Intravenous administration of drugs. How to do intravenous injection

Intravenous method  provides fast and targeted delivery of therapeutic agents to the patient’s body. It (rarely - intra-arterial) is used if the drugs are poorly absorbed by the intestines, noticeably irritate its mucosa, and quickly disintegrate when passing through the gastrointestinal tract.

The extended introduction of drugs by infusion guarantees a stable concentration in the blood. This is due to the immediate effect in this case, the drug introduced, fully reaches the desired tissues and receptors.

With intravenous administration  precise dosing of the drug is ensured, delivery of large volumes of therapeutic compounds, including irritating the mucosa, is possible. A requirement for such drugs is their complete solubility in water and the absence of a damaging effect on. However risk side effects with intravenous drug administration  more than with other methods. This method is not suitable for oily or slightly soluble in water preparations.

Why are drugs administered intravenously?

The intravenous method is not applicable to everyone, and is mainly used only for inpatient treatment.

With cespis and infectious endocarditis, it is better to inject the medicine into a vein.

In addition, the choice of the injection site may depend on the constitution of the human body. Nurses even classify patients as "no muscle" and "no vein." In addition, the choice of the injection site may depend on the skill and professionalism of the staff, since the introduction of the drug into the vein is a higher “aerobatics” than subcutaneous or intramuscular injections.

A special kind of intravenous injection is providing the patient with nutrients when it is not possible to eat through the stomach. In this case, there are a number of difficulties. The scheme of parenteral nutrition of the patient should be calculated on the basis of a huge amount of data that still needs to be determined.

Intravenous drugs and methods of administration

You need to know its weight, the amount of fluid released per day, the data of the electrolyte composition and general blood test, urinalysis data. All the necessary electrolytes (potassium, magnesium, sodium, chlorine and water) should be delivered to the patient’s body. For this, Ringer-Lock solution, trisol, quartosol and the like are used. Another saline solution. Having short carbohydrates provides glucose. Protein concentration is supported by protein lyophysates or amino acid preparations. Fats are provided by emulsifiers of fatty acids. If it is not possible to control the ionic balance of the blood, they are limited only to saline or Ringer's solution.

Lecture No. 15. 04/06/2013 year.

TOPIC: Routes for administering drugs to the body.

Syringe Set drug solution  from ampoules and vials.

Plan:

Ways of introducing drugs into the human body. Advantages and disadvantages.

Set in a syringe a medicinal solution from an ampoule and vial. Algorithms

1. Enteral route - the introduction of the drug inside through:

- mouth (per os), or orally;

- under the language (sub lingua), or sublingually;

- into the rectum (per rectum), or rectally.

Taking the drug by mouth (per os).

Advantages: ease of use; does not require sterile conditions, the absence of complications inherent in parenteral administration.

Disadvantages: the slow development of a therapeutic effect, the presence of individual differences in the speed and completeness of absorption, the effect of food and other drugs on absorption, destruction in the lumen of the stomach and intestines or when passing through the liver, adverse effects on the mucous membrane of the stomach and intestines.

Take medicinal substances inside in the form of solutions, powders, tablets, capsules and pills.

Application under the language (sublingual) (sub lingua).

The medicine enters the large circle of blood circulation, bypassing the gastrointestinal tract and liver, beginning to act after a short time, absorbed through the mucous membrane of the mouth.

Disadvantage: a small list of drugs.

Introduction to the rectum (rectally).

Advantages: creates a higher concentration medicinal substancesthan when administered orally.

Enter candles (suppositories) and fluids using enemas.

Disadvantages: inconvenience of use, psychological difficulties.

Before the introduction of drugs into the rectum, a cleansing enema should be done!

2. The parenteral route is various types of injections.

Intravenous administration (iv). Drugs are administered in the form of aqueous solutions.

Advantages: rapid entry into the blood, if a side effect occurs, it is possible to quickly stop the action; the possibility of using substances that are destroyed, non-absorbable from the digestive tract.

Disadvantages: with a long intravenous route of administration along the vein, pain and vascular thrombosis may occur.

Intramuscular injection (IM). Introduce aqueous, oily solutions and suspensions of medicinal substances. The therapeutic effect occurs within 10-30 minutes. The volume of the administered substance should not exceed 10 ml.

Disadvantages: the possibility of the formation of local soreness, hematomas, infiltrates, abscesses, the danger of accidentally getting the needle into a blood vessel.

Subcutaneous administration (s / c). Aqueous and oily solutions are introduced.

You can not enter subcutaneously and intramuscularly solutions of irritating substances that can cause tissue necrosis.

3. Inhalation route of administration.   Inject gases (volatile anesthetics), aerosols. Advantages: 1. action directly at the site of the pathological process in the respiratory tract; 2. by inhalation of an aerosol, a high concentration of drugs in the bronchi is achieved bypassing the liver.

The article provides an overview of almost all modern drugs that are recommended for use if the patient has a hypertensive crisis.

Attention! This article describes only drugs that are used for hypertensive crisis, i.e., in emergency situations. For a "systematic" treatment of hypertension - the drugs are completely different, they are described in other articles. On our site you will find the most detailed information about the medicines for hypertension. All materials are written in a simple, understandable language. This knowledge will help you effectively collaborate with a doctor who will select pills for you.

The pharmaceutical market is constantly replenished with new medicines, including those that are designed to assist with hypertensive crisis. Our review includes not only drug novelties, but also drugs that are already in use in developed countries because our doctors are still widely using them: trimethafan camsylate (arfonad), clonidine (clonidine), pentamine, dibazole.

Read about the treatment of diseases associated with hypertension:

With a complicated hypertensive crisis, any delay in treatment can cause irreversible consequences. The patient is hospitalized in the intensive care unit and immediately begin intravenous administration of one of the drugs listed in the table.

