procedures such as intravenous injections (they require a cylinder of 10-22 ml), intramuscular (using a cylinder of 2-6 milliliters) , as well as subcutaneous (here you need a cylinder with a volume of three milliliters).
• The largest syringes. This refers to those whose cylinder has the largest volume. These include thirty-milliliter devices. And also having a “displacement” of 60.50 and 100 ml. The largest syringe is most often needed to rinse cavities, suck out liquids and introduce nutrient media.

Advice. Whatever procedure you do, follow the basic rules for performing an injection: be sure to wash your hands, put on gloves, and first treat the injection site with an alcohol swab. And first the entire zone, then the area where the injection will be done. The needle is inserted at an angle equal to half a straight line.

Disinfection of disposable syringes - processing rules Syringe pen for insulin with a removable needle - how to choose? Syringe pen Novopen 4 - injector for insulin administration
Needles for insulin syringe pens, device features and applications

^ Diagram of the structure of a disposable syringe

A disposable syringe consists, just like a glass one, of a cylinder and a piston rod (collapsible or non-dismountable). The cylinder has a Luer-type cone tip (Record syringes can be produced upon request, they are practically not produced), a finger rest and a graduated scale. The rod-piston assembly consists of a rod with a stop, a piston with a seal and a reference line.

Depending on the structure of the piston rod, the design of disposable syringes

They are divided into 2-component (Fig.) and 3-component (Fig.). In 2-component syringes, the rod and piston are a single unit; in 3-component syringes, the rod and piston are separated. The main functional difference between these designs is the characteristics of lightness and smooth movement of the piston. Disposable syringes can also be coaxial and eccentric (Fig. 18), which is determined by the position of the cone tip.

Rice. 18. Disposable syringes, coaxial (1) and eccentric (2)

Fig. 19. Disposable eccentric syringes.

The capacity of syringes is determined by their purpose and ranges (GOST) from 1 to 50 ml. In practice, the range of volumes of disposable syringes ranges from 0.3 to 60 ml. Syringes volume 0.3; 0.5 and 1.0 ml are used for precise administration medicines(tuberculin, insulin, standard allergen extracts) in small volumes - from 0.01 ml.

P The industry produced sterilizing cases for storing and sterilizing syringes. They were sometimes called syringe packs. They were very widespread in various field conditions. Today they have been replaced by disposable syringes, but you can still encounter them in your practice.

Fig.20. Sterilizer cases for storing and sterilizing glass syringes.

^ Medical needles

Piercing or piercing-cutting instruments in the form of a thin rod or tube with a pointed end. In addition, they produce special ligature needles .

Depending on the purpose, medical needles are divided into:

• 
  injection,
• 
  puncture-biopsy,
• 
  surgical.

injection needles

Injection needles are intended for administering drug solutions, drawing blood from a vein or artery, and blood transfusion. They are used together with syringes, as well as systems for transfusion of liquids or blood. An injection needle is a narrow metal tube made of certain types of steel, one end of which is cut and sharpened, and the other is tightly attached to a short metal coupling for connection to a syringe or elastic tube (the internal diameter of the head opening for Record syringes is 2.75 mm, for Luer type syringes - 4 mm). Sterile disposable injection needles are becoming increasingly common. Their use dramatically reduces the risk of infectious complications, they are convenient and do not require prior sterilization. The main significant parameters of the needle are length, outer diameter, sharpening angle and puncture force. Needles have different lengths (from 16 to 90 mm) and diameters (from 0.4 to 2 mm):

• 
  for intradermal injection, a needle with a length of 16 mm and a diameter of 0.4 mm is used,
• 
  for subcutaneous injection, a needle with a length of 25 mm and a diameter of 0.6 mm is used,
• 
  for intravenous injection, a needle with a length of 40 mm and a diameter of 0.8 mm is used,
• 
  For intramuscular injection, a needle 60 mm long and 0.8-1 mm in diameter is used.

Practically a needle maximum length 38 (40) mm provides intramuscular injection of the drug into the area of ​​the superolateral quadrant of the buttock in 15% of men and 5% of women. (rice.)

Rice. 21. Needles for injections, infusions, transfusions: a - injection needle (1 - needle tube, 2 - needle head, 3 - mandrin, 4 - dagger sharpening, 5 - spear sharpening,  - needle cut angle); b - needle with stop for intradermal injections; c - needle with safety bead; d - needle with side holes for air release; d - attachment to an injection needle for connection to blood transfusion systems, etc.; e - transition cannula for injection needles; g - Dufault needle for blood transfusion; h - needle for drawing blood.

