Depending on the aggregate state, there are solid dosage forms (tablets, pills, capsules, powders, etc.), soft (candles, creams, etc.), liquid (solutions, tinctures, decoctions) and gaseous (aerosols). Drugs can be administered through the digestive tract (enterally) or bypassing it (parenterally) in the form of injections (subcutaneous, intramuscular, intravenous), applying them to the skin or mucous membranes, inhalation and some other methods (vaginal, urethral administration, etc.). However, in practice, parenteral administration of substances is often considered consisting of injections or infusions, whereas dermal, inhalation and other methods of non-injectable parenteral administration of drugs are considered to be independent ways of the administration. Intravenous administration of the substance requires compliance with the strictest rules of asepsis and antiseptics, a certain skill in the technique of performing manipulation, as well as knowledge of possible complications and the ability to quickly provide the necessary appropriate assistance in case of their occurrence. Asepsis is provided by sterilization or the use of disposable syringes, needles, cotton swabs or gauze napkins.
During intravenous injection, various complications can occur, the most frequent of them are: injection of a solution into subcutaneous fat due to the migration of the needle end past the vein, or its puncture, or due to simple non-falling into the vein, resulting in infiltrates or hematomas that tend to abscess, or phlegmon may form; the development of thrombophlebitis (a chemical one as well, which is frequently the case on administration of psychostimulants or synthetic substances since chemical damage to the vein in this case occurs in 100% of cases, however, the clinical presentation of phlebitis may be latent and spontaneously self-resolve, either infectious phlebitis due to the ingress of an infectious agent, or mechanical phlebitis due to extensive injuries of the vein as a result of repeated needle damage) or thrombosis of local and main veins; various types of embolisms, including air, thrombotic; pyrogenic reaction (frequently occurs on administration of psychostimulants, euphoretics, a large number of infectious agents or with pronounced immune activity on agents); infection with viral hepatitis (when infectious biological fluid comes into contact with human blood or mucous membrane, which often happens when using the same components for intravenous injection); nerve damage when a needle enters it, causing sensitivity disorders; vein spasm. It is recommended to use a large dilution titer, which involves a dose of the substance diluted in 2-3 ml of water for injection. The lower the concentration of the solution, the safer it is, since a high concentration of the solution irritates the walls of the veins, leads to more severe consequences of the development of infiltration during "blowouts" and increases the risk of developing a post-injection abscess or phlebitis. The blood in highly concentrated solutions coagulates and blocks the administration of the substance and leads to dangerous complications. If you are using in a group of people, it is prohibited to use the same syringes, filters and vials with solution. After use, they must be utilized into a safe, inaccessible place. It is absolutely not recommended performing an injection in the same body area!
To identify the vein, it is necessary to consider a number of parameters: if it is visually visible, protrudes above the surface of the skin and contours; if it remains in the same place and is not dislocated when pulled. To perform the injection, it is necessary to direct the needle parallel to the vein at an angle of 25 degrees and carry out a "puncture" through the skin in the projection of the vein, after which a slight resistance will be felt (this will be the wall of the vein) and at the time of piercing its anterior wall, it gets into its cavity (a feeling of hollowness), to control the puncture, it is necessary to pull the piston towards yourself, after that blood should appear in solution. It is necessary to inject the solution intravenously with careful and very slow movements, controlling the appearance of infiltrates, of "blowouts" (in case of their appearance, it is necessary to remove the needle and stop the injection). After applying the tourniquet, before injection, it is necessary to lower the limb and flex 6-10 times.
For easier memorization of the basic principles of a successful injection, the acronym CAPSID should be remembered, which stands forDuring intravenous injection, various complications can occur, the most frequent of them are: injection of a solution into subcutaneous fat due to the migration of the needle end past the vein, or its puncture, or due to simple non-falling into the vein, resulting in infiltrates or hematomas that tend to abscess, or phlegmon may form; the development of thrombophlebitis (a chemical one as well, which is frequently the case on administration of psychostimulants or synthetic substances since chemical damage to the vein in this case occurs in 100% of cases, however, the clinical presentation of phlebitis may be latent and spontaneously self-resolve, either infectious phlebitis due to the ingress of an infectious agent, or mechanical phlebitis due to extensive injuries of the vein as a result of repeated needle damage) or thrombosis of local and main veins; various types of embolisms, including air, thrombotic; pyrogenic reaction (frequently occurs on administration of psychostimulants, euphoretics, a large number of infectious agents or with pronounced immune activity on agents); infection with viral hepatitis (when infectious biological fluid comes into contact with human blood or mucous membrane, which often happens when using the same components for intravenous injection); nerve damage when a needle enters it, causing sensitivity disorders; vein spasm. It is recommended to use a large dilution titer, which involves a dose of the substance diluted in 2-3 ml of water for injection. The lower the concentration of the solution, the safer it is, since a high concentration of the solution irritates the walls of the veins, leads to more severe consequences of the development of infiltration during "blowouts" and increases the risk of developing a post-injection abscess or phlebitis. The blood in highly concentrated solutions coagulates and blocks the administration of the substance and leads to dangerous complications. If you are using in a group of people, it is prohibited to use the same syringes, filters and vials with solution. After use, they must be utilized into a safe, inaccessible place. It is absolutely not recommended performing an injection in the same body area!