Medications for intravenous administration in complicated hypertensive crises

Drug name	Route of administration, dose	Action start	Action duration	Notes
Medicines relaxing blood vessels
Sodium Nitroprusside	Intravenously, drop 0.25-10 mcg / kg / min (50-100 ml in 250-500 ml of 5% glucose)	Right away	1-3 min	It is suitable for immediate pressure reduction in hypertensive crises of any type. Enter only using a special dispenser with continuous monitoring of blood pressure
Nitroglycerine	Intravenously, drip, 50-200 mcg / min	2-5 min	5-10 min	Nitroglycerin is especially effective in acute heart failure, myocardial infarction
Nicardipine	Intravenously, drip, 5-15 mg / hour	5-10 min	From 15 minutes to 12 hours, with prolonged administration	Effective in most hypertensive crises. Not suitable for patients with heart failure. Caution patients with coronary heart disease.
Verapamil	Intravenously 5-10 mg, intravenous drip can be continued, 3-25 mg / hour	1-5 min	30-60 min	Contraindicated in patients with heart failure and those taking beta blockers
Hydralazine	Intravenously, bolus (stream), 10-20 mg per 20 ml of isotonic solution, or intravenously drip 0.5 mg / min, or intramuscularly 10-50 mg	10-20 min	2-6 h	Mostly with eclampsia. You can repeat the introduction after 2-6 hours.
Enalaprilat	Intravenously, 1.25-5 mg	15-30 min	6-12 h	Effective in acute left ventricular failure
Nimodipine	Intravenously, drip, 15 mg / kg per 1 hour, then 30 mg / kg per 1 hour	10-20 min	2-4 h	With subarachnoid hemorrhage
Fenoldopam	Intravenously, drip, 0.1-0.3 mcg / kg / min	1-5 min	30 minutes	Effective in most hypertensive crises
Adrenergic blockers
Labetalol	Intravenously, bolus (stream), 20-80 mg at a rate of 2 mg / min or intramuscular injection of 50-300 mg	5-10 min	4-8 h	Effective in most hypertensive crises. Contraindicated in patients with heart failure.
Propranolol	Intravenous drip of 2-5 mg at a rate of 0.1 mg / min	10-20 min	2-4 h	Mostly with dissecting aortic aneurysm and coronary syndrome
Esmolol	Intravenously drip 250-500 mcg / kg / min for 1 min, then 50-100 mcg / kg for 4 min	1-2 min	10-20 min	It is the drug of choice for stratified aortic aneurysm and postoperative hypertensive crisis
Trimethafan camphylate	Intravenous drip, 1-4 mg / min (1 ml of 0.05-0.1% solution in 250 ml of 5% solution of glucose or isotonic sodium chloride solution)	Right away	1-3 min	In crises with pulmonary or brain edema, stratified aortic aneurysm
Clonidine (clonidine)	Intravenously 0.5-1.0 ml or intramuscularly 0.5-2.0 ml 0.01% solution	5-15 min	2-6 h	Undesirable for a stroke
Azamethonium bromide	Intravenously 0.2-0.75 ml (increase the dose gradually until the effect is achieved) or intramuscularly 0.3-1 ml of 5% solution	5-15 min	2-4 h	Contraindicated in elderly patients. Causes orthostatic hypotension.
Phentolamine	Intravenously or intramuscularly, 5-15 mg (1-3 ml of a 0.5% solution)	1-2 min	3-10 min	Mostly with pheochromocytoma, clonidine withdrawal syndrome
Other drugs
Furosemide	Intravenously, bolus (jet), 40-200 mg	5-30 min	6-8 h	Mostly in hypertensive crisis with acute heart or kidney failure
Magnesium sulfate	Intravenously, bolus (jet), 5-20 ml of 25% solution	30-40 min	3-4 h	With convulsions, eclampsia of pregnant women

If it is impossible to immediately administer intravenous drugs, use should be taken under the tongue of fast-acting drugs that lower blood pressure: nitrates, captopril, nifedipine, adrenergic blockers and / or intramuscular injection of clonidine, phentolamine or dibazole.

Preference should be given to short-acting drugs (sodium nitroprusside, nitroglycerin, trimethafan camsylate), since they give a controlled effect of lowering blood pressure. Long-acting drugs are dangerous for the possible development of uncontrolled hypotension. A sharp decrease in blood pressure increases the risk of complications: a decrease in cerebral circulation (up to the development of a coma), a lack of blood supply to the heart (angina attacks, arrhythmia, and sometimes myocardial infarction). The risk of complications is especially great with a sudden decrease in blood pressure in elderly patients with severe atherosclerosis of the cerebral vessels.

At the first stage of treatment, the goal is to partially reduce the pressure to a safe level - not necessarily to normal. Most often, blood pressure is reduced by 20-25%.

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Medications for the treatment of uncomplicated hypertensive crisis

In the case of uncomplicated hypertensive crisis, as a rule, there is no need for intravenous administration of drugs. Prescribe orally (through the mouth) drugs that reduce blood pressure, with quick action  or intramuscular injection.

Clonidine (clonidine)

The effective use of clonidine (clonidine), which does not cause tachycardia, does not increase cardiac output, so it can be recommended for angina pectoris. In addition, this drug can be prescribed to patients with renal failure. The effect of the use of clonidine occurs 5-15 minutes after intravenous administration and 30-60 minutes after oral administration. If necessary, the medication is repeated every hour until the effect is obtained.

The main side effects are due to a pronounced sedative (calming) effect, which is why the drug is contraindicated in patients with manifestations of a hypertensive crisis on the part of the central nervous system: a sedative effect can weaken the manifestation of symptoms and make it difficult to objectively assess the severity of the patient's condition. Clonidine (clonidine) should not be recommended for patients with impaired cardiac conduction, especially those who receive cardiac glycosides.

