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Ministry of Health of Republic of Belarus
Education establishment
«The Gomel State medical university»
Chair of Internal Disease №1 with Endocrinology Course
It is discussed at the meeting of chair 30.08.2016
Protocol № ___________
METHODICAL REVIEW
for practical training of foreign students of the 1st course
Subject:
«Methods of medicine use. Enteral and external ways of medicine use.
Technology of subcutaneous and intramuscular injections.
Technology of intravenous injections»
Theme 5 (Lesson 7; 8; 9):
Time: 9 hours
Chief of chair______________
1. Training and educational goals, motivation for theme learning,
requirements of initial level of knowledge
1.1 Aim of training: Get an idea about the basic ways of using drugs, extracts
rules, storage, distribution of drugs, indications and contraindications for
injections, their complications, master the technique of a set of drugs of ampoules
and vials, intradermal technique, subcutaneous, intramuscular and intravenous
injections.
1.2 Requirements to initial level of knowledge: during the training the student
should
To know:
1. Basic methods of using drugs: enteral, topical, parenteral.
2. Discharge, storage, distribution of medicines, cancellation of narcotic and potent
drugs.
3. The concept of device syringes and their variants, the rules get medicines ofrom
ampoules and vials.
4. Indications and contraindications for subcutaneous, intramuscular and
intravenous injections.
5. Features of the introduction of oily solutions and bitsillin.
6. Possible complications of hypodermic, intramuscular and intravenous injections.
To be able to:
1. Use practical knowledge of the discharge and storage of medicines guard nurse
and head nurse office.
2. Perform intradermal, subcutaneous, intramuscular, intravenous injection.
3. Perform drug distribution rules.
2. Questions on an occupation subject:
Lesson №7
1. Methods of medicine using: enteral, external, parenteral.
2. Storage and keeping of drugs in the nurse's office.
3. The rules of ordering medicines.
4. Write-off of narcotic and potent medicines.
5. The procedure for making the requirements for the preparation of drugs from the
pharmacy.
6. Preparation and distribution of medicines for internal use.
Lesson №8
1.Syringes structure and their varieties.
2. Preparation of the workplace to injecting drugs.
3. Nurse reparation for giving injecting drugs.
4. Technology of getting drugs from ampoules and vials.
5. Antibiotics breeding rules.
6. Delivery of the syringe to the patient's bed.
7. Possible complications during subcutaneous, intramuscular, intravenous
injection.
Lesson №9
1. Performance the technique of intradermal injection.
2. Technique of subcutaneous injections.
3. Technique of intramuscular injection.
4. Technique of intravenous injection and intravenous drip infusion.
5. Using a syringe dispensers.
6. Technique of blood sampling from a vein.
7. Features of the entering of oil solutions and bitsillin.
8. Rules of disinfection disposable syringes and systems for intravenous drip
infusion.
3. Materials for self-preparation:
Lesson №7
1. Methods of medicine using: enteral, external, parenteral.
Medical substances may have on local or general body (resorptive) action.
The local effect is in contact with the tissue, due to the total absorption of drugs
into the bloodstream and spread throughout the body. The efficiency depends on
dose, speed of absorption into the bloodstream, the degree of destruction in the
body, the individual patient feature, the disease and others. Important is the method
of administering the drug.
There are external and internal (enteral), parenteral (injectable), inhalation
ways of administration of drugs
By the external process medical substance can be applied to the skin
(ointments, powders, compresses) and mucous membranes (eyes, nose and ears).
This is mainly used their local effect.
The most famous way of administration of drugs is internal (through the
mouth, per os). This method is simple, available, requires no special training of the
patient and medical staff. Since it can be used as a solid (powders, tablets, pills,
capsules) or liquid (solutions, infusions, decoctions, tinctures, mixture) dosage
form. However, by the influence of gastric juice and digestive enzymes, some
drugs are partially destroyed. Further, all substances, including drugs, blood is
sucked into the gastro-intestinal tract, tested with blood flow through the liver,
which performs the function of neutralizing. There they are subjected to further
destruction. These factors should be considered. Most of the medicines
recommended for use for ½-1 hour before meals, so that they less than destroyed
by digestive juices and better absorbed in the digestive tract. Some drugs (eg,
pancreatic enzymes), it is advisable to appoint during the meal, while others
(acetylsalicylic acid, indomethacin, prednisone), adversely affecting the gastric
mucosa, taken after meals.
By receiving the powder, it should be putting on the tongue, and the tablet
placed on the tongue and swallow down with water, tea. Liquid drugs - aqueous
solutions, potions, teas - given in graded cups (5-20 mL), and at home - by spoons.
Capacity 5ml teaspoon, dessertspoon - 10 ml, dining spoon- 15 ml. Liquid
medications unpleasant taste swallow down with water, tea. Alcohol extracts and
liquid extracts metered droplets. Before taking a drop of water was dissolved a
small amount. For each individual drug pipette needed. Currently, most of a bottle
of medicine have their dropper.
Since the start of the reception to the drug passes 15-30 minutes (the time
necessary for their absorption into the blood). Therefore, this method is not
applicable in those cases, if it is necessary to effect the medication came quickly.
In addition, it can not be used in patients who are unconscious.
Use also sublingual (under the tongue) administration of drugs. They are
rapidly absorbed in the mouth and do not break down in the liver. So use
nitroglycerin, validol. For buccal (to internal part of a cheek) administration of
drugs using special dosage forms (plate on the basis of a biopolymer, affixed to the
buccal mucosa), a method of using the drug for speed of its action, as well as
increases the duration of action. The disadvantages of the method with frequent use
include excessive salivation and irritation of the oral mucosa.
There is also a rectal (from the Latin per rectum -. Through the rectum)
drug administration. With this method of administration is not the last test
destructive action of the gastric juice and digestive enzymes are absorbed into the
system hemorrhoidal veins without falling into the portal circulation and bypassed
the liver. This method is used in cases where it is impossible or impractical, oral
administration of drugs (vomiting, swallowing disorders, unconscious patients,
lesions of the mucous membrane of the stomach), or when you need the local
effect of the drug (hemorrhoids, anal fissures, and others). For the administration
of drugs throw the rectum using mostly micro enema or rectal suppositories
(suppository).
In addition, there vaginal (administered tablets, suppositories, solutions,
emulsions, creams, suspensions) and urethral routes of administration of drugs.
They are used for therapeutic and diagnostic purposes (introduction of contrast
agents).
Parenteral drug introduced into the body, bypassing the digestive tract by
syringe. Fast delivery of the drug into the blood makes this method indispensable
for the provision of emergency medical assistance. It provides precise dosage of
drug administered, which makes it possible to maintain their concentration in the
body at the desired level. The disadvantages of the method can be attributed to the
relative complexity, the need for special training of medical staff, fear of injection,
the possibility of infection by certain viral infections with substandard sterilization
instrument.
