PREPARATION OF THE MATERIALS FOR AN INJECTION ă ţ
Learning objectives What you should know
What you should do ’ Definition Injection is a procedure by which a drug substance is introduced into tissues using a special needle and a syringe. Drug administration through injections is called parenteral administration (bypass digestive tract). The ways of parenteral drug administration are: Intradermal route (intradermal injection) Hypodermic route (subcutaneous),(subcutaneous injection) Intramuscular route (intramuscular injection) Intravenous route (intravenous injection and infusion) Intra-arterial route (intra-arterial injection) Intraosseous route (intraosseous injection and infusion)
Indication An injection can be made for therapeutic or diagnostic purposes o For example administration of an intramuscular or intravenous antibiotic is for therapeutic purposes o Testing of antituberculous immunity (so-called intradermally in tuberculin) is done by an intradermal injection (diagnostic purpose). Some drugs may be administered both orally and parenterally. Sometimes, however, the oral route is not available: o Patients with digestive stasis (as is the case with most patients in the first hours / days after surgery) o Patients who throw up o Patients in coma / uncooperative / oro-tracheal catheterization o Patients with facial trauma Some substances can not be given orally (enterally) because they are digested in the digestive tract, inactivated in the liver or have hepatotoxic effects. Even if it involves minor trauma, parenteral drug administration has several advantages: o Precise dosing of the administered substance o Absorption and bioavailability of the substance are virtually complete (100%) o Quick action o Allows administration of medication even when the oral route is not usable o Allows the administration of substances that would be digested in the digestive tract, would be inactivated in the liver or would have liver side effects.
Contraindications . There are no contraindications to injections as a procedure itself. . The choice of medication should take into account possible allergies, side effects. . Anatomical regions with infections, scars, hematoma, etc. Will be avoided as places for administration.
Description of the syringe and needle The syringe is a single use disposable plastic instrument (not re-sterilized) used for Figure 1. Syringe parental drug administration. It consists of a plastic tube (barrel) and a plunger. The needle attaches to the syringe through which the medication is inserted into the tissue. The syringe body has, at one end, a truncated cone extension - the adapter for the needle. The adapter can be located centrally or eccentrically. At the other end, the syringe body has two lateral extensions useful for securing the Figure 2. Parts of the syringe syringe while pushing the plunger. There are syringes with different volumes (1, 2, 5, 10, 20, 50 ml). A scale (milliliters or tenths of milliliter) is marked on the barrel to allow a precise amount of substance to be introduced into the syringe. The plunger is perfectly sealed on the inner diameter of the barrel. Both filling and emptying the syringe is done with the help of the plunger. The syringe needle is a skewed steel tube at one end and has at Figure 3. Needle for injection
Figure 4.
Tuberculin syringe Figure 5. –
Insulin syringe ’ Figure 6. Guyon Syringe It is a large volume sy- ringe (50-60 ml); The ori- Figure 7. Guyon Syringe ginal Guyon syringe has a handle made up of 2 rings; With the generalization of single use syringes, its shape has been simplified and the appearance of a typical syringe, but it has a larger volume.
Pre-filled syringe Some medi- cines are de- livered in Figure 8. Pre-filled syringe (syringe-vial) sterile syringes, with accurate dose (marked on the package) ready for use. Some syringes are provided with needle cover systems after use, which prevent injury and transmission of potential pathology through the syringe. Some important information is noted on the packaging: Volume of the syringe (in milliliters) - important for choosing the right syringe depending on the type injection: o For intradermal injections: syringes of up to 1 ml o For subcutaneous injections: 1 ml syringes o For intramuscular injections: syringes of 2 - 5 ml o For intravenous injections: syringes of 10 - 20 ml Needle size - important for choosing the right needle depending on the type of injection: o 18-19 G: for geting the medication into the syringe o 20-21 G: for intramuscular and intravenous injections o 25-30 G: for intradermal and hypodermic injections (subcutaneous) Shelf life - only syringes / needles are used that are within viability Stages of an injection –
Drugs to be administered Figure 9. Figure 10. Figure 11. o rely solely on the appearance of the packaging (there are medicines with similar packaging); o The amount of substance contained - usually there is the quantity for a single administration in the vial / bottle, but there are cases where there are doses for multiple administrations; o The expiration date.
