With long-term treatment of a patient Related­ki patient can not always take advantage of Uslu­Gami nurse clinics, “ambulance” or private health care providers.

The pain may be experienced by the patient at any time, require immediate facilitate­Nia. In this situation, the patient can helploved ones. This requires a medical consultation in the appointment of painkillers­GOVERNMENTAL means (this applies to dose the injection site).

You must use disposable luer syringe. To dial into the syringe nuzh­hydrochloric dose of the drug, it is necessary to know the “price” of syringe division, ie, how much of the solution may be between the near­Chimie cylinder divisions (division, and the numbers indicate the syringe capacity in milliliters and to­Lyakh milliliters). In order to determine the “price” of the division, should be to find a sub-cone closest to the number on the syringe barrel (to­lichestvo milliliters) and divide by the number of business­Nij on the cylinder (between this number and a sub-cone). This will be the “price” of syringe division. Together with the disposable syringe and needle are often packaged for injection. Syringe for single use produced in the assembled state. Selection of the syringe for injection depends primarily on the type and amount of injection administered medical preparation­own funds.

To prepare the syringe for injection must be Opening of the packages with the side where the piston is palpable (if opaque package). Needle, packed­Naya together with a syringe, is used both to set a medicament and to perform in­projections. The sequence of actions is as follows:

• Preparation method: the drug substance odnora­zovy syringe, a vial with alcohol, cotton wool;
• Wash the hands;
• check the date of sterilization indicated on the package, and sealing;
• open (break) a packet with that side where the piston, and use its internal sterile surface during assembly of the syringe;
• take the syringe (it is packed in the assembled state) and enter into the cannula needle;
• fix cannula needle fingers, lapping it to a sub-cone (a needle cap);
• check the patency of the needle, releasing the WHO­spirit of the syringe (keeping the syringe needle up vertically);
• put the syringe assembled to the inner surface of the package.

A set of ampoules of solution (Figure 49.):

• read the name of the drug, dosage, expiration date;
• gently shake the vial to the entire solution was in its widest part;
• nail file to file an ampoule;
• process vial with a cotton bud moistened with alcohol (in case the needle touches the outer surface of the ampoule in the recruitment of drug­
  of funds);
• break off the end of the ampoule;
• take the right hand gun, left – to remove number­pachok the needle;
• take the second and third fingers of the left hand vial was prepared with the drug substance;
• keep the vial at chest level and gently introduce a needle;
• syringe intercept the first, fourth, fifth fingers of the left hand;
• dial the desired number of drug ve­exists (dialing solution, gradually raise the bottom ampoules);
• Grab piston first and second fingers of the right hand;
• let the air out of the syringe without removing the needle from the vial;
• put into a syringe pack and two cotton balls,
  soaked 70-degree alcohol.

Due to the fact that the subcutaneous fat layer ho­Rosho equipped with blood vessels for more rapid action of the drug Prima­nyayutsya subcutaneous injection. Usually they make them to a depth of 15 mm needle with 20 mm length, cross section­of – 0.4 mm. Administered subcutaneously solutions – up to 3 ml of drugs that are quickly absorbed in the loose subcutaneous tissue and does not turn out to­vayut her harmful actions.

it is necessary during the subcutaneous injections of­run around the neighborhood of the large vessels and nerve GUSTs­fishing. The most convenient sites for injection are the outer surface of the shoulder region of the forearm or radiation, subscapular space ne-rednenaruzhnaya thighs, the side surface of the abdominal wall. In these areas the skin easily trapped in the fold and there is no danger of damageblood vessels, nerves and NADK­’s staircase.

Not recommended injections:

• in places with edematous subcutaneous fatty tissue;
• in place of the seals after the previous injection.

subcutaneous injection:

• Wash the hands;
• palpated place impending injection;
• treat the injection site with a cotton swab successively two initially – a large area, then – directly to the injection site;

take the third ball soaked in alcohol, and under­to lay down under the fifth finger of the left hand;

• take the right hand of the syringe (second finger pra­howl hand to hold the needle cannula, 5th finger syringe -porshen, 3 – 4th fingers holding cylinder
  bottom, first finger keeps the cylinder from above);
• remove the cap from the needle with his left hand;
• collect the left hand in the skin fold of a triangular shape, with the base downwards (see Fig..);
• introduce the needle into rapid motion base of the triangle at an angle of 45 ° to a depth of 1 – 2 cm between the first and second fingers of the left hand.