Inhalation drug administration (by inhalation of vapor) is used to quickly
achieve the effect due to the large surface area of absorption of tiny drug particles.
To use this method, you must use special inhalers, as well as to train the patient's
rules of their use.
Transdermal drug administration is accomplished by application to the skin
or film patches (transdermal therapeutic systems), slowly releasing the drug.
Ensures rapid therapeutic effect, the method avoids the adverse effects of the drug,
arising after oral administration and rapidly discontinue treatment when developing
adverse effects. This method of application is simple. Drug is improved patient
compliance to the treatment, the dose of the drug can be reduced, as it reduces
losses associated with metabolism. The disadvantage of this method is the
possibility of irritation at the site of use of the system, as well as its high cost.
These systems are used for the treatment of nicotine dependence (substitution
treatment), gynecology (hormone replacement therapy), in oncology (for the
treatment of chronic pain).
2. Storage and keeping of drugs in the nurse's office.
The medications are stored at the department’s office (locked) on separate
labeled shelves depending on the route of administration (internal, external, for
injection). Separately stored flammable substances (alcohol), dressing tools,
strong-smelling medicine, disinfectants.
Vaccines, serum, antibiotics, infusions and decoctions water should be
stored in a dedicated freezer at a temperature of + 2-4 ° C.
Poisonous and narcotic drugs (atropine, pilocarpine, morphine, promedol et
al.) are stored in metal safes, secured to the floor (the wall) which must be locked
with a key. On the inside of the safe or cabinet doors should be the inscription "A"
and a list of toxic and narcotic drugs.
After the end of the working day metal safes sealed. Keys and printing are
the persons authorized to do so by order of the health institution, under conditions
ensuring their complete safety. At night, the keys are sent on duty doctor or nurse
on duty, as recorded in a special register, and signatures of persons who transmit
and receive keys and inventory of these drugs. Medicines dispensed in a pharmacy
subdivisions institutions in the amount of current needs are: a list of drugs «А»,
psychotropic, ethyl alcohol - 7 day, narcotic drugs - 5 day, the outher drugs
materials – 10 daily needs. The rooms and safes that store drugs and highly toxic
drugs, should have the alarm system.
When the distribution of medicines should be aware of their shelf life. All
storage times indicated on the vials. Opened vials should be used within 24 hours.
Eye drops made in vials under a run-in, sterilized - 1 month produced aseptically
(not sterilized) - 2 nights; emulsions and suspensions - 3 days.
3. The rules of ordering medicines.
The doctor on a daily basis, inspect the patient in office, writes a piece of
appointments necessary to the patient medications, their dosages, dosing
frequency, route of administration.
Ward nurse every day, making the selection of destinations from the leaf of
appointments, overwrite them in a special notebook. Information about the
injections patients are transferred to the assigned treatment room nurse performing
the injection.
A list of all assigned resources and procedural ward nurses serving senior
nurse department, which summarizes this information and writes on a particular
form of claim or invoice to receive drugs from the pharmacy.
4. Write-off of narcotic and potent medicines.
Medicines containing narcotic substances and preparations having a
stupefying effect, shall be subject-quantifiable in a special register, numbered,
bound and sealed with the signature of the head physician and stamped by the
medical institution.
Narcotic medicines are prescribed by a doctor or procedural ward nurse
with a note on their introduction into the history of the disease. If you enter a
portion of the dose, then a note of the time of administration and the destruction of
the remaining quantity in a piece of medical devices and in the patient's medical
record. Entries are confirmed by the signature of the nurse and the doctor. A
similar entry shall be made in the book in detail-quantitative accounting
department.
Used vials out of the narcotic drugs are dealt with a report on the same day,
except for weekends and holidays, a person authorized by the order of the chief
doctor of the institution. The fact of putting nurses empty vials out of the narcotic
drugs recorded in a special register, numbered, laced, sealed, and signed by the
head of the institution.
5. The procedure for making the requirements for the preparation of drugs
from the pharmacy.
The requirements are written head nurse offices forms, with the stamp of
medical institutions, cachet of medical institution, signed by head of the
department, approved by the chief doctor of the medical institution or his deputy.
Requirements are numbered in order from the beginning of the year and are written
in a health care setting in triplicate if the hospital is supplied from the hospital
pharmacy (1st copy remains in the pharmacy, 2nd in the senior nurse department,
the 3rd is transferred to the accounting department) . The requirements specify the
full name of the drug, dosage, formulation, packaging and quantity. The individual
components of the demand for ready-made medicines, funds for emergency
assistance, dressings, on drugs, on the drugs in detail-quantitative account for toxic
drugs, alcohol in its pure form.
The name means the requirement is written in Latin, is emphasized in red
pencil, the amount is put in figures and words, indicate the number of medical
history, surname, name, patronymic name of the patient, which is issued for a
means to produce narcotic drugs. For the reception, trauma, surgery, intensive care
unit are allowed to prescribe drugs without medical history number, marked
"emergency relief".
6. Preparation and distribution of medicines for internal use.
Contraindications to the use of internal medicine: intolerance, reduced
absorptive capacity of the mucosa of the gastrointestinal tract.
During the distribution of drags for internal use are needed: a movable
table, medicines (as prescribed by the doctor), lists of appointments, scissors,
tweezers, pipette, graduated cups, carafe of water, container for used materials.
Mobile table with medicines and other necessities transported to the ward.
Each patient is selected according to the sheet medicament medical purposes, with
the mode and time of reception (before, during or after a meal). Check the
expiration date of the drug (the expiry date indicated on the packaging), labeling
study, verify with the assigned dose (drug should only be in the pharmacy
packaging). To receive powder unfolded a piece of paper, give it the shape of a
groove and poured the contents on the patient's tongue, give a drink of water.
Capsules or tablets taken out of the package with tweezers or cut with scissors,
freeing from the wrapper, put on the tongue and allowed to drink water. If the
patient can not swallow the tablet as a whole, then it is ground to a powder. Potions
and decoctions dosed using graduated cups or dining and dessert spoons.
Medications prescribed drops metered pipette, dissolve them in a glass of water, if
necessary. For the introduction of suppositories into the rectum of the patient is
placed on the left side with those given to the abdomen legs. Open the package,
with one hand pushing the patient's buttocks and the other hand is introduced
candle narrow end so that it fits over the external sphincter of the rectum. After the
introduction of candles patient should lie down for 5-10 minutes (children after the
introduction of a suppositories and stick to compress the buttocks 5-10 min).