Necessary materials Syringe and needle - of the right size A thick needle (18 G) for suction can be used The administered drug: vial (dissolved drug) or bottle (powder to be dissolved) + a solvent vial (physiological serum) 2 alcohol pads or a cotton pads with alcohol.
Syringe preparation techniquening Washing of hands Place the necessary materials on a table at hand Check the identity of the patient receiving the medication Verify the medication: o The substance (confirmation that the prepared substance is the one indicated in the prescription), o Dose, o Expiration date. Check the syringe and needle (needles): o The integrity of the packaging o Expiry date o Syringe volume; needle size Opening the syringe / needle pack: the end to which it opens is Figure 12. Opening the syringe package marked by a triangle (the mark should be searched on the syringe plunger side). At this end, the packaging sheets (paper and plastic) can be easily separated. Remove the 2 sheets and remove the syringe and needle. The syringe bevel is firmly inserted into the needle attachment. It loosens (without removing) the needle cap (this maneuver allows easier handling of the Figure 13. syringe later on). The Attaching the needle syringe is placed on the working table. Below there are three technical options: Suction of the substance from the vial with the help of a loading needle Getting the substance from the vial using only the syringe Dissolving the powder from the vial and aspirating the solution.
Aspiration of the substance from the ampoule by means of a loading needle A thick needle (18 G) is used to load the syringe, The needle was attached to the syringe, the sheath of the needle loose, the syringe remains on the table Opening the vial: the vial is held with a hand (usually left) having the point marked on the neck of the vial before the eyes, with the other hand (usually right) toppling the top of the vial; The vial is broken at the neck. To avoid injuries by shards in the case of the neck of the vial (accidents are rare), the neck Figure 14. of the vial may be wrapped in a bandage. Opening the vial Take the syringe by letting the needle sheath fall (previously it has been weakened so taking the syringe is very easy) Figure 15. Figure 16. Figure 17.
Figure 18.
Aspiration of the substance from the vial using only the syringe – Vial and the bevel allows, with the plunger up. By drawing the plunger, the fluid is sucked into the syringe. During the aspiration, the bottom of the vial rises so that the liquid flows to the neck of the vial; in parallel Figure 19. Aspiration from the vial the syringe tilts downwards using only the syringe
Dissolving and aspirating medication from the bottle Remove the bottle cap; The rubber stopper is wiped with an alcohol pad Aspire into a 2-5 ml syringe of phy- siological serum used for dissolu- Figure 20. Removing the bottle cap; Sterilization tion (one of the of the rubber stopper above techniques) Insert the needle into the vial through the rubber stopper By pushing the plunger the physiological dissolving serum is introduced into the vial; from time to time the plunger is released to allow the air in the vial to pass into the syringe (in this way the pressure in the two spaces is balanced). Shake the vial until all the substance is dissolved. The resulting solution must be clear, with no undissolved particles floating in the liquid Figure 21. Aspirating the solution from the vial - variant 1 Puncture of o Insert the air from the syringe into the the bottle cap bottle; in this way, we have a greater pressure in the bottle than in the syringe and the suction will be easy o Keep the bottle upright with the stopper down; needle syringe up; the tip of the needle is located inside the bottle as low as possible in the immediate vicinity of the stopper o By drawing the plunger the liquid passes into the syringe o When all the liquid has been sucked out the needle is removed Aspirating the solution from the vial - variant 2 (if the needle is long enough): o Keep the bottle upside down, slightly inclined so that the solution moves to one of the edges o Insert the air from the syringe into the vial; In this way the bottle will have a positive pressure, which facilitates the suction of the solution o The needle advances toward the bottom of the bottle, towards the most inclined edge o By pulling the plunger, the fluid is sucked into the syringe
A. B. Figure 22. Taking the solution out of the bottle: A. Variant 1; B. Variant 2 Irrespective of the technique used, it is possible that not only liquid but also air is sucked into the syringe. To remove the air from the syringe proceed as follows: o The syringe is held with the bevel / needle upwards to the eyes o You can apply a few light blows to your syringe with your finger to make the air bubbles rise o With the syringe in front of the eyes, gently push the plunger so that the air is pushed out. Figure 23. Getting the air If it is necessary, the needle is out of the syringe changed; Then the needle sheath is loosened and the syringe is ready to be used for injection.