The cutting angle of injection needles ranges from 15 to 45° depending on the task of execution:

• 
  15-18° for injection needles,
• 
  30° at needles for inserting catheters into a vein, for spinal puncture,
• 
  30 and 45° for short-bevel needles for introducing radiocontrast agents

The needles have a spear- or dagger-shaped sharpening. The outer diameter of the needle ranges from 0.4 to 2 mm, length - from 16 to 150 mm. The needle number corresponds to its size (for example, No. 0840 means that the needle diameter is 0.8 mm, length is 40 mm).

Fig.22. A - disposable needles with

Various designs of cannulas with a case.

IN - various options needle sharpening,

Produced by industry.

The needle for intravenous infusions is cut at an angle of 45, and the needle for subcutaneous injections has more sharp corner cut. The needles should be very sharp, without jagged edges. (Fig. 21). The needle point is sharpened in 3 planes (spear-shaped sharpening), which ensures that the piercing effect prevails over the cutting effect when piercing tissue. The protective cap protects the needle from external damage and ensures safety when handling it. On the packaging, the type of needle cut is indicated by a special symbol ©. IN in this case the needle has a medium bevel length and is intended for intradermal administration of drugs.

The characteristics of the injection needle are important. The ease of tissue penetration (penetrating force), the accuracy of hitting certain anatomical structures, the stability of the needle position in the vessels, the degree of tissue trauma, and therefore the pain of the injection, depend on them. The listed characteristics of the needle in certain cases, along with the cost, determine the choice of the entire set (syringe + needle).

A good injection needle has the following requirements:

• 
  minimum force for puncture,
• 
  longitudinal resistance to bending (elasticity),
• 
  strength, stability of connections with the syringe,
• 
  minimal roughness of the outer surface and sharpening area.

Puncture force

The force required for puncture is determined by various factors, including design and manufacturing. This indicator depends on the shape and quality of the needle tip and cut, as well as on its diameter and special surface coating. A poor-quality cut can capture microfragments of the skin. With an increase in needle diameter from 0.5 mm (insulin syringe needle - orange cannula) to 0.8 mm (standard needle - green cannula), the puncture force increases by 1.5 times. Better glide of the needle at the moment of puncture is achieved by applying a silicone coating to the surface of the needle, which is used by most manufacturers, including large domestic ones.

^ Packaging of needles

The packaging of needles must provide:

• 
  maintaining the sterility of the contents when stored in dry, clean, properly ventilated areas;
• 
  minimal risk of contamination of the contents at the time of opening;
• 
  adequate protection of contents when normal conditions storage and transportation;
• 
  creating conditions under which an opened package cannot be resealed without much effort, and the fact of opening is obvious.

In addition to the primary packaging, there must be a secondary rigid one that protects the contents. On the packaging of needles, in addition to information about the manufacturer and supplier (name and trademark) and contents, they indicate: “best before..” (English - exp. date), and then the day, month and year of manufacture. Full details of the manufacturer or supplier are included on the secondary packaging. The packaging must remain intact during transportation (temperature from -50 to +50°C) in vehicles protected from precipitation and storage at temperatures from -5 to 40°C in heated and ventilated rooms. The packaging is sensitive to moisture. The susceptibility of domestic syringe packages to getting wet during short contact with water can be determined by paper density, print quality, and the presence of voluminous accompanying information. Domestic analogues of packaging are more resistant to moisture. Foreign-made syringe packages are more prone to getting wet.

When choosing injection devices, you should give preference to syringes in a package consisting of two parts, since when the paper part of the package is torn, fibers of the packaging paper are found on the syringe parts and the needle. If the package consists of two parts, you must follow the opening method indicated on it.

^ Safe manipulation (injection)

By improving injection devices, first of all, they have ensuring their safety for both the patient and the nurse. According to WHO data, the world produces about 12 billion injections. Different kinds injections are an invasive procedure that is recognized as the most common in the world.

According to the American Nurses Association, in the United States there are from 600 thousand to 1 million cases of injuries to medical workers with medical needles, which is the cause of at least 1 thousand new cases of HIV infection, as well as diseases of viral hepatitis “B” or “C” . The risk of infection is:

• 
  with HIV infection, 1 case in 300 injuries from contaminated needles (1:300),
• 
  for viral hepatitis C -1:30.
• 
  for viral hepatitis B - 1:3

Reuse of injection instruments according to different estimates, leads to infection:

• 
  from 8 to 16 million people with hepatitis B virus,
• 
  from 2.3 to 4.7 million - hepatitis C virus,
• 
  from 80 to 160 thousand people become infected with HIV.