Note: If the syringe has a small air bubble, the drug should be administered slowly and do not let all the solution under the skin, and leave a small amount together with air bubbles in the syringe.

• move the left hand to the piston, the cylinder base 2 capture – third fingers (5th right thumb away from the piston);
• press the first finger of his left hand on the far­shen;
• enter the drug;
• remove the first finger of his left hand with the piston.

Note: shift the syringe during injection with the right hand to the left – you can not!

• press the left hand, a sterile cotton wool moistened­hydrochloric alcohol at the injection site;
• remove the needle right hand while continuing to hold it for the cannula;
• make a gentle massage of the injection site, not from­Nimai wool from the skin;
• Put the needle on the syringe cap, throw in the dirt tank.

Intramuscular injection – most widespread­roubleshooting may be performed in the field ple­ca, thighs, buttocks.

Muscles have an extensive network of blood vessels, so the conditions for rapid and complete absorption of medication and receive treatment­matic effect in a short period Vreme­no.

For intramuscular injections are Luer syringes with needles thickness of 0.8 -. 1.5 mm and a length of 8-10 cm needle length depends on the stratum­us subcutaneous tissue layer, so how necessary­Mo, when administered to the needle passed, and the subcutaneous fat layer was thicker in the muscle. TSBs­dit intramuscularly from 5 to 10 ml medication­GOVERNMENTAL funds.

The most convenient place for intramuscular injection is the gluteal region, but, as there are large sciatic nerve and shelter­-bearing vessels, injection should produce roofing felt­to in verhnenaruzhnogo quadrant. quadrant defined­lyayut mentally dividing the buttock into 4 parts.

Set the drug from a vial:

• cook disposable syringe, drugs­Noe means wool vial with 70-degree alcohol;
• Wash the hands;
• read the label on the bottle;
• open the lid covering the rubber stopper;
• wipe the rubber stopper 70 gradysnym Speer­Tom;
• insert the needle at an angle of 90 ° in the rubber stopper of the bottle standing on the table (left hand holding the bottle, right hand by introducing the syringe needle into the
  bottle);
• flip vial upside down;
• pinch them 2-3 fingers of the left hand vial;
• transfer I-IV-V fingers of the left hand on the syringe;
• take the right hand of the syringe plunger;
• dial in the right amount of medical preparation syringe­GOVERNMENTAL solution, pulling the plunger downward;
• remove the needle from the vial;
• bleed air from the syringe;
• Change needle and put on the protection cap;
• packed in a disposable syringe and three cotton balls soaked in 70-degree alcohol

Procedure for vnutrimy­antiplaque injection:

• help the patient to take a comfortable position (on your stomach or on the side);
• determine the location of injection;
• palpated place impending injection;
• Wash the hands;
• treat the injection site two series cotton swab, first – a large area ofthe – directly injection site;
• take the right hand syringe (fifth finger putneedle cannula, the second finger – the plunger 1-3-4-th fingers – in the syringe barrel), remove the protective cap from the needle;
• stretch and secure the 1-2-th finger-le­howl hands skin at the injection site;
• insert the needle into the muscle, leaving 2-3 mm of the needle from the skin;
• remove the fifth finger of the right hand with a syringe plunger;
• shift the left hand on the piston, taking 2-3 im finger syringe barrel, the first finger pressure on the plunger of the syringe;
• enter the drug;
• press the left hand, the skin at the injection site with a cotton ball soaked in 70-degree alcohol;
• remove the needle right hand;
• make a gentle massage of the injection site, not from­imaya wool from the skin.

Remember! Vial of oil solution before­preliminarily should be warmed in a water bath to a temperature of 38 ° C, and only then introduce les­a medicament.

When the subcutaneous and intramuscular injection is necessary to observe the rules of asepsis:

• Wash hands with soap and water, doubly lathering;
• during assembly of the disposable syringe does not touch­Xia fingers syringe to the cannula when attaching thereto needle;
• Typesetting when the drug from am­pools or bottle they must handle bi­Multiples cotton swab dipped in 70-degree­nym alcohol;
• before the injection should be treated twice with injection site with a cotton swab moistened­GOVERNMENTAL 70-degree alcohol.

In case of violation of the rules of the patient at the injection site formed abscess – purulent inflammation of soft tissue to form a cavity filled with pus and demarcated from surrounding tissue meme­brane. The patient complains of pain and swelling at the injection site. Visually, – redness of the skin in the IU­ste injection, tenderness, povy­temperature rise at the injection site, sometimes povy­shenie patient’s body temperature. This complication requires surgical intervention.