To identify the vein, it is necessary to consider a number of parameters: if it is visually visible, protrudes above the surface of the skin and contours; if it remains in the same place and is not dislocated when pulled. To perform the injection, it is necessary to direct the needle parallel to the vein at an angle of 25 degrees and carry out a "puncture" through the skin in the projection of the vein, after which a slight resistance will be felt (this will be the wall of the vein) and at the time of piercing its anterior wall, it gets into its cavity (a feeling of hollowness), to control the puncture, it is necessary to pull the piston towards yourself, after that blood should appear in solution. It is necessary to inject the solution intravenously with careful and very slow movements, controlling the appearance of infiltrates, of "blowouts" (in case of their appearance, it is necessary to remove the needle and stop the injection). After applying the tourniquet, before injection, it is necessary to lower the limb and flex 6-10 times.
С - Concentration, which means that it is necessary to produce and control the weakly concentrated solutions with a large dilution of the substance in water for injection, which reduces the risk of local inflammation in the vein and helps titrate doses for the desired effect and control of side effects.
A - Air and Antiseptic, which means that it is necessary to control and detect bubbles of air in the syringe and get rid of them by expulsion from the syringe and cannula; as well as absolute and unconditional compliance with the rules of asepsis and antiseptics.
P - Prevention, which means that it is necessary to comply with basic preventive measures that will improve the condition of the veins and prevent post-injection complications. Prevention includes compliance with the injection algorithm, the safety of using all materials and the use (local and systemic) of special preventive pharmacological therapy for veins.
S - Sterility, the use of disposable and sterile materials and instruments for intravenous injection.
I - Individuality, this word means the exclusive and unconditional individual use of materials and tools for intravenous injection (use for yourself and only for yourself!).
D - Disposal, implies mandatory and safe disposal of all materials and tools for safe injection in such a way that no one can use them or injure themselves (for example, with used needles).
Before intravenous injection, it is necessary to prepare the appropriate equipment: two disposable syringes with a volume of 2 ml (it is strictly not recommended to use insulin syringes or a volume of more than 2 ml, one syringe should be used for solution preparation and filtration, and the other syringe with a needle should be used for direct intravenous injection, a disposable sterile vessel for solution preparation, napkins with alcohol, a sterile solution of water for injection or a saline solution of 0.9% sodium chloride; a rubber tourniquet, sterile material for filtration.
For intravenous injection, the following algorithm must be strictly complied with:
1. Wash your hands thoroughly twice with antibacterial soap from the fingertips to the place that is located above the elbow bend by 10 cm.A - Air and Antiseptic, which means that it is necessary to control and detect bubbles of air in the syringe and get rid of them by expulsion from the syringe and cannula; as well as absolute and unconditional compliance with the rules of asepsis and antiseptics.
P - Prevention, which means that it is necessary to comply with basic preventive measures that will improve the condition of the veins and prevent post-injection complications. Prevention includes compliance with the injection algorithm, the safety of using all materials and the use (local and systemic) of special preventive pharmacological therapy for veins.
S - Sterility, the use of disposable and sterile materials and instruments for intravenous injection.
I - Individuality, this word means the exclusive and unconditional individual use of materials and tools for intravenous injection (use for yourself and only for yourself!).
D - Disposal, implies mandatory and safe disposal of all materials and tools for safe injection in such a way that no one can use them or injure themselves (for example, with used needles).
Before intravenous injection, it is necessary to prepare the appropriate equipment: two disposable syringes with a volume of 2 ml (it is strictly not recommended to use insulin syringes or a volume of more than 2 ml, one syringe should be used for solution preparation and filtration, and the other syringe with a needle should be used for direct intravenous injection, a disposable sterile vessel for solution preparation, napkins with alcohol, a sterile solution of water for injection or a saline solution of 0.9% sodium chloride; a rubber tourniquet, sterile material for filtration.