IN 1987, WHO, as part of the Expanded Immunization Program, called for the introduction into production of technologies that prevent the reuse of disposable syringes. As a result, original mechanisms appeared that made it possible to block and partially destroy a disposable syringe after use. One of the most popular designs of self-locking disposable syringes is the V-clip. (Fig. 22). After drawing up the drug and its complete administration, the clip blocks the piston rod in the position of maximum displacement, which makes it impossible to reuse such a syringe. Self-locking syringes are widely used in mass immunization. Today, disposable syringes supplied by UNICEF are produced in a self-locking version.

Fig.22. Self-locking syringe.

There is another common way to prevent the reuse of a disposable syringe - this is its self-destruction when the contents are forced out of it, which is ensured by cutting edges or blades built into the piston rod that damage the syringe barrel. As a result, the disposable syringe no longer performs its functions and is therefore not suitable for further use.

In the USA, it was signed by the President in 2000 and has the force of law. Federal act about the safety of medical needles and the prevention of accidental injuries. This document categorizes medical needles as potentially hazardous, identifies risk factors, and provides access to safe instruments.

Currently, safety syringes are produced, which are standard injection devices equipped with special protective screens that, after use, cover the needle, protecting the nurse from subsequent contact with the tip. The syringe must then be disposed of.

But all the advantages of safe injection instruments created and produced by industry lose their significance if they need to be further processed, which includes washing, detaching the needle, rinsing the instruments after soaking, etc. Thus, safety is ensured not so much by the design of the tool, but by a whole range of preventive measures.

^ List of some special purpose syringes

Anel's syringe (historical D. Anel) - a dismountable syringe for washing the nasolacrimal duct, having a ring at the end of the piston rod and three cannulas - straight, slightly curved and strongly curved. Currently not produced by industry.

Brown syringe (C.R. Braun, 1822-1891, Austrian gynecologist) - a syringe with a capacity of 2 or 5 ml with a metal tip, slightly curved at the end, 15 cm long, used for intrauterine infusions.

Guyon's syringe (J.C.F. Guyon) - a syringe with a piston moving in a cylinder using a screw, with each half-turn of which one drop of content is released. Designed for instillation into the posterior urethra and bladder.

Syringe Janet (J. Janet) is intended for washing, characterized by a significant capacity (100-200 ml). There are soldered rings at the end of the rod and on the ring surrounding the glass cylinder for ease of operation.

Luer syringe (Luer) - an injection syringe made entirely of glass and having a larger tip cone diameter (4 mm) than metal syringes (2.75 mm).

Continuous Syringe designed for massive infusions, having a side cannula with a check valve through which the injected liquid enters the syringe barrel.

Polikarpov syringe (S.N. Polikarpov, Soviet surgeon) continuous action with a hollow piston having a valve that opens during suction and closes during discharge. It is used mainly for local anesthesia.

Syringe machine equipped with a mechanical device that provides a given depth of tissue puncture with a needle and the introduction of a given volume of liquid.

Syringe tube (syn. siretta) - a disposable device for administering drugs subcutaneously or intramuscularly, consisting of an elastic container filled with injected liquid and connected to a sterile injection needle, hermetically sealed with a cap with a mandrel.

Injections

Injections- parenteral administration of drugs (drug entry into the body, bypassing the digestive tract). (give a diagram of different injections, we had it!)

The main advantages of this method of delivering drugs into the body are their speed of action and possible dosage accuracy. Negative side lies in the possibility of developing various complications, since these manipulations require, although minimal, damage to the integument (skin, mucous membranes, etc.). Depending on the type of injection, one or another type of complication or combination thereof may develop.

Injections are most often carried out in adapted rooms - the treatment room of a hospital or clinic, but it is possible to perform them in a ward or at home, when a health worker visits the patient. IN emergency situations are also carried out at the scene of the incident. It all depends on the situation and need. For example, if a patient suffering from insulin-dependent diabetes mellitus is not given insulin in a timely manner, then the development of coma and even death cannot be ruled out.

For injections, syringes (see the syringes section) and needles (see the needles section) are used. The syringe must be sealed, that is, it must not allow air or liquid to pass between the cylinder and piston. The piston must move freely in the cylinder, tightly adjacent to its walls.

Before drawing a medicine into a syringe, you must carefully read its name to ensure that it is appropriate for its intended purpose. (action diagram and photo) There is a specific order for preparing and performing various manipulations. For each manipulation we try to show step by step actions, which should facilitate familiarization with various manipulations and their implementation in practice.

^ Algorithm for performing the manipulation: a set of medicinal solution from an ampoule

Target

Perform the injection.

Indications

Injection methods of administering medicinal solutions.