It should be remembered that the drugs issue only once. The patient should
take the drug in the presence of a nurse.
Funds designated "before the meal", should be taken 15 minutes before a
meal, "after a meal" - 15 minutes after a meal, the funds designated by "fasting",
apply for 20-60 minutes before breakfast. Sulfonamide washed down with alkaline
water. You can not drink milk, fruit or vegetable juices. Sleeping pills are taken 30
minutes before bedtime.
Lesson №8
1. Syringes structure and their varieties.
Syringe is a medical instrument, consisting of a hollow graduated cylinder
and piston. Syringe is pushed on the tapered cone needle that is a metallic tube
having at one end section and the other clutch (for the needle to the syringe
nozzle).
Currently, the world uses only disposable syringes and needles, disposable
systems for intravenous drip solutions. Issued disposable syringes of different sizes
(1, 2, 5, 10, 20 ml), the tube-syringe with a solution of the drug or vaccine, insulin
syringes. The needles used for injection are of different lengths (from 1.5 to 10 cm
and more) and a different lumen diameter (0.3 to 2 mm).
2. Preparation of the workplace to injecting drugs.
Injection is the administration of drug in the tissue, blood vessels, cavity,
subarachnoid space. Nurse performing intradermal, subcutaneous, intramuscular
and intravenous injection, the remaining injection (intra-arterial, intraosseous)
makes a doctor, but a nurse prepares the necessary tools.
When the injection is necessary to strictly observe the rules of asepsis.
Material support:
- Sterile cotton or gauze balls in the package;
- Sterile disposable syringes with needles of different volumes;
- Sterile forceps;
- Procedural table;
- Manipulation table;
- Tray to deliver a sterile syringe to the chamber;
- File for opening ampoules;
- A bottle of antiseptic skin for the treatment of patients;
- A bottle of disinfectant for processing ampoules and other packages of
medicinal injectable forms;
- Scissors for opening metal cap of the vial;
- The capacity for medical waste;
- Drugs for injections (ampoules and vials);
- Appointment of the sheets;
- Labeled container of disinfectant solution (to disinfect table, harness,
pads)
- A special device for removing used needles;
- Clean rags.
The sequence of execution.
1. Wash hands with liquid soap under running water and carry out hygienic
hand antisepsis by European standards, wear gloves.
2. Check the date of sterilization of disposable packaging material (for
example, with sterile balls), forceps, tweezers, package integrity and the term of
use of a disposable syringe. *
3. Wipe the surface of the treatment table, auxiliary table, tray, slut with a
clean cloth moistened with a disinfectant solution.
4. Put on the bottom shelf of the table of procedural capacity for waste
materials **.
5. Process gloved hand disinfectant "Perosan" (or an analogue thereof, is
used for disinfection of rubber gloves).
6. Put on the auxiliary table packing with sterile balls, syringes, needles,
tweezers, forceps, drugs for injection, scissors, nail files for opening ampoules,
vials with alcohol, tray delivery syringe into the chamber.
7. Open the packaging with sterile balls, towels.
8. Open the pack with sterile forceps.
Note
* Each sterile package must be marked with the date of sterilization and
expiration date of the material, before working with the material must bear the date
(time) opening material, as well as the signature of a provider, revealed the
packaging.
** Shared storage on the working surface of the table manipulation and
sterile tools and the waste material is not allowed.
3. Nurse reparation for giving injecting drugs.
The sequence of execution.
1. Put on a gown or a special suit, medical cap (hair in front and behind to
pick up in a hat), armlets.
2. Cut your nails short, to remove from the hands of jewelry, watches.
3. Delete the violation of the integrity of the skin or skin conditions (if any,
the health care worker is suspended for the duration of the disease from the patient
care).
4. Put on a mask, apron, goggles or plastic screen (only if the intravenous
injection).
5. Wash your hands under warm running water (and with soap to rub
against each other for at least 10 seconds).
6. Dry hands with a towel or a single individual with a napkin.
7. Carry out hygienic hand antisepsis.
8. Wear medical gloves *.
Note
* Employees of health care organizations should use sterile gloves in the
following clinical situations: after performing surgical hand antisepsis of the skin;
during the medical examination of the damaged skin of the patient; when
performing medical procedures on the damaged (involving damage, except for
injection), skin, mucous membranes of a patient.
4. Technology of getting drugs from ampoules and vials.
The sequence of execution.
1. Perform all the stages of preparation for injecting drugs (look above.)
2. Take the prescription of medicines in ampoules or vials, to verify the
destination with a sheet concentration and dose, pay attention to integrity,
transparency and the shelf life of the solution.
3. The vial with an oil solution preheated in a water bath to a temperature
of + 38 ° C.
4. Shake the vial to the liquid from the neck of the ampoule has left in the
wide part.
5. Take a sterile forceps sterile cotton ball (from the individual packaging
material can be taken by hand), moisten it with alcohol and treat the upper third of
the ampoules or metal cap and the upper third of the bottle.
6. If necessary, cut the neck of ampoule or open metal cap of the vial with
scissors.
7. Re-treat the vial or the rubber stopper of the vial (leave a cotton ball on
top of the rubber stopper).
8. Open the vial by breaking the neck of ampoule in the opposite ( "from
himself") side and put on an auxiliary table.
9. Take the syringe with sterile packaging, check the expiration date and
tightness.
10. Keep the packaging with a syringe in his left hand up * piston.
11. Open the packaging of the syringe from the plunger.
12. Remove the syringe from the pack and shift it to the other hand a subcone up, packaging put on the table.
13. Open the package with the needle, remove needle arm with a protective
cap.
14. Attach the needle cannula to a sub-cone and fix grind movements.
15. Remove the hand with a needle protective cap, take the opened
ampoule or vial in the left hand between the fingers 2 and 3 in the syringe and
collect the required amount of the drug.
16. Change the needle by hand.
17. Hold the syringe in your left hand
needle up, index finger holding the needle for
the cannula.
18. The right thumb to press the
plunger to displace the air, check the needle
for continuity.
Note
* Algorithms are given for the "righthanded", hereinafter referred to as "lefthanded" need to be manipulated mirror.
5. Antibiotics breeding rules.
Contraindications: hypersensitivity to antibiotics, allergic reactions.
Financial support.
- Everything you need for injections.
- Bottles with antibiotics 250 000 units 500 000 units, 1,000,000 units.
- The vials or ampoules of solvent: 0.5% novocaine solution or 0.9%
sodium chloride solution or distilled water for injection.
The sequence of execution:
1. Wash your hands, dry, wear gloves.
2. Deal with gloved hands with disinfectant.
3. Prepare the bottles to work (on the bottle with the solvent vial mark the
opening date and sign, with a cotton ball dipped in alcohol, cut the metal lid and
the upper third of the bottle Open the metal cap of the vial, re-treat with alcohol the
rubber stopper of the vial.).