Nifedipine

Nifedipine is also used, which has the ability to relax blood vessels, increase cardiac output and renal blood flow. A decrease in blood pressure is observed already 15-30 minutes after its administration, the effect persists for 4-6 hours. The nifedipine capsule should be chewed and swallowed. 5-10 mg of nifedipine is usually sufficient. If there is no effect, after 30-60 minutes the administration is repeated.

Nifedipine in some patients can cause intense headache, as well as uncontrolled arterial hypotension (especially in combination with magnesium sulfate), so its use should be limited to cases where patients responded well to this drug earlier, during planned treatment.

It should be noted that the United National High Blood Pressure Committee of the United States considers the use of nifedipine inappropriate during a hypertensive crisis. The fact is that the speed and degree of lowering blood pressure when taking the drug under the tongue is difficult to control in order to avoid the risk of developing cerebral or coronary ischemia.

Captopril

Captopril ACE inhibitor lowers blood pressure within 30-40 minutes after administration due to the rapid absorption in the stomach. If captopril is used, then after lowering blood pressure, cerebral blood flow does not deteriorate. Occasionally, this medicine causes an excessive decrease in blood pressure, especially in patients with renal failure or a decreased volume of circulating blood.

A positive therapeutic effect is also observed with intramuscular injections of clonidine (clonidine) or dibazole. In case of increased sweating, anxiety, fear - sedatives are indicated, in particular, benzodiazepine derivatives, which can be prescribed orally or as intramuscular injections, as well as droperidol. Combinations of 2 or 3 drugs are effective (for example, nifedipine + metoprolol or nifedipine + captopril).

Medications for the Emergency Treatment of Hypertensive Crises - An Overview

Conventionally, two groups of drugs can be distinguished for the treatment of hypertensive crises using intravenous injections: the first is universal drugs suitable for stopping most crises, the second is specific drugs that have special indications.

The first group includes sodium nitroprusside, hydralazine, trimethafan camsylate, azamethonium bromide, labetalol, enalaprilat, nicardipine. To the second - nitroglycerin, esmolol, phentolamine.

Sodium Nitroprusside

Sodium nitroprusside has a quick and easily controlled effect on lowering blood pressure, which manifests itself immediately after the start of its administration and ends a few minutes after the cessation of administration. Obviously, the use of the drug should be carried out under close monitoring of blood pressure. Sodium nitroprusside is effective in all forms of hypertensive crises, especially in acute hypertensive encephalopathy, postoperative bleeding, or acute left ventricular failure. It is contraindicated in eclampsia due to the risk of fetal poisoning with cyanides.

Sodium nitroprusside has in its composition a NO group (endothelium-dependent relaxing factor), which, splitting off in the body, causes the expansion of arteries and veins. This leads to relaxation of blood vessels, a decrease in blood flow to the heart and a decrease in stroke volume. Heart rate increases. Due to significant relaxation of blood vessels, redistribution of blood flow occurs with its decrease in ischemic zones (robbery syndrome). In this regard, sodium nitroprusside can impair coronary blood flow in patients with coronary heart disease.

Due to the expansion of the large cerebral arteries, sodium nitroprusside increases cerebral blood flow and can increase intracranial pressure. However, a decrease in systemic blood pressure reduces this effect, due to which most patients with encephalopathy tolerate the drug well.

Sodium nitroprusside is destroyed by sulfhydryl groups of red blood cells to cyanide, and then - in the liver - to thiocyanate. High concentrations of the latter, if they are retained in the blood for several days, have a toxic effect in the form of nausea, weakness, sweating, disorientation, toxic psychosis. The risk of thiocyanate poisoning increases with prolonged use  the drug (more than 24 hours) and in high doses (more than 10 mcg / kg in 1 min). In case of intoxication, sodium nitrate (4-6 mg) and sodium thiosulfate (50 ml of a 25% solution) are used as antidotes.

Nitroglycerine

Nitroglycerin is administered intravenously to patients with myocardial ischemia, regardless of the presence or absence of hypertension. This is the drug of choice for hypertensive crisis, which is accompanied by angina pectoris, myocardial infarction or acute left ventricular failure, as well as after coronary artery bypass grafting. Nitroglycerin has the same advantages in stopping a hypertensive crisis as sodium nitroprusside: quick onset and rapid cessation of action, the possibility of a gradual increase in dose to obtain the desired effect on lowering blood pressure.

Like sodium nitroprusside, nitroglycerin causes vascular relaxation through the formation of NO. However, unlike sodium nitroprusside, nitroglycerin is an indirect NO donor. The latter is formed from nitroglycerin in the body through a series of enzymatic reactions.

The main therapeutic effect of nitroglycerin is vascular relaxation. At the same time, large arteries expand first, then medium-sized arteries, and with a further increase in the dose, arterioles.

The relaxation of large veins helps to reduce venous flow, stroke volume and the appearance of reflex tachycardia. In patients with heart failure, on the contrary, the administration of nitroglycerin increases the stroke volume by normalizing the pressure / volume ratio in the heart cavities.

Unlike sodium nitroprusside, nitroglycerin does not cause a robbery syndrome: there is no increase in blood supply to non-ischemic sections of the heart muscle to the detriment of ischemic ones.

At higher doses, nitroglycerin dilates the small arteries, helps to reduce systemic blood pressure. The systemic response depends on the dose of the drug and individual sensitivity to it.

Diazoxide

Diazoxide dilates resistive arteries without affecting the capacitive veins. A decrease in blood pressure under the influence of diazoxide may be accompanied by fluid retention, facial flushing, dizziness. To minimize these phenomena, the drug is administered slowly drip or in low doses intravenously bolus (jet) every 5-10 minutes and combined with the introduction of diuretics. Currently, it is considered obsolete due to the emergence of a large number of new drugs that quickly reduce blood pressure.