Equipment

• 
  Disposable syringe.
• 
  Disposable sterile rubber gloves.
• 
  Sterile tray.
• 
  Sterile tweezers.
• 
  Medicines in ampoules.
• 
  Procedure nurse assignment sheet.
• 
  Capacity with 0.25% aqueous solution Gibitana.
• 
  Files.
• 
  Bix with sterile dressing material;
• 
  Bottle with 70° alcohol.
• 
  Container for used needles.
• 
  Container for used material.

Prepare all the necessary equipment and prepare yourself for the procedure.

• 
  Wash your hands.
• 
  Take the ampoule and carefully read the name of the medicinal solution, dose, and expiration date.
• 
  Check the label information with your doctor's prescription.
• 
  It is necessary to move the drug from the narrow part of the ampoule to the wide one. To do this, take the ampoule by the bottom with one hand, and lightly strike the narrow end of the ampoule with the fingers of the other.
• 
  File the ampoule in the center of the narrow part of the ampoule. Narrow part The ampoules are filed with a special file.
• 
  Apply a cotton ball soaked in alcohol to the cut area. Using a cotton ball, break off the end of the ampoule at the opposite side from the cut, and throw it into a container for used material.
• 
  Take the syringe in your right hand so that the divisions are visible. Grab the opened ampoule between the 2nd and 3rd fingers of your left hand, so that the opened part is facing inside the palm. Insert the needle into the ampoule.
• 
  Place your right hand on the plunger and dial required quantity medicinal solution, tilting it as necessary, while ensuring that the cut of the needle is constantly immersed in the solution.
• 
  Without changing the position of your hands, give the syringe a strictly vertical position. Press the plunger with your right hand and force the air out of the syringe into the ampoule (if it is empty).
• 
  Next, you need to remove the ampoule from the needle and place it in a container for used material.
• 
  Using tweezers, take the injection needle and place it on the cone of the syringe. Be sure to push the air out of the needle again. By pressing on the syringe plunger and gradually pushing the air out of the syringe (until drops appear from the lumen of the needle). If we introduce an oily liquid, the ampoule should be preheated by immersing it in warm water. A single-use needle must be capped.
• 
  You are all ready to perform the manipulation. Place a syringe and sterile cotton balls moistened with alcohol in a sterile tray.

^ Algorithm for performing the manipulation of diluting the powder in a bottle

Target

Perform the injection.

Indications

Injection methods of administering medicinal solutions.

Equipment for performing manipulations

• 
  bottle with medicinal powder;
• 
  solvent (0.25% novocaine solution, 0.9% sodium chloride solution, water for injection);
• 
  sterile syringe with needles;
• 
  cotton balls soaked in 70% alcohol solution,
• 
  tray,
• 
  gloves,
• 
  tweezers;
• 
  bix with sterile wipes.

Algorithm for performing the manipulation

• 
  You must wash your hands and wear sterile gloves.
• 
  Read the label on the bottle carefully (name, dose, expiration date).
• 
  Using non-sterile tweezers, open the aluminum cap in the center of the antibiotic bottle.
• 
  Apply a cotton ball soaked in alcohol to the rubber stopper of the bottle.
• 
  Fill a disposable syringe with the amount of solvent required for this medicine. If solvent ampoules are included with the powder bottle, use one of them.
• 
  Take the syringe in your right hand. Puncture the rubber stopper of the bottle with the powder with a needle and inject the solvent.
• 
  Remove the bottle along with the needle in it from the syringe cone and shake the bottle until the powder is completely dissolved.
• 
  Place the needle with the vial on the cone of the syringe.
• 
  Lift the bottle upside down and draw the required dose of the drug into the syringe (this can be the entire contents of the bottle or part of it).
• 
  Remove the bottle along with the needle from the syringe cone.
• 
  Attach and secure the injection needle to the cone of the syringe.
• 
  Raise the syringe strictly to a vertical position. Release 1-2 drops of solution through the needle.
• 
  Place a syringe, cotton balls soaked in alcohol in a sterile tray, and cover the tray with a sterile napkin.

Each injection requires two needles, one for drawing the solution into the syringe, the other for the injection itself. It is desirable that the first needle has a wide bore. Changing needles ensures sterility. This requirement is met by pre-treating the neck of the ampoule or the rubber stopper of the bottle containing the medicine with alcohol or iodine. (action diagram and photo)

Before the injection, prepare the patient's skin: use a sterile swab soaked in alcohol to wipe a fairly large area of ​​skin where the injection is to be given. Proper preparation syringe, needle, nurse's hands and patient's skin has a very great importance. The main thing is to comply with all the rules of asepsis. The syringe, ready for injection, is delivered to the patient’s room in a sterile tray, at the bottom of which there are sterile gauze pads. (action diagram and photo)

IN ^ INTRADERMAL INJECTIONS

Intradermal injections are used both for diagnostic purposes and for local anesthesia.