4. Assemble a sterile syringe (10 ml), attach the needle for reconstitution.
5. Type of the solvent in the syringe at the rate of 1 ml per 100 000ED
antibiotic (for example, 500 000ED antibiotic necessary to take 5 ml of solvent per
1 000 000ED - 10 ml, etc.) or 1 to 200 ml 000ED antibiotic (e.g. 500 000ED
antibiotic necessary to take 2.5 ml of solvent per 1 000 000ED - 5 ml, etc.).
6. Enter the solvent into the vial with an antibiotic.
7. Remove the needle from the syringe, shake the bottle several times
without touching the needle, until complete dissolution of the antibiotic.
8. Reconnect the syringe to the needle and dial the prescribed dose of an
antibiotic.
9. Change the needle for injection, expel the air, check the patency of the
needle.
10. Deal with gloved hands disinfectant ("Perosan" or others.).
11. Use according to an antibiotic prescription.
6. Delivery of the syringe to the patient's bed.
The sequence of execution
1. Do all stages of preparation for the injection of the drug.
2. Prepare tray.
3. Syringes with medicament dialed is placed in its original packaging.
4. In the tray is placed in a syringe packaging, cotton balls in individual
sterile packaging for each patient, the harness (for intravenous injection).
5. In addition to the tray nurse takes a container with a skin antiseptic and
capacity for waste material.
6. Bedside treat gloved hands first with a cotton ball.
7. The second ball treat injection site extensively.
8. Treat the third injection with a cotton ball a narrow field.
9. Follow the injection.
10. Finish by pressing the fourth injection cotton ball.
11. Put the balls used syringe and needle in a container for the waste
material.
12. Wash hands, dry them.
7. Possible complications during subcutaneous, intramuscular, intravenous
injection.
Various complications may arise during injection. Many of them are
associated with technical errors when performing these procedures. A possible
complication is the introduction or penetration of the drug in the wrong
environment, in which the injection is carried out. Thus, the penetration of some
drugs intended only for intravenous administration (e.g., calcium chloride), a
subcutaneous fat layer can entail its necrosis. Conversely, when exposed to oil
solutions subcutaneous injections into the lumen of the blood vessels can lead to
fat embolism. If air enters the lumen of the blood vessels can develop air
embolism.
Failure to comply with the rules of aseptic and antiseptic, using too cold
fluids, especially oil seals may develop (infiltration) at the injection site. In some
cases, they suppurate with the outcome of postinjection abscess. Vascular injury
during injection is able to cause hemorrhage, followed by the formation of
hematomas. Such hematomas, complicated by inflammation of the vein wall and
its lumen thrombosis (phlebitis, thrombophlebitis), sometimes seen as a result of a
failed puncture the vein puncture with two of its walls.
It is also a violation of the rules of asepsis and antiseptics can lead to
contamination of the patient with viral hepatitis, HIV or other infectious diseases.
Breaking needle in the tissues may occur during all injections. This
complication arises from the defects of the needle itself, and as a result of rough
manipulation, accompanied by a sharp reflex muscle contraction.
A serious problem is allergic reaction to the drug, observed not only
patients, but also nurses, is constantly in contact with the drug.
Clinical manifestations of drug allergy are varied: acute urticaria,
angioneurotic edema, erythema nodosum, allergic dermatitis, rhinitis,
conjunctivitis, etc. The most serious allergic reaction that occurs on a background
of drug therapy is anaphylactic shock, which often develops suddenly and is
characterized by a sharp drop in blood pressure. bronchospasm, loss of
consciousness. At the first sign of shock is necessary to immediately stop the
introduction of drugs administered to the patient immediately epinephrine, steroids,
antihistamines.
Lesson №9
1. Performance the technique of intradermal injection.
Indications:
- Identification of hypersensitivity to the drug (biological sample).
- Diagnostic test.
- Local anesthesia.
Contraindications:
- Swelling of the subcutaneous adipose tissue at the injection site.
- Skin diseases at the injection site.
Injection site:
- The inner surface of the middle third of the forearm.
- The upper third of the outer surface of the shoulder (for BCG
vaccination).
Material support:
- Everything you need for parenteral administration.
- Syringe 1-1,5ml.
- Needle for injection long 15ml, section 0,4ml.
- Needle for a set length of 40mm drug, cross-section 0.8 mm.
- Medicine.
The sequence of execution:
1. Wash your hands, dry, put on gloves.
2. Deal with gloved hands disinfectants ("Perosan" or others.).
3. Prepare the ampoule or vial with medicament.
4. Assemble a sterile syringe, attach the needle to set drug.
5. Fill the syringe 0.3-0.4 ml of the drug.
6. Change the needle for injection, bleed, check the patency of the needle
without removing the cap.
7. Wash gloved hand with disinfectants ("Perosan" or others.).
8. Ask the patient to lie down or sit down.
9. Treat the skin to inject a cotton ball soaked in antiseptic skin, well,
second - narrowly.
10. Take the syringe in your right hand, place your index finger on a needle
sleeve, the other on the cylinder.
11. Remove the cap from the needle. Make sure that the needle was cut
from the top.
12. With his left hand tighten the skin at the injection site, upper arm or
shoulder hugging the bottom.
13. Insert the needle under the stratum corneum to the length of the cut
needle, holding it parallel to the skin.
Technique intradermal injection
14. Fix the position of the needle by placing the index finger of his right
hand on the needle sleeve.
15. Enter the drug by pushing on the plunger with the thumb of the left
hand. If done correctly, the injection papule is formed as a "lemon peel".
16. With a quick movement, remove the needle.
17. Put a dry sterile cotton ball for 2-3 minutes (no crushing) at the
injection site.
18. Put the balls used syringe and needle in a puncture-resistant disposable
container (bags of thick wrapping paper, paper bags).
19. Wash hands, dry them.
Note:
• When carrying out biological sample reaction rate through 20-30 minutes.
• When conducting diagnostic tests to assess the reaction after a certain
time on the instructions warn the patient that it is impossible to wet the injection
site.
2. Technique of subcutaneous injections.
Objective: To teach the drug administration in subcutaneous fat.
Contraindications for manipulation:
- Allergic reactions to drugs;
- Dermal and subcutaneous fat of any nature at the injection site.
Site administration
Injection site after subcutaneous injection
The outer surface of the shoulder and hip.
- Chuck area.
- The anterior abdominal wall.
Financial support.
- Everything you need for parenteral
administration.
- Syringe 1-2 ml.
- An injection needle of 20 mm
length, section of 0.4-0.6 mm.