When performing a blunt needle injection.

• When using a short needle (for under­cutaneous injection) when the vnutrimyshech­hydrochloric injection drug thus introduced causes strong chemical stimulation of tissue, prolonged absorption.
• Inaccurate range of injection sites, frequent in­projections in the same place.
• The introduction of drugs into the pack places­lotneniya after the previous injection. All these at­grades collectively lead to the formation yn­
  

Infiltrate characterized by the formation of seals at the injection site, which is easily determined by palpation (palpation). The patient at the same time feels pain at the injection site, complained that it hurt to lie on his back because of the pain in the buttock.

For the treatment of the patient is recommended infiltrate­compress dissolved using 25 percent sul­magnesium veil or 45-degree ethanol. It can cause a 5 percent solution of iodine in the form

mesh in place of infiltration, dry heat of 15 mi­chickpeas (warmer – if allows the physician).

Needle breakage. The reason for this complication may be a sharp contraction of the muscles buttocks during intramuscular injection. It can pro­radiate, if it was not carried out with the patient psycho­preventive conversation before the injection, the patient is afraid of you entrust the implementation of this manipulation, or when the injection is made patsien­the standing.

Help with this complication:

• Reassure the patient and calm yourself;
• if the patient is standing, put him on his stomach, if was in a prone position – ask him not to move;
• strongly breech pin in the injection site 1- second fingers of his left hand;
• when a needle tip grab its Pintsi­is gripped in his right hand (repeated several times);
• consult a doctor if this manipulation to extract needles you failed.

Damage to the nerve trunks intramuscular injections are the choice at the wrong­D injection site or chemically – when medical preparation­own funds is close to the nerve. pas­cient complains of pain not only in the place inj­tion, but also in the entire lower extremity. Pain is not about­walking for a few days.

Help with this complication:

• dry heat (heating pad) for a few days to 15 minutes (if the patient’s state of health is doctor appoints).

Hot compress.

Hot compress is a long race­extension of the blood vessels, which leads to Uwe­lichenie blood flow not only to the skin, but also to the deeper located tissues. This is achieved by resolving and analgesic effect kompres­sa (Fig. 55).

Remember! Hot compress should not be at­change at high temperature, in violation of the integrity of the skin.

Upon application of a compress on the upper finite­Nosta you must:

• prepare: vial with a 45-degree alcohol or ampoule 25 percent solution mage sulfate­Niya, gauze compress paper, cotton wool, bandages, capacity;
• Wash the hands;
• fold gauze in the 6 – 8 layers;
• Moisten with a 45-degree alcohol capacitance at­gotovlennuyu gauze;
• attach soaked cloth in place in­projections;
• Place a cloth compress boom­gu larger (on paper should be greater than 2 cm gauze from all directions);
• put on top of paper layer of cotton wool compress, completely covering the two preceding layers (wool should be 2 cm longer compress the paper, so
  it will retain the heat generated by compression);
• secure a compress bandage so that it fits close to the course, but not displeased motion­Nij;
• leave a compress on the b – 8 hours (preferably overnight);
• Wash the hands;
• check the degree of humidity lower napkin at 1.5 – 2 hours after blending;
• Wash the hands;
• compress stay at 6 – 8 hours;
• wipe the skin dry;
• apply dry dressing;
• Wash the hands.

Note: drugs Apply­emye to compress can cause irritation, therefore, before you put a compress, skin lubricate with vaseline oil.

Alcohol compresses dry quickly, for­that they need to be replaced every 4 – 6 hours.

should not apply the compress to the skin, sma­zannuyu iodine – this can cause deep burns.

In the formation of infiltration in Iago­ditsy after intramuscular injection rec­sulking apply a compress and fix it lei­koplastyrem.

• Preparation method: B – 8-layer gauze compress paper, cotton wool, bandages, adhesive tape;
• Wash the hands;
• to moisten the tissue in the container 4 5 degree alcohol;
• wring out and attach to seal a place in an­domain buttocks;
• put a napkin on top compress paper 2 cm longer gauze;
• put on top of paper layer of cotton wool compress to 2 cm longer compress paper completely on­kryvayuschy two preceding layers;
• Place a compress bandage segment, with­kryv their wool, and secure on all four sides with a plaster;
• wear underwear, if the patient can DWI­gatsya;
• Wash the hands;
• check the degree of humidity lower napkin at 1.5 – 2 hours after overlay, opening one of the corners of the dressing;
• Wash the hands;
• compress stay at 6 – 8 hours;
• wipe dry the skin at the site of the complex overlay­Ress;
• Wash the hands.