Intradermal administration of drugs is usually carried out on inner surface forearms. The skin at the injection site is treated

antiseptic. A thin needle with a small clearance and a length of no more than 2-3 cm is injected into the thickness of the skin to a slight depth so that the tip enters only under the stratum corneum. Directing the needle parallel to the surface of the skin, advance it to a depth of 0.5 cm and inject 1-2 drops of liquid, causing a whitish tubercle in the form of a lemon peel to form in the skin. photo from disk ( video 1) Gradually moving the needle and squeezing out a few drops of liquid from the syringe, inject the required amount under the skin. Rice. 20

Indications

• 
  Antibiotic sensitivity test.
• 
  Mantoux test.
• 
  Katsuoni sample.
• 
  Burnet's test.
• 
  Local anesthesia (“lemon peel”).

Contraindications

Equipment

• 
  Sterile beads.
• 
  Antiseptic.
• 
  A 1 ml syringe with an intradermal needle (15 mm) or an insulin syringe.
• 
  Necessary drug.
• 
  Sterile gloves.

Injection site

The middle third of the anterior (inner, palmar) surface of the forearm ( rice. 20).

Patient position

Sitting, lying down, standing.

Algorithm for performing intradermal injection

• 
  Specify whether the patient has previously encountered this procedure:
  • 
    if so, for what reason and how did he endure it?
  • 
    if not, then it is necessary to explain to the patient the essence of the procedure.
• 
  Obtain the patient's consent for the procedure.
• 
  Wash your hands.
• 
  Place the patient in a comfortable position (supine or sitting) in which the intended injection area is easily accessible. Ask the patient to remove her clothing. photo from disk
• 
  By inspection and palpation, determine the immediate site of the upcoming injection.
• 
  Wear a mask.
• 
  Put on gloves (if you are already wearing them, treat them with a cotton ball moistened with alcohol).

• 
  Treat the injection site with an antiseptic. Usually two or three balls of alcohol or other antiseptic are used. (Petrospirt) Strokes must be done in one direction. Wait until the alcohol dries.
• 
  Take a filled syringe with a needle pointing upward at an angle of 0-5°, almost parallel to the skin, so that the needle bevel disappears into the thickness of the epidermis. (action diagram and photo)
• 
  Inject the drug intradermally. A blister should form at the injection site. (photo)
• 
  Remove the needle without pressing the injection site with a ball moistened with alcohol. Explain to the patient that water should not come into contact with the injection site for 1-3 days (if one of the diagnostic tests was performed).
• 
  Ask the patient how he is feeling. Make sure he feels okay.

^ Complications and their solutions

When administering various drugs intradermally, the most common complication is infection of the injection site or the administration of drugs not designed for intradermal administration. In both cases, an inflammatory process develops in the tissue, requiring special treatment procedures.

The first actions upon detection of a complication - infection:

• 
  If infected, treat the area with an antiseptic and apply a “semi-alcohol” compress.
• 
  If necrosis of the skin area develops, treat with an antiseptic (diamond green or potassium permanganate solution). Apply a sterile bandage. If necrosis develops as a result of injection chemical substance(for example, a solution was injected that is intended only for intravenous administration due to its high concentration, which caused tissue necrosis), then it is necessary to quickly prick this area with either distilled water taken from a sterile ampoule or saline solution or novocaine solution (0.25%) to reduce the concentration of the previously administered solution.
• 
  Consultation with a doctor is necessary, as surgical intervention may be necessary.

^ SUBCUTANEOUS INJECTIONS

Due to the fact that the subcutaneous fat layer is well supplied with blood vessels, for more fast acting The drug is administered by subcutaneous injection.

From a small amount of liquid to 2 liters can be injected under the skin.

Indications

• 
  Administration of medications.
• 
  Local anesthesia (infiltration).

Contraindications

Any skin lesions at the site of the intended injection.

Previous allergic reaction to the drug

Equipment

• 
  Antiseptic.
• 
  Sterile beads.
• 
  Syringe 2-5 ml.
• 
  Necessary drug.

Subcutaneous injections are made with a needle of the smallest diameter to a depth of 15 mm and up to 2 ml of medications are injected, which are quickly absorbed into the loose subcutaneous tissue and do not have a harmful effect on it.

^ The most convenient areas for subcutaneous administration are:

Outer surface of the shoulder; - subscapular region;

Anterior outer surface of the thigh; - anterolateral surface of the abdominal wall.

In these places, the skin is easily caught in the fold (take a photo) and there is no danger of damage blood vessels, nerves and periosteum.