- Needle set for medicament 40 cm
long section of 0.8 mm.
- Medicines.
- Water bath.
The sequence of execution.
1. Wash your hands, dry, put on
gloves.
2. Deal with gloved hands disinfectants ("Perosan" or others.).
3. Prepare the ampoule or vial of the drug to work, if the medicinal oil
solution, the pre-heat it in a water bath to 38 ° C temperature.
4. Assemble a sterile syringe, attach the needle to set drug (40h 0,8 mm).
5. Type in a syringe drug (dosage according to the doctor's prescription).
6. Change the needle for injection (20h0,4-0,6 mm), bleed, check the
patency of the needle without removing the cap from the disposable needle.
7. Deal with gloved hands disinfectants ("Perosan" or others.).
8. Ask the patient to sit or lie down.
9. Take 3 sterile cotton ball moistened skin antiseptic.
10. Deal with one ball injection site wide, the second - narrowly. The third
ball, leave in the left hand.
11. Take the syringe in the right hand, remove the cap from the needle,
place your index finger on the needle sleeve from the bottom, and the rest - on the
cylinder, cut the needle position up.
12. With his left hand, 1 and 2 fingers, gather the treated area of skin in a
triangular fold-down basis.
11. Right-handed quick motion insert the needle into the base of the fold at
an angle of 45º to a depth of 15 mm (2/3 of the length of the needle) (Fig. 21).
12. Before the introduction of the direct subcutaneous fluids, especially oil
of pharmaceutical solutions, make sure that the needle is in the lumen of the vessel
by pulling the plunger slightly to himself. If there was a syringe blood, push the
needle slightly forward or back and check again where the needle, in order to avoid
drug embolism.
13. Slowly inject the drug by pushing on the plunger with the thumb of the
left hand.
14. With a quick movement, remove the needle, attach to the place of the
third injection, a cotton ball soaked in antiseptic skin, perform a light massage of
the injection site without taking a cotton ball on the skin.
15. Put the balls used syringe and needle in a puncture-resistant disposable
container (bags of thick wrapping paper, paper bags).
16. Wash hands, dry them.
Complications.
- Violation of the rules of aseptic technique can lead to local inflammation
and fever.
- Erroneous administration of hypertonic saline may result in local tissue
necrosis.
- Introduction of an oily solution in the vessel lumen can cause drug
embolism.
- Introduction of hot (above + 40 ° C) solution may cause tissue necrosis.
3. Technique of intramuscular injection.
Objective: To administer the drug into the muscle tissue. Therapeutic effect
occurs within 10-30 minutes. Injectate volume should not exceed 5 ml per single
administration.
Contraindications.
- Atrophy of muscle tissue.
- Skin lesions and subcutaneous fat of any nature at the injection site.
- An allergic reaction to the drug.
injection site.
- The upper outer quadrant of the buttock.
- The middle part of the outer surface of the thigh.
Material support.
- Everything you need for parenteral administration.
- Syringe 5-10 ml.
- Needle length of 40-100 mm, the cross section of 0.8 mm.
- Medicines.
- Water bath.
Places intramuscular injections of drugs
The sequence of execution.
1. Wash your hands, dry, put on gloves.
2. Deal with gloved hands disinfectants ("Perosan" or others.).
3. Prepare a vial or the drug vial to the (oily solution or suspension to heat
the temperature 38 ° C).
4. Assemble a sterile syringe, attach the needle dial, dial the prescribed
dose of the drug.
5. Change the needle for injection, bleed, check the patency of the needle
without removing the cap from the disposable needle.
6. Deal with gloved hands disinfectants ("Perosan" or others.).
7. Ask the patient to lie on his stomach or on the side to make room for the
injection of clothing.
8. Identify the injection site. Mentally divide the buttock into 4 quadrants
of the vertical line passing through the ischial tuberosity, and a horizontal line
through the greater trochanter of the femur. Injections are made only
verhnenaruzhnogo quadrant of the buttocks.
9. Palpate the injection site, to avoid the appearance of nodules and seals.
10. Take three sterile cotton ball, soak their skin antiseptic.
11. Deal with one ball injection place widely different - narrowly. The third
ball to leave your hand, securing it with 2 or 3 or 4 or 5 fingers.
12. Take the syringe in his right hand, holding the collar of the needle 4 or
5 fingers, and the rest of the syringe barrel.
13. With his left hand, 1 and 2 fingers, pull the skin at the puncture site and
press down slightly.
14. Hold the syringe with the needle perpendicular to the skin over the
injection site, the needle enter the fast movement at right angles to the muscle
tissue, leaving her 0.5-1 cm over the needle rod.
15. Enter the drug by pushing on the plunger with the thumb of the left
hand. When administered intramuscularly, solutions, suspensions, especially oil
and check that the needle does not hit a blood vessel, slightly pulling the piston
itself. If there was a syringe blood, change the needle position, put it up and away
again check where the needle. After confirming that the needle is not in the vessel
enter into the muscle drug.
16. With a quick movement, remove the needle and attach to the injection
site for 2-3 minutes, the third a cotton ball soaked in antiseptic skin. Gently
massage the injection site without taking a cotton ball on the skin.
17. Put the balls used syringe and needle in a puncture-resistant disposable
container (bags of thick wrapping paper, paper bags).
18. Wash hands, dry them.
Ventroglyutealnye injection into medium and small gluteal muscles.
Currently, in addition to traditional places for intramuscular injection are
used ventroglyutealnye injection. When the injection the patient must lie on his
side. In order to relax the muscles of the upper leg should be bent at the knee and
hip. To determine the injection site, place the brush at the base of the greater
trochanter hip: right hand - the left thigh, the left - for the right thigh.
Ventromedial Glyutealnaya
injection
Brush should be located so that the thumb was sent to the patient's groin,
and the remaining four fingers - to the crest of the ilium; the index finger is on the
top front spine and medium - stretches along the iliac crest toward the buttock. The
index and middle fingers, iliac crest to form a V-shaped triangle. The needle is
inserted into a muscle 90 ° in the center of the triangle.
Injections in the vastus lateralis muscle.
Intramuscular injection may be performed in the vastus lateralis, which is
well developed, not only in adults but also in children. The average one-third of the
muscles - the best place for injection. To determine the injection site should be
placed on the right hand 1-2 cm below the trochanter, the left - at 1-2 cm above the
patella, the thumbs of both hands should be on one line. The injection site is
located in the center of the area formed by the thumb and forefinger of both hands.
The position of the patient during this injection - lying on his back with a
slightly bent leg at the knee joint, in which the injection, or sitting will be made.
The needle is inserted into a muscle 90 °.
Complications.