Hydralazine

Hydralazine (dihydralazine) - relaxes the arteries without affecting the capacitive veins. A decrease in the total peripheral vascular resistance under the influence of hydralazine causes tachycardia and an increase in cardiac output. The drug can also provoke a headache, due to increased intracranial pressure.

Hydralazine is administered intravenously in a bolus (stream) or drip; sometimes - intramuscularly. To prevent tachycardia, a beta-blocker is added to it. Usually, a diuretic (furosemide) is also required, since hydralazine promotes fluid retention. A diuretic is not administered if signs of dehydration are observed due to vomiting or excessive urine output caused by a sharp increase in blood pressure (“pressure diuresis”).

Hydralazine is the drug of choice for pregnant women with eclampsia. It improves blood circulation in the uterus and does not adversely affect the condition of the fetus. Contraindicated in acute myocardial ischemia and stratified aortic aneurysm. It is also not recommended for relief of crises accompanied by cerebrovascular complications, as it increases intracranial pressure and can worsen cerebral circulation due to the appearance of high and low pressure zones.

Trimethafan camphylate

Trimethafan camsylate is a ganglion-blocking drug with a short, easily controlled action. It is administered intravenously. It causes a blockade of the sympathetic and parasympathetic ganglia. Due to the risk of developing atony of the bladder and intestinal obstruction, it is not recommended to use it in the postoperative period.

Previously, trimethafan camsylate (in combination with a beta-blocker) was the drug of choice for acute stratified aortic aneurysm due to its ability to reduce heart rate and cardiac output. In today's clinical practice, more modern drugs are more often used, in particular the Esmolol beta-blocker of ultrashort action, which is considered the most effective remedy  with stratified aortic aneurysm (in combination with sodium nitroprusside).

Trimethafan camsylate is more toxic than sodium nitroprusside, which is due to generalized blockade of the autonomic nervous system. With repeated use, its effectiveness decreases - tachyphylaxis develops.

Azamethonium bromide

Azamethonium bromide is used if more effective and safe drugs are not available. Being a ganglion blocker, azamethonium bromide relaxes the veins and arteries, thereby reducing the load on the heart. It is used for the relief of hypertensive crises, accompanied by acute left ventricular failure. Enter intravenously in the form of repeated fractional injections (0.3-0.5-1 ml) very slowly.

Azamethonium bromide can also be used for other types of hypertensive crises (preferably intramuscular injection). The disadvantages of the drug are the same as that of trimethafan camsylate. In addition, it has a long-lasting effect (4-8 hours), which complicates the individual selection of an effective dose. It can cause a sharp decrease in blood pressure, up to the development of collapse.

Phentolamine

Phentolamine is used if the hypertensive crisis is caused by an excess of catecholamines (pheochromocytoma, sudden cancellation of clonidine (clonidine), etc.). Intravenous administration of phentolamine causes an effective, short-term blockade of alpha-1 and alpha-2 adrenergic receptors. The drug reduces blood pressure by no more than 15 minutes after a bolus (jet) intravenous administration. Its action is accompanied by reflex tachycardia, which can aggravate myocardial ischemia (up to a heart attack) or cause the appearance of severe arrhythmias.

Labetalol

Labetalol - a blocker of beta-1, beta-2 and alpha-1-adrenergic receptors, is considered by many authors as the drug of choice for most hypertensive crises. It is effective and safe, has no toxic effects, does not cause tachycardia or increased intracranial pressure, like direct vasodilators. The action of labetalol with intravenous administration begins after 5 minutes and lasts 3-6 hours. Labetalol is effective in any form of hypertensive crisis, except for complicated by acute insufficiency of the left ventricle of the heart. In the latter case, the use of the drug is undesirable because of the pronounced effect of reducing the strength of the heart contractions due to the blockade of beta-adrenergic receptors.

Esmolol

Esmolol is a cardioselective beta-blocker. It is rapidly destroyed by blood enzymes, as a result of which it has a very short (about 9 min) half-life and, accordingly, a short duration of action (about 30 min). It is especially indicated for anesthesia and dissecting aortic aneurysm (in the latter case, it is used in combination with sodium nitroprusside or another drug that relaxes blood vessels).

Enalaprilat

Enalaprilat is used in cases where ACE inhibitors have an advantage over other antihypertensive agents, in particular with severe heart failure. Enalaprilat has a mild effect on cerebral blood flow, which is expressed in the absence of signs of a deficiency in the blood supply to the brain even with a significant decrease in blood pressure.

Nicardipine and other calcium agonists

Nicardipine is comparable in effectiveness with sodium nitroprusside, while it is better tolerated by patients. Another dihydropyridine calcium agonist - nimodipine - has a selective effect on the cerebral vessels, which is why it is used to eliminate the spasm of these vessels in patients with subarachnoid hemorrhage. Of the other calcium antagonists, verapamil is also used, which is administered intravenously for hypertensive crises.

Fenoldopam

Fenoldopam is a new selective dopamine receptor agonist. Renders direct action to relax blood vessels and lower blood pressure, similar to sodium nitroprusside, but with less frequent side effects. Along with lowering blood pressure, fenoldopam significantly improves urination, excretion of sodium from the body and increases creatinine clearance, which is why it is the drug of choice in patients with renal failure. It is indicated for any type of hypertensive crisis. The experience of its use to date is small.

Diuretics for stopping hypertensive crises

Diuretics, usually loopback - furosemide or bumetanide - are administered in cases where there are signs of fluid retention, especially in patients with congestive heart failure or when treated with drugs that relax blood vessels and cause fluid retention. Patients with a reduced volume of circulating blood due to vomiting or excessive diuresis are not recommended for diuretics. In these cases, lowering blood pressure, on the contrary, can be achieved by restoring the volume of circulating blood using intravenous administration of an isotonic solution.