• 
  in places with edematous subcutaneous fat;
• 
  in compactions from poorly absorbed previous injections.

^ Subcutaneous injection technique

Wash the hands.

Wear gloves.

Treat the injection site sequentially with two balls of alcohol, disinfectant solution or soap and water: first large area, then - directly to the site of the upcoming injection.

Place a ball of alcohol under the 5th finger of your left hand.

Take the syringe in your right hand (2nd finger right hand hold the needle cannula, with the 5th finger - the syringe plunger, with 3-4 fingers hold the cylinder from below, and with the 1st finger - from above) (make a photo series).

With your left hand, gather the skin into a triangular fold, 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 needle length), hold the needle cannula with your index finger.

Postpone left hand onto the piston and insert medicine(without transferring the syringe from one hand to the other).

Remove the needle by holding it by the cannula.

Press the injection site with a ball of alcohol.

Give a light massage to the injection site without removing the ball from the skin.

-Place a cap on the disposable needle, throw the needle and syringe into the needle disposal container (Fig. 21), or

Immerse the syringe and needle (reusable) in a container with a disinfectant solution (Petrospirt, give a list of drugs).

^ Complications and their elimination

If it enters a vessel. Press the injection site with a ball for 5–10 minutes. Rice. 21

Infection is possible if asepsis is broken. Treat the injection site with an antiseptic. Apply a “semi-alcohol” compress.

If phlegmon forms at the injection site ( rice. 22) surgical treatment is indicated.

Rice. 22 Formation of purulent infiltrate after injection in (A) the shoulder area, (B) on the anterior abdominal wall.

In medicine syringe- a medical instrument intended for injections, diagnostic punctures, and suction of pathological contents from cavities. Comes from the German Spritze (from spritzen - to splash).

Based on the number of components (component parts), syringes can be divided into 2- and 3-component ones.

How to choose a syringe?

Which syringe is better, 2-component or 3-component?

Two-component syringes (photo No. 1)- these are syringes consisting of 2 parts (components): a cylinder and a piston

Three-component syringes (photo No. 2)- these are syringes consisting of 3 parts (components): a cylinder, a piston and a rubber seal

Video material: two-component, three-component syringes, luer-lock and luer-slip fastening

To inject viscous solutions (for example, oil-based), it is better to use a syringe with a Luer Lock fastening (photo No. 3).

This type of fastening of the needle to the syringe eliminates the possibility of it slipping, since the needle is “screwed” into the mount, and not just put on it, as is the case with Luer Slip (for photos of syringes with Luer Slip mount, see photos No. 1 and No. 2)

Luer Lock mount

(photo No. 3)

Pros and cons of two-component and three-component syringes.

PRICE

As a rule, the cost of two-component syringes is lower than their three-component counterparts. This is largely due to the simplification of manufacturing technology: creating a syringe from 2 parts is easier and cheaper than from 3 parts.

EXPLOITATION

To displace the piston of a two-component syringe may be needed application of greater force and its movement is not as free as that of a three-component one, and accordingly, after a while the specialist using these syringes in his work will get tired

Due to the fact that when the syringe piston moves, plastic rubs against plastic, control of injection uniformity may be difficult , which, again, requires the medical worker using this syringe to increase tension in the arm muscles, which leads to rapid fatigue

With a smoother (see 3-part syringe) sliding of the piston inside the cylinder, injection to the patient there must be less painful.

A good two-component (two-part) syringe will provide a smoother and more painless administration of the medicinal solution than a cheap three-component syringe purchased only “on advice” due to the presence of a rubber seal in it.

The rubber seal does not guarantee the smooth running of the syringe, just as its absence will not spoil the smooth running of a good two-component syringe.

SAFETY

RISK OF MICROPARTICLES ENTERING THE INJECTION SOLUTION

There is an opinion that when the piston rubs against the cylinder of a two-component syringe, particles of the polymer material of which they are composed can be “scraped off” by the piston from the inside of the cylinder and, together with the contents of the syringe, enter the body tissues when the injection is administered

The three-component syringe has a special rubber part that improves the sliding of the piston inside the cylinder and eliminates the possibility of scraping off the plastic inside the piston, and also ensures greater tightness and prevents the injection solution from getting beyond the surface of the piston with a rubber nozzle

The rubber part (component) of the syringe may contain natural latex, which may cause allergic reactions with the appropriate predisposition. It should be noted that in the production of most modern three-component syringes, synthetic hypoallergenic materials that do not cause allergies are used.