- The turning point of the needle due to the sudden muscle contractions
when administered to a blunt or defective needle.
- Damage to the nerve trunks (wrong choice of the injection site, irritating
drugs, thrombosis, nerve supply). Nerve damage results in disruption of the
sensitivity and movement in the limbs (paralysis, paresis).
- Drug embolism when administered oil solutions.
- Purulent infection (abscess) due to violation of the rules of aseptic
technique and administration.
- Allergic reactions: the appearance of urticaria, acute rhinitis, acute
conjunctivitis, angioedema. On the occurrence of any allergic reactions you should
immediately inform your doctor.
- Anaphylaxis - the most threatening form of allergic reactions.
Symptoms: redness, rash, coughing, expressed concern, breathing rate,
heart rate, arrhythmia, drop in blood pressure. On the development of such allergic
reactions should be reported immediately to the doctor and begin providing
emergency aid. In the treatment room must always be ready antishock set.
4. Technique of intravenous injection and intravenous drip infusion.
Intravenous drug used in cases when it is necessary rapid effects on the
body, and also when administering by other routes, for various reasons, not shown.
Medicinal substances authorized for intravenous administration can be
administered bolus and infusion.
Very important is the rate of drug delivery. When administered to an inkjet
plunger slowly be pressed in order to introduce 15-20 ml spend at least 2 minutes.
With the introduction of drip speed measured by the number of input drops per
minute. This usually 60 drops per minute. Only sterile solutions used for
intravenous infusions.
Material support.
- Everything you need to perform the injection.
- A single application system.
- The drug in vials, ampoules.
- Syringes, needles of various sizes.
- Oilcloth pillow.
- Rubber bands.
- Stand for infusion.
Disposable system is made of a pyrogen-free, non-toxic plastic, sterilized
by the manufacturer, comes in packaging indicating the date of sterilization. The
system consists of: receiving a needle cap duct dropper clamp the filter to cap the
injection needle.
Intravenous drip of drugs with the help of disposable system
Purpose: slow drip drug, if necessary administration of large quantities of
liquid (in liters to several hours). Slow delivery of drugs and fluids does not cause
large fluctuations in blood pressure and does not hamper the functioning of the
heart.
Injection site: surface veins elbow, forearm, hands, feet.
Indications.
- Conditions that need to quickly provide a therapeutic effect.
- The introduction of drugs, which in subcutaneous and intramuscular
injection cause irritation or necrosis of tissues.
Contraindications.
- The inability to puncture the vein.
- The introduction of oily materials and insoluble.
- An allergic reaction to the drug.
The sequence of execution.
1. Wash your hands, dry, put on a mask, goggles, apron, gloves.
2. Deal with gloved hands disinfectants ("Perosan").
3. Prepare the vial and ampoule with medicine.
4. Fill the syringe drug and enter into the vial with the infusion medium
through the rubber stopper (if required by the destination).
5. Check the tightness of the system package and shelf life.
6. Open the package with the system by means of scissors or a single
package.
7. Remove the arm system from the packaging.
8. Remove the cap from the needle of the duct along the bottle so that the
end of the tube was at the bottom.
9. Close the clamp system.
10. Remove the cap from the receiving needle and insert the needle into the
vial until it stops.
11. Turn the bottle upside down and attach it to a tripod.
12. Open the clip and fill the dropper to half volume.
13. Close the clamp. Return to the starting position IV.
14. Open the clip and fill the system over the entire length of the liquid
until all air displacement.
15. Close the clamp, fix the entire system on a tripod.
16. Reconnect the injection needle with the cap, open the clamp, check the
patency of the needle.
17. Close the clamp.
18. Deal with gloved hands disinfectants (eg "Perosan").
19. Place the rubber tourniquet above the injection site over clothing or
towels. Check the pulse on the artery below the tourniquet place.
20. Ask the patient several times to compress or decompress a fist (with the
puncture veins of the upper limbs).
21. Palpate the vein, determine its content, ask the patient to make a fist.
22. Take three sterile cotton ball and moisten their skin antiseptic. Treat the
vein puncture site movement from the bottom up, one ball well, second - narrowly.
Third, take the ball in his left hand.
23. The following locations vein puncture, place a sterile cloth.
24. The thumb of the left hand pull the skin down. Below vein puncture site
secure.
25. Remove the cap from the injection needle system and puncture the
vein.
26. Make sure that the needle is in a vein (blood appears in the cannula),
remove the wiring carefully, re-check that the needle in the vein.
27. Open the clamp, adjust the speed of drug administration - 20-60 drops
in 1 min (according to the doctor's prescription).
Intravenous drip
28. Remove contaminated cloth.
29. Put a sterile injection needle under the napkin.
30. A few minutes watch the introduction, make sure that the fluid has been
received under the skin (in this case there is swelling).
31. Close the sterile tissue puncture site and the connection of the needle to
the system, fix plaster.
32. During the injection follow the work of the entire system: Do not get
wet wipe solution is not formed if infiltration or swelling in the area of injection, if
fluid flow has stopped.
33. Follow the appearance of the patient, pulse, respiratory rate, pay
attention to his complaints. At the slightest deterioration urgently call a doctor.
Intravenous drip, the position of the needle
34. Upon completion of the infusion close the clamp. Peel off the adhesive
tape, to the place of puncture lightly press a cotton ball soaked in alcohol, and
remove the needle.
35. Press the cotton ball to the puncture site, ask the patient to bend the arm
at the elbow and hold the ball for 3-5 minutes.
36. Remove the bloody ball and put it in a disposable container for the
collection of waste of group B (package of thick packing paper, paper bag).
37. In place of the venipuncture, apply dry sterile swab (cotton ball), secure
it with a bactericidal plaster.
38. Put the used balls, needles and gloves, system puncture-resistant
disposable container (bags of thick wrapping paper, paper bags).
39. Wash hands, dry them.
Technique of intravenous injection
Objective: To administer the drug into the vein (bolus). It provides a quick
effect (within 1-2 min), the exact dosage, the possibility of administering drugs
that are not absorbed in the gastrointestinal tract or irritating the gastric mucosa.
The amount of drug in a single administration - 10-20 ml.
Contraindications.
- An allergic reaction to the drug.
- Skin lesions and subcutaneous fat in the proposed injection site.
- Phlebitis (inflammation) punktiruemoy veins.
Injection site.
- Superficial veins of the elbow, forearm, hand.
- Superficial veins stop.
- Superficial veins of the cranial vault (in children).
Material support.
- Everything you need to perform the injection.
- 5-20 ml syringes.
- Needle 40 mm long section of 0.8 mm.
- Needle for solvent set (40h0,8 mm).
- The rubber tourniquet or cuff with Velcro.