How to hold the syringe During the injection, the syringe is held between the finger navel (on one hand) and the fingers II-V (on the other); For intradermal, subcutaneous and intravenous injections, the syringe is held with the needle oriented in the direction of the index; For intramuscular injections, the needle is usually held in the direction of finger V.
Figure 24. Ways of holding the syringe Avoid holding a finger on the plunger or the plunger in the palm of your hand while inserting the needle (the plunger may be pressed involuntarily)
Figure 25. Unrecommended syringe-holding variants
Disinfecting the injection area The anatomical region where the injection is to be made will be chosen according to the type of injection The presence of skin infections, scars or signs of a local pathology is indicating that the injection cannot be done in that region and it Figure 26. Disinfecting the injection is required to use a different area anatomical region Disifecting of the region is done by wiping the region with an antiseptic solution pad (usually alcohol). Clearing of the skin is done circularly and centrifugally (from the center of the region to the periphery). The used pad is put on the table by a supination of the hand. The part that has been in contact with the skin is facing upward.
Figure 27. The pad is placed on the table with the used face facing upward
Discharging the needle after the injection After the injection, the needle is to be considered conta- minated and dis- charged into the special container for sharp objects. There are several cuts of different shapes and Figure 28. sizes in the lid of this The container for sharp objects box. The needle discharge technique is designed to minimize the risk (reducing to zero) of puncture with the contaminated needle: o Insert the tip of the syringe with the needle attached in the box so that the syringe bevel slides into one of the lid cutouts o The syringe body is located above the slit, the bevel passes through the slit, and the needle attachment piece is located just below the slit o By pulling the syringe up, the needle slides off the syringe tip and falls into the box
Figure 29. Discharging the needle into the container for sharp objects
Incidents and accidents Crushing the vial during the opening process: it is rare, but can cause bleeding wounds of the fingers. Contamination of the needle, syringes, alcohol pads or medication. Assessment / Self-Assessment Form
1. Suction from the vial Srage / Criterion Corect Incorect Collect the necessary materials Check the materials The integrity of the packaging The expiry date Check the medication The nature of the substance; dose The expiry date Prepare the syringe for the suction of the solution Opening the packaging for the syringe and the needle Attaching the needle Loosening the needle cover Open the vial Aspire the solution With the needle attached to the syringe Using only the syringe Take the air out of the syringe Put the needle cover (if applicable) !!! Sterility during all stages 2. Suction from the bottle Round / Criterion Corect Incorect Collect the necessary materials Check the materials The integrity of the packaging The expiration date Check the medication The nature of the substance; dose The expiration date Prepare the syringe for the suction of the solution Opening the packaging for the syringe and the needle Attaching the needle Loosening the needle cover Draw the solvent into the syringe Dissolves the substance in the bottle Unsealing the bottle Wipe the rubber stopper with alcohol Puncture the rubber stopper Introducing the solvent and dizolve the substance Draw the solution into the syringe The position of the vial, the syringe and the tip of the needle Aspirating of the substance Take the air out of the syringe Put the needle cover !!! Sterility in all stages