Magnesium sulfate

Magnesium sulfate is used for the prevention and relief of convulsive syndrome in patients with preeclampsia and eclampsia, as well as other clinical forms of hypertensive encephalopathy. Magnesium sulfate has an anticonvulsant, dehydrating, antispasmodic effect, inhibits the vasomotor center, which reduces blood pressure.

The drug is administered intravenously or intramuscularly. With intravenous administration, an increase in the concentration of magnesium ions in the blood can lead to inhibition of the respiratory center and respiratory arrest. The antidote of magnesium sulfate is calcium chloride, which is administered intravenously at the first signs of respiratory failure. Intramuscular administration can cause the formation of abscesses.

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In the treatment of a number of diseases, intravenous administration is used. drug. An injection in the vein helps the drug spread throughout the body and initiate healing. However, it is recommended to take several vitamins at once, this refers to vitamin B group, which are prescribed by doctors as injections. One of the reasons for intravenous injection is a dietary restriction that prevents vitamins from entering the body.

Intravenous administration

Making intravenous injections skillfully and accurately is the norm and the rule. So an experienced nurse puts an injection. If a situation arises in which there is no nurse, the procedure is performed on its own. According to the rules of antiseptics:

• take sterile disposable syringes;
• make disinfection of the skin at the injection site;
• wash hands with soap before the procedure.

Venous vessels, the contour of which is palpable, in the elbow bend are an ideal place for injection. The reason for this also lies in the thin layer of skin covering them. an injection can be done in any palpable veins on the body. Schematically, veins are divided into the following types:

• not palpable, not visible, but sometimes slightly visible venous vessel - an uncontrolled vein;
• palpable, visible, not protruding over the skin vein - poorly contoured;
• visible, distinctly protruding vein from under the skin - well contoured.

Attention! Intravenous injections are prescribed by the attending physician.

The procedure for injecting the drug into a vein

It is quite difficult to do intravenous injections into the arm, because only one arm works. But the action is doable.

  Correctly injecting means conducting the entire procedure in a consistent manner, observing hygiene. The person who puts the injection before this procedure thoroughly washes hands with soap and puts on rubber gloves disinfected with alcohol. Prepare in advance:

• venous tourniquet;
• cotton swabs moistened in alcohol;
• means for introducing into a vein.

Procedure Flow

• The patient takes a comfortable position for the time during which the injection is injected;
• In the middle of the shoulder, with the arm bent at the elbow, a tourniquet is applied over the clothes;
• A properly applied tourniquet does not change the characteristics of the pulse;
• The maximum increase in the vein stimulates several clenching-unclenching of the fist (10-15 times);
• The syringe is filled with the drug for injection, the contents are examined for the absence of air bubbles, a cap is put on the needle for sterility;
• The injection site is disinfected with an alcohol cotton ball;
• The other hand re-palpates the vein in the puncture area to improve needle penetration;
• With a prepared syringe (almost parallel to the vein) with the needle, with the cut up, pierce the skin a third of the length of the needle (fist clenched);
• Continuing the fixation of the vein, pierce it to "failure in the void";
• With free entry into the syringe through the needle of venous blood, the drug is administered;
• Release the hand from the tourniquet, unclench the brush;
• Slowly administer the drug, the direction of the syringe is in its original position;
• Leave a part of the solution in the syringe to prevent air from entering the vein;
• Pressing the injection site with a cotton swab, pull the needle out of the vein;
• Put a swab soaked in alcohol at the injection site, bend your arm at the elbow, and stay in this position for five minutes;
• Throw away all objects for injection.

Tip. When the veins in the ulnar fossa are bad or “floating, in order to minimize their injury, you need to stab into the hand. Suitable injection veins are also located in this area. The fact that the needle penetrates the venous vessel confirms the flow of blood into the syringe.

Visualization of an intravenous injection is provided in the video:

Brief conclusions. At the beginning of the procedure with an intravenous injection, veins protruding above the surface of the skin or veins lying deep beneath the skin, but visible from the outside, are placed in the arm. Hands probing areas of the possible location of the veins. Especially convenient for injection veins are located in the ulnar fossa.

The veins of the lower extremities are not used for injections. The reason for this is arising vein pollution, the appearance of infectious complications, the formation of blood clots.

Complications after intravenous injections

Comments on the forum. “I give myself intravenous injections. Tell me, how many times can I prick in one place? Will there be an injury? ”

"I suppose that frequent injections at the same point will provoke the appearance of infiltrate."

"What are you talking about?! All injections can be done correctly by health workers with admission to the performance of medical activities.

Especially, intravenous injection. You endanger life. Moreover, treatment is allowed when prescribed by a doctor. If something happens, where do you find the guilty? And trouble may happen. It is foolish to take an example from drug addicts. They are suicides. ”

If injections into a blood vessel are prescribed for treatment, you can trust a professional. Unprofessional invasion of the bloodstream in some cases ends sadly.

The following post-injection complications are distinguished:

• anaphylactic shock - a reaction to drugs that causes loss of consciousness and a rapid drop in blood pressure;
• embolism of the branches of the pulmonary artery;
• sepsis - an infection spreading through the blood;
• local allergic reaction;
• infiltrate;
• hematomas;
• necrosis;
• abscesses;
• phlegmon;
• phlebitis;
• thrombophlebitis;
• ulcerative necrotic tissue lesions.

Swelling in the injection area means the absence of a needle inside the vein and the flow of the drug into the fiber. Remove the needle immediately, inject into another large vein.