- Napkin (an area tourniquet with no clothes).
- Oilcloth pillow.
The sequence of execution.
1. Wash your hands, dry, put on a mask, glasses or plastic screen, apron,
gloves, clean them with disinfectant, used for processing gloves.
2. Prepare a bottle or vial with a solvent for use.
3. Assemble a sterile syringe, attach the needle to set drug prescribed dose
dial and get to 10-20 ml of solvent (by appointment).
4. Change the needle for injection, bleed, check the patency without
removing the cap.
5. Put the prepared syringe for injection into the package.
6. Ask the patient to lie down or sit down so that Vienna was well
punktiruemaya available.
7. Under the patient's elbow enclose oilcloth pad (for a maximum extension
of the limb in the joint).
8. Above the injection site, over clothes or towels for compression of
superficial veins apply a rubber band or cuff with Velcro, without disturbing blood
flow in the artery. Harness tie so that its ends are directed upwards and the loop down.
9. Palpate the radial pulse (heart rate should be maintained).
10. Ask the patient several times to compress and unclench his fist (for
better vein blood filling). Massage vein from the bottom up. Ask the patient to
make a fist.
11. Find the most filled vein, palpated her.
12. Deal with gloved hands disinfectant ("Perosan").
13. Take three sterile ball and moisten their skin antiseptic. Treat injection
movements from the bottom up, one ball well, second - narrow, and the third ball,
take the left hand.
14. Take the syringe in his right hand, index finger, place the needle sleeve
(to fix), make sure that the syringe was no air and cut the needle pointing upwards.
15. The thumb of the left hand pull the skin down, below the puncture site
2-3 cm, fix the vein.
16. Without changing the position of the syringe in the left hand, pierce the
skin, holding the syringe almost parallel to the skin, gently insert the needle to 1/3
length, parallel to the vein.
17. Continuing with his left hand to capture the vein, slightly change the
direction of the needle and gently puncture the vein, advance the needle along the
vein. It must be a feeling of falling into the "void."
18. Make sure that the needle is in the vein by pulling the plunger in a
syringe blood should appear.
19. Left-handed Loose harness for one of the free ends, ask the patient to
unclench his fist.
20. Re-check that the needle in the vein.
21. Without changing the position of the syringe, with the left hand, press
the plunger and slowly enter the drug left in the syringe 1-2 ml.
22. Gently push the injection site three cotton ball soaked in antiseptic skin,
rapid motion, remove the needle.
23. Ask the patient to press the ball, bend your arm at the elbow and hold
for 3-5 minutes.
24. Remove the ball, throw it in a disposable container (bag of thick
packing paper, paper bag).
25. Put in place a dry sterile injections ball (apply a pressure bandage, if
necessary).
26. Used syringes, needles and balls to clear the special puncture-proof
disposable containers (bags of thick wrapping paper, paper bags) for the
subsequent disinfection and possible recycling.
27. Wash hands, dry them.
Complications
- Hematoma (bleeding under the skin) with the inept vein puncture. In
place of the hematoma should be imposed alcohol hot compress.
- Spasm vein during puncture.
- Necrosis (necrosis) when administered under the skin of a significant
number of highly irritant (eg, 10% calcium chloride solution).
- Thrombophlebitis (vein inflammation with formation of a thrombus in it)
with frequent venipuncture same or vein using blunt needles. In order to help
bandage with ointment Vishnevsky ointment or heparin. Consultation of the
surgeon.
- Damage to the nerve trunks at the wrong choice of the site of
administration of the drug, close to the nerve. The severity of the complications
can be different - from neuritis (nerve inflammation) to paralysis (loss of function).
- Air embolism in violation of art intravenous administration.
- Septicemia (severe infectious and allergic disease caused by infection
generalization) in flagrant violation of the rules of asepsis.
5. Using a syringe dispensers.
Currently, the hospital for intravenous administration of drugs often used,
electronic, automatic dispensers. These devices are used for accurate dosing and
prolonged administration of drugs in the established program, such as hospital
wards and patients during transport. The device controls the infusion parameters:
the infusion is carried out with a given size and speed. At any time, you can change
the parameters of administration: bolus or titration. The dispenser is equipped with
a memory for documentation of data, a pressure sensor for monitoring the
occlusion system, battery-powered, built-in fastening system at the front.
Additionally dispenser provides signaling the end of drug administration or
emergency. All data are visualized on a color LCD display, can be transferred to a
computer. Disposable syringes of 5, 10, 20 ml can be used in the system.
Syringe dispenser
6. Technique of blood sampling from a vein.
In recent decades, for the abstraction of both venous and capillary blood
often use disposable vacuum system (Vacutainer). Using these systems makes it
possible to avoid some complications (contact with blood, blood clotting in the
needle), as well as the use of the necessary an anticoagulant to calculate the
number, pick up the desired blood volumes in the shortest amount of time without
re-insertion of the needle into the vein.
The vacuum system consists of three components: a needle, needle holder
and vacuum tube with lid. These tubes do not break during transportation,
centrifugation, do not open spontaneously. When you work with them on modern
analyzers without having to open them up and pour the biomaterial.
Goal:
1. To ensure the maximum safety of medical personnel during a blood
collection procedure.
2. Ability to collect blood in a tube 2 and in a short time and without reinsertion of the needle into the vein.
3. To ensure compliance with maximum accuracy ratio blood anticoagulant.
4. Ability to use the tubes without opening the lid during centrifugation.
The vacuum system (Vacutainer)
Contraindications.
- Skin lesions and subcutaneous fat in the proposed injection site.
- Phlebitis (inflammation) punctured veins.
Injection site.
- Superficial veins of the elbow, forearm, hand.
- Superficial veins stop.
- Superficial veins of the cranial vault (in children).
Material support.
- Sterile wipes, balls;
- Antiseptic for hand washing;
- gloves
- Rubber band or cuff with Velcro.
- Cloth (on the area of a tourniquet with no clothes).
- Oilcloth pillow.
- A one-time holder Vacutainer;
- 2-way EME sterile needle with Vacutainer safety valve;
- Sterile tubes Vacutainer;
- Container transport tubes;
- Container for sharps disposal.
Preparation and execution sequence.
1. Wash your hands with liquid soap under running water and carry out
hygienic hand antisepsis by European standards, wear gloves.
2. Prepare all the necessary equipment, select the system for blood sampling.
3. Check the tightness of the package and the shelf life of the main
components of blood collection.
4. Deal with gloved hands with disinfectant.
5. Open the package.
6. Take the needle and remove the protective cap from the side, closed with a
rubber membrane.
Removing
the
protective
cap
from
the
needle
7.
Insert the needle into the holder and tighten until it stops.