For intravenous injection, the following algorithm must be strictly complied with:
2. Weigh the required amount of the injected substance, pour it into a sterile vial or vessel (with dense glazing and a volume of 5 ml) to prepare the solution, fill the syringe with water for injection in a volume of 3 ml.
3. Mix the injection water and the suspended substance in a sterile vessel.
4. Mix for two minutes (by shaking the closed bottle in different directions) until the substance is completely dissolved with no sediment (although precipitation often forms).
5. It is advisable to bring this substance to a boiling point by gently heating it over an open flame until "bubbles" appear on the bottom (provided that the bottle is closed). Wait for the glass bottle and the solution to cool completely to room temperature.
6. Put a sterile filter in the bottle, even if the prepared solution has a light color and has no precipitation.
7. Collect the filtered solution into the syringe through placing the needle in the filter.
8. Change the needle in the syringe to a new, unused, sterile one.
9. Wash your hands with disinfectant soap, treat your hands (back and palm surfaces of the hands) with alcohol wipes twice.
10. Lay the upper limb on the table, put a roller for convenience.
11. Identify the necessary vein for injection (it is recommended to use a smoking vein).
12. Apply a tourniquet to the shoulder.
13. Treat the injection site from the center to the periphery twice with sterile alcohol disposable wipes.
14. Make sure the positioning of a new, sterile, unused needle is correct and make sure there is no precipitation and air in the syringe.
15. Perform an injection with the orientation of the needle at an angle of 25 degrees, with the control of intravenous localization of the needle by pulling the piston and identifying retrograde blood flow. Loosen the tourniquet after ensuring the insertion of the needle into the vein and very slowly inject the solution into the vein, visually and tactilely monitoring the administration and the presence or absence of infiltrates of "blowouts" (in case of infiltration, remove the needle and stop the injection).
16. After removing the needle from the vein, attach a disposable sterile alcohol napkin to the injection site and press firmly for a few minutes. If the injection was carried out in the area of the elbow bend, then it is possible to bend the arm in the elbow joint together with a sterile alcohol napkin.
17. Dispose of all used materials and tools safely to a safe place.
In case of the following symptoms after intravenous injection of the substance, or during the period after, even after a few days, it is necessary to seek out medical help: an increase in body temperature to 39 degrees Celsius or continuous fever, impaired consciousness up to coma, delirium, intense hallucinations with psychosis, pronounced and painful redness of the injection site, the presence of painful infiltration, the appearance of a dense painful string in the projection of the vein, numbness and impaired sensitivity in the limb where the injection was performed, the appearance of an extensive hematoma of this area, swelling of the limb.
The algorithm of vein care recommended with intravenous use of psychoactive substances:
1. Exclude fatty and fried foods, mandatory compliance with the diet.The algorithm of vein care recommended with intravenous use of psychoactive substances:
2. Exclude hypothermia and overheating (including baths and saunas), limit physical activity.
3. The algorithm listed below is not a treatment for phlebitis and venous thrombosis, and is relevant only as preventive therapy.
4. Use heparin-based ointments with venotonizing and venoprotective effects: apply about 3 cm of gel or ointment on the injection site and the surrounding area; rub over the entire diameter and spread a little to the healthy areas. Perform this procedure once a day for 7-10 days.
5. Alternate heparin-based creams and troxerutin-based creams, while not rubbing the latter, but keeping a layer of a cream of about 1-2 mm and carrying out the procedure for 14 days.
6. Flavonoid preparations in tablet form, for example "diosmin", "hesperidin" at a dose of 500 mg twice a day 30 minutes after meals, for two months.
7. Tablet form of pentoxifylline 400 mg once a day, in the morning, for 14 days.
8. Phlogenzym wobenzym 2 tablets three times a day with meals for 1 month.
Compliance with these recommendations is necessary for people, using psychoactive substances by intravenous administration for long-term period. These recommendations are preventative measures of various complications (including venous thromboembolic complications). In case of redness, pain, lumps, an increase in local temperature in the injection area, an increase in body temperature, the spread of pain and changes - it is recommended to consult a doctor in person. If intravenous use is carried out by injection into the veins of the lower extremities, it is recommended to use medical compression knitwear for elastic compression of the lower extremities (degree of compression II). Before using this knitwear, be sure to read the instructions (freely available). The above list of medications is a recommendation. Before use, it is necessary to consult your doctor to resolve the issue of the approval of these drugs.
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