DISPOSAL

It is known that disposable medical syringes must be disposed of after use. The medical worker who is responsible for preparing syringes for disposal knows that preparation 2-component syringes are much simpler. It consists of “disassembling” the syringe into its component parts: the medical worker disconnects the needle from the syringe in one of the following ways, depending on the availability of special devices in the medical institution:

• - removing the needle using a needle puller;
• - cutting off the needle using a needle cutter with an integrated puncture-proof container for needles;
• - destruction of the needle using a needle destructor - devices for burning needles by exposure to high temperature.

And finally, especially for mothers who came here to find out: “Which syringe should I use to inject my child?”

1) Selecting the volume of the syringe for injection.

The volume should correspond to the volume of the medicinal solution that you plan to administer to the baby, but 0.5-1 cc more. Syringes often have extra space, for example a 2 ml syringe. may have a scale of up to 2.5 ml., and a syringe of 5 ml. - scale up to 6 ml. That is, if you need a 2ml syringe, then a 3ml one will do. But, as the volume of the syringe increases, the product becomes more expensive, so there is no point in overpaying for empty cubes.

2) Select a two- or three-piece syringe.

It will be more convenient for you to use a 3-component syringe (the one with a rubber seal). It will ensure a smoother (without jerking) injection and will prevent leakage of the medicine (leakage of the medicine more often occurs when using low-quality 2-component syringes, i.e. poorly assembled and without a rubber seal on the piston)

3) High-quality syringe from a trusted manufacturer.

The assortment includes syringes with volumes of 0.5ml, 1ml, 2ml, 3ml, 5ml (and others).

What really matters is choosing an injection needle. There is a high probability that the needle supplied with the syringe will not be suitable for your baby. It is important to choose needles very carefully. Ask your healthcare provider which needles are needed for your prescribed injections. Of course, you want to prick your baby with the thinnest and most painless needles, but this is not always possible, because... the injected substance may be viscous and injection will be difficult. Therefore, it is important to know the thickness and length of the required needle.

TYPES OF NEEDLES AND SYRINGES USED FOR INJECTIONS

There are two main types of syringes and injection needles for them. A syringe is a simple pump designed for injection and suction. Historically, syringes of the “Record” type (assembled from metal parts and a glass cylinder) and syringes of the “Luer” type (previously made entirely of glass, now made of plastic) have been produced. Syringes, made of glass and metal, are designed for repeated use; they are sterilized. Plastic syringes are manufactured and sterilized in the factory, are used once and are not subject to repeated sterilization. Syringes of the "Record" type and the "Luer" type differ in the shape of the cannula - the sub-needle cone. The consequence of this is that the needle for the Record syringe does not fit the Luer-type syringe and vice versa. Disposable syringes are packaged in sterile packaging along with an injection needle.

Syringes are manufactured in various capacities - 1, 2, 5, 10 and 20 ml. Twenty-milliliter syringes are intended for intravenous infusions. One-milliliter syringes are used to administer insulin or tuberculin and have special graduations. Injection needles are also available in various sizes, differing both in the length of the hollow metal tube, and in its diameter and the angle of the needle cut. Disposable plastic syringes are predominantly used.

Rice. 21. Needles for injections, infusions, transfusions: A- injection needle (1 - needle tube, 2 - needle head, 3 - mandrin, 4 - dagger sharpening, 5 - spear sharpening, b - needle cut angle); b- needle with stop for intradermal injections; V- needle with safety bead; G- a needle with side holes for air release;

d- attachment to an injection needle for connection to blood transfusion systems, etc.; e- transition cannula for injection needles; and- Dufault needle for blood transfusion; h- a needle for drawing blood.

· Needles for intradermal injections: 0410, 0415, No. 25-27 (0.9-1 cm) needle cut 5 0 .

· Needles for hypodermic injections: 0420, 0425, 0430, No. 25-27 (0.9-1.6 cm), 0620 – needle cut 3 0 .

· Needles for intramuscular injections: 0640, 0860, 0840, 1060, No. 23-25 ​​(1.6-2.5 cm - for small muscles), No. 18-25 for adults - 2.5-3.8 cm.

· Needles for intravenous injections: 0440, 0840, 0860, needle cut 45 0.

· Needles for blood transfusion and blood testing: 0860, 0840.

· Needles for insulin injection: 0410, 0415, 0420, 0430, 0440 (depending on the method of administration).

The first two digits indicate the diameter of the internal lumen of the needle in mm, increased by 10 times, the next two digits indicate the length of the needle in mm.

Needles for single-use syringes have colored cannulas.

Rice. 22. Needles for single use

· Hypodermic needles – blue color;

· Needles for intramuscular injection – green;

· Intravenous needles – Pink colour;

· Needles for intradermal injection – beige.