Subcutaneous hematoma - a type of bruising, accumulation of blood. The reason for the appearance is inept venipuncture. A puncture of both walls of the vessel occurs and a crimson stain forms under the skin.

To prevent the appearance of swelling and hematoma during an injection, the following rules are followed:

1. use large superficial veins,
2. pierce only the front wall;
3. the needle should go inside the vein,
4. incomplete puncture of the wall causes blood to leak through the bevel of the needle;
5. remove the tourniquet before removing the needle.

Remember! Oil solutions are not administered intravenously!

A friend told me how she used the antibiotic she was prescribed intramuscularly cefazolin. Since intramuscular administration of cefazolin even with lidocaine  painfully enough, the girl decided to inject herself with this antibiotic intravenously. And also with lidocaine, an instruction to which she did not read. A friend divorced 1 g of cefazolin in 5 ml of 1% lidocaine and administered it intravenously for 5-10 seconds. Subsequent sensations caused by side effect  the rapid introduction of 2 drugs, discouraged her any desire to continue treatment intravenously. I will tell about the arising adverse reactions a bit later. A friend returned to intramuscular injection.

We will see if administer antibiotics intravenously, which were prescribed intramuscularly, and on which it is necessary to dilute the antibiotic powder from the vial.

Back in 1976, it was proposed to divide all antibiotics into 2 groups. The effect of antibiotics of the first group depends on the duration of their presence in the focus, the second group - on the maximum concentration achieved in the focus.

Antibiotics have 2 effects on sensitive bacteria:

• bacteriostatic  (Greek: statike - still) - the cessation of the growth and reproduction of bacteria;
• bactericidal  (lat.cidere - kill) - the killing of bacteria with subsequent decay.

There are antibiotics that give only a bacteriostatic effect. The remaining antibiotics in low doses give a bacteriostatic effect, and in higher doses - bactericidal.

Now consider a figure showing the relationship blood drug concentrations  from the method of its introduction.

Intraperitoneal administration is mainly used in animals.

• At intravenous introduction into the blood immediately creates a very high concentration of the drug, which quickly drops, because the drug goes into the tissue, is destroyed and excreted by the liver and / or kidneys.
• At intramuscular  the introduction of the antibiotic is more slowly absorbed into the blood from muscle tissue and lasts longer, while the peak concentration is lower than when administered intravenously.
• When taking the drug inward  there is a slow absorption and slow excretion of the active substance, and the peak concentration is small.

Antibiotics, the effect of which depends on time

The method (where) and the frequency (how many times a day) of the introduction of antibiotics of this group are aimed at maintaining the antibiotic content in the blood and in the focus of infection in concentrations as long as possible above minimum  (above IPC). The main parameter is timeduring which the concentration of the antibiotic in the blood is higher than the IPC.

So, the first group includes antibiotics, for which it is important time (duration of action) Antibiotics of this group are often prescribed intramuscularly, since intravenous administration leads to large fluctuations in blood levels and insufficient effect. In intensive care units, in order to maintain a stable concentration of the drug in the blood when administered through an intravenous catheter, special   dispensers (infusomats, infusion pumps, infusors, syringe pumps), which allow you to drive the medicine for several hours.

Infusion pump
Photo: http://www.medicalpointindia.com/cariac-SyringeInfusionPump.htm

Antibiotics for which time is more important (the first 4 groups relate to beta-lactam antibiotics):

1. PENICILLINS: benzylpenicillin, ampicillin, amoxicillin, oxacillin, carbenicillin, ticarcillin, azlocillin  and etc.

   Benzylpenicillin sodium  in a vial it is diluted with saline (0.9% sodium chloride solution), water for injection or 0.25-0.5% novocaine solution. It is administered intramuscularly 4-6 times a day, intravenous administration is allowed (only when diluted in water for injection or in saline).

   Novocaine salt  benzylpenicillin ( procaine benzylpenicillin) is diluted with water for injection or saline. It can not be administered intravenously, it is administered intramuscularly.

   Extended forms of penicillin, or bicillins (benzatine benzylpenicillin), are administered only intramuscularly, since they are sparingly soluble, slowly absorbed, and maintain the desired concentration of penicillin in the blood for a long time.

2. CEPHALOSPORINS: cefazolin, cefalexin, cefepime, cefixime, cefoperazone, cefotaxime, cefpir, ceftazidime, ceftriaxone, cefuroxime  and etc.
3. CARBAPENEMS: meropenem, ertapenem, doripenem.
4. MONOBACTS: aztreonam.
5. MACROLIDES: erythromycin, roxithromycin, clarithromycin, oleandomycin, spiramycin, midecamycin.

   Note: azithromycin  (tradename - sumamed), belonging to the macrolide group, belongs to the second group of antibiotics. Its effect depends on the maximum concentration achieved. The reason is that azithromycin accumulates inside the cells and is very effective against intracellular pathogens. The concentration of azithromycin in tissues and cells is 10-50 times higher than in blood plasma, and in the focus of infection - 24-34% more than in healthy tissues. Azithromycin is taken 1 time per day. It can not be administered intramuscularly or intravenously, only intravenously or intravenously slowly.

6. LINCOSAMIDES: lincomycin, clindamycin.

Antibiotics, the effect of which depends on the concentration

The second group of antibiotics gives the maximum effect upon reaching maximum concentration. As a rule, they can be administered intravenously.