8.
Screwing the needle into the holder.
9.
Prepare all necessary tubes.
10.
Ask the patient to lie down or sit down so that Vienna was well
punctured available.
11.
Under the patient's elbow enclose oilcloth pad (for a maximum
extension of the limb in the joint).
12.
On the arm above the site of the proposed venipuncture, apply a
tourniquet.
13.
Palpate the vein in the elbow, located closest to the surface of the skin.
14.
Ask the patient several times to compress and unclench his fist (for
better vein blood filling). Massage vein from the bottom up. Ask the patient to
make a fist.
15.
Deal with gloved hands with disinfectant.
16.
Take three balls sterile and antiseptic soak them in an amount of 3 ml
("Septotsid-Synergy").
17.
Treat the injection movements from the bottom up one ball wide for
30 seconds, the second - narrowly.
18.
Take a set of needle-holder in his right hand, remove the protective
cap from the needle.
19.
The thumb of the left hand pull the skin down, below the puncture site
2-3 cm, fix the vein.
20.
Without changing the position of the holder in the left hand, pierce
the skin, keeping the system almost parallel to the skin, gently insert the needle to
1/3 length, parallel to the vein.
21.
Continuing with his left hand to capture the vein, slightly change the
direction of the needle and gently puncture the vein, advance the needle along the
vein. It must be a feeling of falling into the "void."
vein puncture
22.
Make sure that the needle is in the vein, the needle holder to attach the
tube system (insert the tube into the holder up to the stop), the in vitro blood
should appear.
Joining
tubes
for
blood
sampling
23. Left-handed Loose harness, ask the patient to unclench his fist.
24. Remove the tube from the holder, if it contains an anticoagulant blood
sample mix gently, turning vakutayner 10 times After the cessation of blood flow.
If necessary, the other holder can be inserted into the tubes necessary to
obtain the desired volume for blood research.
25. Gently push the injection site three cotton ball soaked in antiseptic
solution, quick motion, remove the complex-holder needle from a vein.
26. In place of the venipuncture, apply dry sterile swab, fix its bactericidal
plaster.
27. Vakutayner Label (an individual number for each blood sample).
28. The used needle holders and balls to clear the special puncture-proof
disposable containers (bags of thick wrapping paper, paper bags) for the
subsequent disinfection and possible recycling.
29. Wash hands, dry them.
Complications
- Hematoma (bleeding under the skin) with the inept vein puncture.
- Spasm vein during puncture.
- Thrombophlebitis (with frequent venipuncture same vein using blunt or
needle).
- Damage to the nerve trunks at the wrong choice of the site of administration
of the drug, close to the nerve.
- Air embolism in violation of art intravenous administration.
- Sepsis.
7. Features of the entering of oil solutions and bitsillin.
The sequence of execution.
1. Wash your hands, dry, put on gloves.
2. Deal with gloved hands disinfectants ("Perosan" or others.).
3. Prepare the ampoule or vial of the drug to work, if the medicinal oil
solution, the pre-heat it in a water bath to 38 ° C temperature.
4. Assemble a sterile syringe, attach the needle to set drug.
5. Type in a syringe drug (dosage according to the doctor's prescription).
6. Change the needle for injection, bleed, check the patency of the needle
without removing the cap from the disposable needle.
7. Deal with gloved hands disinfectants ("Perosan" or others.).
8. Ask the patient to sit or lie down.
9. Take 3 sterile cotton ball moistened skin antiseptic. Treat the injection well
initially, then narrowly.
10. Enter the medicament subcutaneously or intramuscularly (depending on
the application), pushing the plunger with the thumb of the left hand. With the
introduction of oily solutions, suspensions bitsillina and check that the needle does
not hit a blood vessel, slightly pulling the piston itself. If there was a syringe blood,
change the needle position, put it up and away again check where the needle. After
confirming that the needle is not in the vessel, type drug.
11. With a quick movement, remove the needle, attach to the place of the
third injection, a cotton ball soaked in antiseptic skin, perform a light massage of
the injection site without taking a cotton ball on the skin.
12. Put the balls used syringe and needle in a puncture-resistant disposable
container (bags of thick wrapping paper, paper bags).
13. Wash hands, dry them.
8. Rules of disinfection disposable syringes and systems for intravenous drip
infusion.
After use, disposable syringes, intravenous systems undergo decontamination
solutions and recycling. The procedure for disinfecting products and medical
supplies for single use are regulated by instructions and guidelines of the Ministry
of Health of Belarus.
After the manipulation, used syringes, disposable systems and other tools, as
well as dressing material (cotton balls, swabs) without prior decontamination
discharged into disposable containers. Often the collection and further
decontamination of used tools and the dressing is carried out using special
sterilization of metal boxes (NIRS), which are pre-inside are lined with wrapping
paper to prevent adhesion to the walls. Collection of sharps (needles, pens, etc..) Is
carried out separately from other waste types in a special puncture-proof container
(container) disposable. All material collected in bags or delivered in the autoclave
Bix (SSC), which is subjected to disinfection in a steam sterilizer (autoclave) in
sterilization mode 2 atmosphere, + 132 ° C, 20 minutes.
This procedure of disinfection products for single use completely prevents the
possibility of infection pathogens personnel bacterial and viral infections.
After disinfection caked mass is removed in the waste with subsequent
removal and disposal in landfills of municipal solid waste. It should be noted that
at present the desired full utilization of used equipment. Decontaminated autoclave
disposable syringes should be sent to reprocessing plants polymeric materials for
re-use in production.
4. LITERATURE
Main literature
1. Zalikina, LS Nursing: the textbook / LS Zalikina. - M .: OOO "Medical
News Agency", 2008. - 201 p.
2. Fundamentals of nursing: Ouch. Benefit / LV Roman'kov [et al.]. - Minsk:
Elaida, 2012. - 200 p.
3. Basics of therapeutic care patients: Ouch. Benefit / KN Sokolov [et al.]. Grodno, 2016. - 252 p.
Additional literature
4. Pocket Guide nurse. "Medicine for you" series. / OV Chernoff [et al.] Rostov n / D .: Phoenix, 2010. - 672 p.
5. Mendzheritsky, IM Directory nurse / IM Mendzheritsky. - Rostov n / D .:
Phoenix, 1997. - 640 p.
6. Obukhovets, ETC. Fundamentals of Nursing: a tutorial. / TP Obukhovets, TA
Sklyarov, OV Chernoff. - 6 th ed., Ext. and rev. - Rostov n / D .: Phoenix, 2005.
- 505 p.
7. The lecture material.
Head of the department of Internal Diseases No.1
with Endocrinology Course,
PhD, assist. of Professor
E.G. Malaeva