Cold compress.

A cold compress is applied with strong bo­Lyakh when bleeding at high temperature (above 39 ° C). It causes a cooling of the skin and su­voltage of blood vessels. When applying cold­Foot compress caring for a patient not dollars­wives absent as napkins change should be carried out every 2 – 3 minutes. Duration­telnost procedure – from 5 to 60 minutes.

Prepare: a container of cold water temperature 14 – 16 ° C (cooled in a refrigerator), 2 sal­fetki:

• to moisten the tissue in cold water;
• squeeze water;
• to fold a napkin in several layers;
• put a napkin on the surface of the skin;
• moisten the tissue in a second container with cold
  water;
• squeeze water;
• to fold a napkin in several layers;
• replace the first sheet (if it is hot)

Note: press the cloth is better that it is not leaking from the water on the pillow or the bed of the patient.

Bubble with ice.

For a more profound impact on blood vessels, organs­us and tissue pain, bleeding, apply pu­zyr with ice. Action due to the dry cold vasoconstriction, as well as reducing­em sensitivity of nerve receptors. Prepare: bubble ice, an ice container, a container of water temperature 14 – 16 ° C:

• place ice packs on the smooth top­Nosta and screw the lid;
• bubble wrap cloth and place it on the patient’s body;

Drain water from the bladder to the extent of melting;

add ice cubes in a bubble.

Note: if there is no bubble for ice, you can prepare two plastic bags, putting one into the other. Fill the bags with ice, lay on a flat surface. Crushing pack Lado­New, release him from the air, tie tightly, the chief­Nita cloth and use it as an ice pack. As the ice melts change packages. Ice packs keep a long time. Every 20 – 30 minutes is necessary to remove the bladder or bag with ice for 10 – 15 minutes.

Modern aseptic offers a range of disinfectants in the care of the patient. a new generation of disinfectants lay­ki in the preparation and effective in the treatment of subjects and care facilities. These dezinfitsi­ruyuschie means no harmful effects on the patient.

Efforts table for preparation of working solutions and application of different concentrations of disinfectants for the treatment of medical supplies and patient care.

• The room in which the tyazhelobol­Noah must be processed twice: in the morning, with at­Menenius sanitizing solution evening – using a 2 percent solution of soda. Afterprocessing hold ventilation of the room, before­preliminarily concealing patient.
• Cloth, which cleaning is carried out morning should be soaked for a time corresponding to the selected disinfectant. Cloth, rinse under running water and dry. Ra­target pour.

care items placed in specially vyde­fief enamel bowl and pour one of the solutions proposed in the time-dependent
concentration of disinfectant. When the time to rinse items under the pro­exact water, dried and placed on BEDSIDE­hydrochloric nightstand in the patient’s room. The solution was poured.

• Utensils for eating desirable dezinfitsi­Rowan by boiling a 2 percent soda solution for 15 minutes after boiling.
  Then rinse under running water and dried. Sideboard stands enameled container.
• Linen, stained vomit, Feka­liyami, you must fill in the tank for a while, depending on the concentration dezinfitsi­ruyuschego means, then – washing and drying laundry.

Disinfectant of new generation facilities

Disinfectants “Virkon”, “Saint-bik” – it’s super funds have viruletsidnymi, bactericidal, fungicidal action. apply:

• for disinfection of medical desig­cheniya of metal, rubber, glass, plastic;
• for disinfection of premises;
• for the treatment of hands of the surgeon and the operating honey­

Means “Septodor”It represents colorless­ny transparent liquid concentrate with a weak spe­Graphical odor. Shelf life of the concentrate when it isstored in closed manufacturer’s packaging structure­I wish to set up 5 years. The product has good detergentproperties, has no corrosive action.

Precautionary measures:

1. Preparation of working solutions means “Septodor” and all work carried out with them in cramps of new gloves.
2. Surface treatment may be carried out in the presence of the patient.
3. For all work to avoid falling into the eye and the skin.
4. When working with the need to observe good personal hygiene. Upon completion of work wash hands and face with soap and water.
5. Means should be stored separately from the medical preparation­governmental agents in locations not accessible to children.