Antibiotics of the second group:

1. AMINOGLYCOSIDES: gentamicin, amikacin, kanamycin, netilmicin, streptomycin, tobramycin, framycetin, neomycin.

   Aminoglycosides are not absorbed in the intestine, therefore, they are taken orally only for intestinal sanitation (due to high toxicity neomycin  assigned only inward). Traditionally, aminoglycosides are administered intramuscularly 2-3 times a day, however, studies have shown that intravenous administration of the whole daily dose once a day is not only not inferior in effectiveness, but also cheaper and has fewer side effects (aminoglycosides can impair renal and inner ear function ) The only exception for intravenous administration once a day is bacterial endocarditis (inflammation of the inner lining of the heart with a predominant lesion of the valves), in which the traditional intramuscular administration is recommended. In elderly patients and in case of impaired renal function, caution is also needed, in such cases it is recommended to administer the daily dose of aminoglycoside intramuscularly in parts, as well as determine the level of the drug in the blood before administration.

2. Fluoroquinolones: ofloxacin, ciprofloxacin, norfloxacin, lomefloxacin, levofloxacin, sparfloxacin, grefafloxacin, moxifloxacin, gemifloxacin, gatifloxacin.

   Animal experiments have proven the high antibacterial efficacy of administering daily doses of intravenously, however, high concentrations of fluoroquinolones can cause adverse reactions from the nervous system, so a daily dose of fluoroquinolone is administered intravenously, usually within 60-90 minutes.

3. TETRACYCLINES: tetracycline, oxytetracycline, doxycycline, minocycline, tigecycline.

AZITROMYCIN (exclusion from the group macrolides).

VANCOMYCIN

Antibiotic Injection Solvents

The most famous 5 solvents for injection dosage forms  (dissolving the dry contents of the vials):

• isotonic (0.9%) sodium chloride solution,
• glucose solution (usually 5%),
• novocaine solution
• lidocaine solution.

All solvents for injection should be purchased at the pharmacy, be sterile and open immediately before use (ampoules, vials).

WATER FOR INJECTIONS  - sterile specially prepared water with low salt content. However, the introduction of large volumes of water for injection can disrupt the ion-salt balance in the body, therefore, for bulk infusions (infusions), saline or Ringer's solution (contains sodium, potassium and calcium chlorides) is used.

The standards for the content of microbes in water for injection in the USA and Europe are stricter a thousand times than in Russia
Source: https://newsapteka95.wordpress.com/2011/08/31/ obtaining- various- types-water-for-//

How to get water for injection
Source: same

ISOTONIC (0.9%) SODIUM CHLORIDE SOLUTION (saline, saline) has an osmotic pressure of salt equal to the osmotic pressure of blood plasma. The introduction of saline does not cause additional movement of fluid in or out of the blood vessels. However, saline contains sodium chloride (sodium chloride), which may be undesirable for dissolving single antibiotics.

Any antibiotic it is safest to breed in water for injection. It is also usually permissible to use an isotonic sodium chloride solution (read the instructions for the antibiotic). For intravenous administration, antibiotics should be diluted on water for injection or on saline (no anesthetics with intravenous administration).

Sometimes a 5% Glucose Solution is used to dissolve the medicine. Is it possible to dilute an antibiotic with a solution of 5% glucose? In many cases, it is possible, but not in all, so always focus on the instructions for the drug. The glucose solution is destroyed when stored in a glass container with alkali residues, therefore, for stability, hydrochloric (hydrochloric) acid (HCl) is added to it. Glucose itself, being a strong oxidizing agent, can also enter into chemical reactions. Therefore, a number of drugs are not allowed to be dissolved in glucose, starting with ascorbic acid and cardiac glycosides and ending with antibiotics. benzylpenicillin, lincomycin, streptomycin.

Intramuscular injection cefazolin  very painful, so it is usually bred on a local anesthetic (an anesthetic that blocks pain receptors). Previously, a solution was widely used in medicine Novocaine (procaine). Can antibiotics be diluted with novocaine? Not all. Injectable solutions of novocaine are also stabilized with hydrochloric acid, so some antibiotics can be destroyed in an acidic environment: ampicillin  (can only be bred in water for injection) amphotericin B  (only in water for injection). Solution streptomycin  in novocaine can be stored no more than 6 hours. Concerning benzylpenicillin, then its decomposition in an acidic environment does not occur immediately, but gradually: after 30 minutes - 1.5%, after a day - 40%. Hence the conclusion: dissolve benzylpenicillin  in novocaine is possible, but only before use. Unused benzylpenicillin solution cannot be stored. You may ask: how is the procaine salt of benzylpenicillin (procaine benzylpenicillin) made? In this case, novocaine is not stabilized with hydrochloric acid, and before administration, the drug is diluted with water for injection.

Novocaine has now lost its former role and has been replaced by LIDOCAIN since the mid-1990s. Lidocaine is 2 times better than novocaine in strength and duration of analgesia, and also works well in inflamed tissues. Lidocaine is less likely to cause allergies and is considered less toxic.

According to the instructions to cefazolin, for intramuscular administration, it can be bred lidocaine. Lidocaine is not only a local anesthetic, but also an antiarrhythmic drug (treatment of ventricular arrhythmias). Lidocaine gives many undesirable reactions, especially with rapid administration or in high doses.

ADVERSE EFFECTS OF LIDOCAINE

By nervous system and sensory organs: depression or excitement of the central nervous system, nervousness, euphoria, flickering of “flies” before the eyes, photophobia, drowsiness, headache, dizziness, tinnitus, diplopia, impaired consciousness, respiratory depression or respiratory arrest, muscle twitching, tremor, disorientation, convulsions (the risk of their development increases against the background of hypercapnia and acidosis).

By cardiovascular system and blood  (hematopoiesis, hemostasis): sinus bradycardia, impaired conduction of the heart, transverse block of the heart, lowering or increasing blood pressure, collapse.

From the organs Gastrointestinal tract: nausea, vomiting.

Allergic  reactions: generalized exfoliative dermatitis, anaphylactic shock, angioedema, contact dermatitis (hyperemia at the site of application, skin rash, urticaria, pruritus), a short burning sensation in the area of \u200b\u200baction of the aerosol or at the place of application of the plate.