Types of syringes

According to their purpose they are distinguished the following types syringes:

I. Single and multiple use.

II. By volume: 1 ml, 2 ml, 3 ml, 5 ml, 10 ml, 20 ml, 30 ml.

III. By purpose:

· for administering insulin;

for the administration of heparin;

· tuberculin;

· for rinsing cavities and feeding - Janet syringe;

· injection.

Fig.23. Disposable syringe device

The syringe passed long history from the invention of Hippocrates to three-component disposable designs. Today, the types of syringes and needles are quite varied and the choice depends on what exactly they are used for.

History of the syringe

The first types of syringes were created in antiquity. Thus, Hippocrates used a pig’s bladder, and the first reusable syringes, which became somewhat widespread at the end of the Middle Ages, were made of rubber. The first injection devices, similar to modern ones, were invented by the scientist Blaise Pascal, but then the novelty went unnoticed. Around the same time, the German scientist Elsholtz conducted his experiments on injections. The first injection devices similar to modern ones appeared in the 19th century, and disposable versions of the device appeared in the mid-20th century. The inventor, Murdoch, was a veterinarian and patented his brainchild in New Zealand. After a short time, he came up with the idea of ​​​​using a new product for subcutaneous and intravenous injections not only in cows, but also in people. The first disposable syringes were not very perfect, because they consisted of only two components: a piston and a cylinder. Several decades ago, the idea arose to create a three-component syringe. All current types of disposable syringes can be divided into several categories: cylinder volume, position of the cone-tip, needle fastening and design.

Volume

The volume of a syringe can be small, standard or large.

• Small-volume syringes include types such as insulin, tuberculin, for neonatology and for conducting skin tests for allergies, as well as for vaccination.
• Standard volume syringes are needed for subcutaneous injections, intramuscular injections and intravenous injections. Standard devices include all devices with a volume from 2 mm to 22.
• A large volume is needed for procedures such as rinsing the cavity, suctioning out fluids and introducing culture media. Large ones include devices with a volume of 30 ml, 60 and 100.

Cone tip

Concentric tip position. In this case, the cone is located right in the middle of the cylinder. This arrangement is typical for syringes that are used for injections under the skin and into muscles.

An eccentric or offset position is needed for a syringe with a volume of 20 ml. , which is used to draw blood from a vein. Their tip is located in the side of the cylinder.

Needle attachment

There are three types of fastening of needles to cylinders: non-removable (integrated), luer-type fastening of needles and luer-lock fastening.

• Integrated into the cylinder or non-removable fastening of needles is found in syringes with the smallest volume: 0.3 or 0.5 ml.
• Luer type needle fastening. The most popular type of fastening of needles is in which they are put on a cylinder, or more precisely, its protruding part. This is a standard needle mount for devices with different volumes - from 2 ml. up to 100. Sometimes it happens with millimeter syringes.
• "Luer-lock." This is a fastening in which the needle is screwed into the cylinder. Typically, luer lock occurs in machine-driven syringes and droppers. Sometimes they are used for simple injections, but this is not very convenient, because changing such a needle and then disassembling the syringe is not so easy. But if you need a particularly strong connection between needles and syringes, then Luer-lock is quite suitable.

And there are many varieties of injection needles. They are divided by size, there are infusion, puncture-biopsy and transinfusion. They are also divided into normal ones, with a bead, a stop and a side hole. You can also divide them into curved and straight, and also according to the shape of the sharpening: it can be spear-shaped or dagger-shaped.

Design

There are two-component and three-component injection devices.

The two-component one consists of only a piston and cylinder and is considered obsolete, and it can also make the injection painful. It can be movable in the hands of a medical worker, and this affects the mobility of the needle, and therefore the pain of the injection.

Three-component ones are considered modern, the design of which also includes a seal on the rubber piston. It makes the device operate smoothly and softly, and also ensures that no particles of the materials from which the piston and cylinder are made will get under the patient’s skin.

And most importantly, three-component syringes make injections completely painless, because “picking with a needle” in the muscles and subcutaneous tissue is excluded.

Expiration dates of syringes

The shelf life of disposable syringes does not vary much depending on the volume or whether the syringe is a three-part or two-part syringe. But still, the shelf life depends on the type of sterilization. She also has different types, but depending on the type of this procedure, the shelf life of the device can vary from three years to five. During this period, the syringe should not lose all its properties and remain non-toxic and sterile. When the shelf life has expired, the device can be used for injections, but only if the syringes have been stored far from sun rays: in this case, a disposable syringe still does not pose a danger. If the shelf life exceeds ten years, all the materials in it age and all its properties deteriorate. In addition, such a long shelf life with poor quality packaging can cause bacteria to penetrate into the syringe.

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