Other: Feeling of heat, cold or numbness of the extremities, malignant hyperthermia, suppression of the immune system.

My acquaintance informed me that she diluted 1 g of cefazolin in 5 ml of 1% lidocaine and administered it intravenously for 5-10 seconds. In less than half a minute, like her " turned inside out”(Severe vomiting). Fortunately, after a few minutes the condition returned to normal, but vomiting really frightened a friend. Nausea and vomiting can be side effects not only of lidocaine, but also of cefazolin, and in our case, the side effects of 2 drugs and their rapid administration were probably superimposed. Such a dose of lidocaine does not need to be administered intravenously faster than in 1 minute. Although it could be worse - for example, cramps.

With intravenous injection in the instructions for cefazolin, administration within 3-5 minutes is recommended. If you ignore the instructions, you can seriously harm yourself.

For i / m administration, a solution of cefazolin is prepared ex tempore; 500 mg of the drug is dissolved in 2 ml of water for injection, 1 g in 2.5 ml of water for injection. For iv bolus  of administration, the resulting solution is diluted with 5 ml of water for injection, then it is administered slowly over 3-5 minutes. For iv drip, the drug is diluted with 50-100 ml of 5% or 10% glucose solution, 0.9% sodium chloride solution, Ringer's solution, 5% sodium bicarbonate solution. Vials are shaken vigorously until the powder is completely dissolved.

Explanations:

• ex tempore  (lat. " out of time") - as required, immediately, without storage;
• parenteral  (from Greek para - near, enteron - intestines) - the introduction of the drug into the body, bypassing the gastrointestinal tract. Parenteral administration includes injections (intravenously, intramuscularly, subcutaneously, etc.), as well as inhalations, intranasal, intraosseous, subconjunctival administration, etc .;
• bolus  introduction (lat. bolus - com, piece) - parenteral administration of the drug in a short time (usually no more than 3-5 minutes), in contrast to a longer infusion (dropper). The concepts of " intravenously"And" intravenously bolus»Almost coincide.

The main thing from the article

1. Antibiotics are divided into 2 groups. Important for the first group time  (long-term maintenance of the desired concentration in the blood), this includes all beta-dactam antibiotics ( penicillins, cephalosporins, carbapenems, monobactams), macrolides  (excluding azithromycin) and lincosamides.

   For the second group more important peak concentration  antibiotic in the outbreak, these include aminoglycosides, fluoroquinolones, tetracyclines, azithromycin and vancomycin.

2. It is strictly forbidden to administer intravenous antibiotics of prolonged action, which are allowed to be administered only intramuscularly (for example, bicillin-1, bicillin-3, bicillin-5) If bicillin is administered intravenously, a serious complication is likely embolism (blockage by insoluble particles) vessels of the lungs and brain, which can lead to heart attack and death. Intraarterial administration of bicillin will clog small arteries and lead to gangrene  (death) of a limb or other part of the body. It is recommended that immediately before the administration of bicillin, the syringe plunger is pulled intramuscularly towards yourself to make sure that no blood enters the syringe (that the needle did not accidentally enter the vessel).
3. For intravenous administration, the antibiotic is bred into water for injection. You can use saline or 5% glucose solution for dissolution only if this is allowed by the antibiotic instructions. In case of painful injections, an antibiotic for intramuscular administration can be used lidocaineif permitted in the instructions for the drug.
4. You can not enter an antibiotic in one syringe  with any other drugs, unless specifically authorized by the instructions. For example, mutual inactivation of drugs is possible - loss of activity (for example, penicillins  and cephalosporins  inactivate aminoglycosides  when mixed, but when separately introduced into the body, reinforce each other's effect). It is undesirable to administer antibiotics and other drugs on your own.
5. Only enter freshly cooked  antibiotic solutions. Soluble antibiotics can decompose or interact with the solvent, and therefore are usually not to be stored.
6. The final decision on the antibiotic regimen is made by the attending physician taking into account the diagnosis, concomitant diseases and risk factors.
7. Required read instructions  to drugs. If it is written that the drug should be administered intravenously for 3-5 minutes or the rate of administration is indicated, it should be understood that faster administration can be fraught with complications.

My comments on the treatment of a friend

• Cefazolin was prescribed for the treatment of cough with purulent sputum. Antibiotics should be prescribed in case of pneumonia  (pneumonia), and bronchitis  is not .
• Often, an antibiotic is prescribed irrationally: without indications, inappropriate or with the wrong dosage regimen. In this case cefazolin  intramuscularly 2 times a day can be replaced by cephalexin  inside 3 times a day. Cefazolin and cephalexin belong to the 1st generation cephalosporins, have an almost identical spectrum of action and cost about the same.
• It was possible to add to the treatment, which is effective for purulent infections, enhances the effect of antibiotics (but can be used without them) and does not give side effects. And to relieve sputum and reduce inflammation, I usually recommend a complex herbal preparation Bronchipret.

Regarding Cough Prevention

• Do not smoke - smoking violates the protective function of the ciliary epithelium of the respiratory tract. Over the years, coughing becomes chronic (" smoker's cough»).
• For the prevention of purulent complications of respiratory infections (including smokers), I recommend using bacterial lysates : Ismigen (Respibron), Bronchomunal  other. A detailed article on this subject I. Bacterial lysates will not be able to protect against the occurrence of ARI / ARVI, but they will significantly reduce the severity of the disease and the risk of complications.

When writing this article, the material The influence of the pharmacodynamics of various classes of antibacterial drugs on the dosage regimes was used (L. Strachunsky, A. A. Mukonin, Smolensk State Medical Academy. ANTIBIOTICS AND CHEMOTHERAPY, 2000 - N4, pp. 40-44).