Any prescription of injections signifies the seriousness of the situation and the complexity of the disease, however, children have to be given injections quite often. There are many reasons for this, one of which is complications after the disease. In inpatient treatment, injections are common practice, but it happens that the child can stay at home if it is possible to give him an injection. In addition, injections can relieve acute conditions, including extremely high temperatures.

Injections for children: how to do it yourself

Photo by Shutterstock

Types of injections

Injections are given not only in the butt - depending on the purpose and method of administration, intravenous, intramuscular, and subcutaneous injections are distinguished. Subcutaneous medications are administered when there is no need to achieve an immediate effect or when it is necessary for the drug to act for a long time. For example, this is how most childhood vaccinations are done.

Intravenous administration of the drug is carried out when an immediate effect of the substance is required

This injection requires strict adherence to the rules of implementation, it is technically complex, therefore intravenous injection and placement of a drip is the responsibility of a medical professional exclusively.

Another thing is intramuscular injection. This is the method used to carry out the vast majority of injections. There are several favorable places for intramuscular injections: thigh, buttocks, shoulder. Preference is given to the buttocks.

How to give an intramuscular injection to a child

When injecting a child yourself, it is important to know where to inject and to strictly follow the sequence of actions during the manipulation.

You will need:

• ampoule with medicine
• injection syringe
• sterile cotton wool
• alcohol

Choose a syringe with the thinnest possible needle, which will make the injection less painful. Wash your hands thoroughly with soap and dry them with a sterile cloth. Using massage movements, knead the baby's buttock.

Open the bottle of medicine using cotton wool soaked in alcohol and open a disposable injection syringe. Make sure that the syringe plunger is lowered all the way, that is, there is no air in it. Draw the medicine into the syringe in a slightly larger quantity than necessary. Holding the syringe vertically, with the needle up, release the air that has formed inside the syringe and the excess amount of the drug.

In children's hospitals or departments, the procedure for providing medications to the patient is clearly regulated. It consists of several successive stages: 1) the doctor prescribes the necessary medications to the patient; 2) a doctor’s entry into the medical history and into the list of medical prescriptions of medications, indicating the doses and methods of their administration; 3) the guard (ward) nurse draws up a request for the necessary medications and transfers it to the senior nurse of the department; 4) formation general requirement in the department, the head nurse sends him to the pharmacy and receives the appropriate medications; 5) receipt of medicines by the guard (ward) nurse from the head nurse; 6) delivery of medicines to the patient by the ward nurse.

There are several ways to administer drugs: internal (enteral) - through the mouth or rectum and parenteral - bypassing the gastrointestinal tract.

Technique for administering medications for internal use to children (by mouth).

Children receive medications by mouth in the form of pills, powders, capsules, solutions, emulsions, etc. The difficulty of taking medications by mouth lies in the possible negative reaction of the child, the presence of medications with an unpleasant odor or taste, and the large size of pills or dragees. It is best for children to take medications by mouth in a solution or suspension; when taking medications in dry form, they must be crushed and diluted with milk or syrup. For infants, it is better to administer the entire prescribed dose of liquid medication not immediately, but in parts, in several spoons, using caution. Before distributing medications, the nurse selects the necessary medications according to the prescription sheet, carefully reads the labels and groups the medications in the order in which they will be taken by the patient. Particular attention should be paid to the dosage of medications. Powders and drops are diluted in a small amount of sweet tea, in a spoon or a special beaker, each medicine is given separately. For a child in his first year of life, the sister presses two fingers on the cheeks, opens his mouth and carefully pours in the medicine. Devices for convenient use are added to modern medications for children: dosing measuring spoons, pipettes built into the cap, syringes.

Application under the tongue (sublingual). With this method of administration, the medicinal substance is not exposed to gastric juice and enters the systemic bloodstream through the veins of the esophagus, bypassing the liver, which eliminates its biotransformation. The drug should be kept under the tongue until completely absorbed. Sublingual use is possible only in older children

When distributing medications to older children, the nurse should personally monitor the administration of each medication.

It is strictly prohibited to delegate the distribution of medicines to other persons authorized to care for children. Technique for using suppositories for rectal administration The rectal route of administering suppositories (suppositories) is widely used in pediatric practice. It makes it possible to avoid the irritating effect of the drug on the stomach, at the same time the drug is not destroyed by gastric juice, and is also used in cases where it is impossible to administer the drug through the mouth (fainting child, vomiting, diseases of the esophagus, stomach, intestines , liver). This method of administering drugs is used to obtain local and systemic effects.

Suppositories are a dosage form that has a solid consistency at room temperature and soft consistency at body temperature. Rectal suppositories can have the shape of a cylinder, cone, cigar, their weight ranges from for children, it is necessary to indicate the dose of the active substance in 1 suppository.

Pharmacological substances that, using rectal

suppositories are introduced into the rectum, act faster than when administered through the stomach, due to absorption through the lower and middle hemorrhoidal veins and entry into the general circulation (inferior vena cava), passing through the liver. The composition of rectal suppositories used in pediatric practice includes antipyretics, painkillers, immunostimulants, agents for the prevention and treatment of viral infections, constipation in children.

Suppositories should be stored in a dry, dark place, out of reach of children, at a temperature not exceeding 27 0 C. It is prohibited to store suppositories with an open or missing protective shell.

Introduction technique: Lay an oilcloth on the changing table, couch or bed and cover it with a diaper. Wash your hands, wear rubber gloves. Place an infant on his back; over a year old - on his left side with his legs brought up to his stomach. Take the prescribed rectal suppository, remove the protective cap from it ~ With your left hand, spread the child’s buttocks, and with your right hand, carefully insert the narrow end of the suppository into the anus so that it enters behind the external sphincter of the rectum, otherwise, as a result of contraction of the sphincter muscles, the suppository will be thrown outward. After this, you need to squeeze the child's buttocks for a few minutes.In older children, this procedure is best done after a bowel movement.

Features of intramuscular, b/w, subcutaneous injections for children The parenteral route of drug administration for severe illnesses of a child remains the main route.

Remember! The type of medications, their dosage, administration intervals and type of injection (s.c., i.v., i.m.) are prescribed by the doctor! All instruments and injection solutions must be sterile!

To medicinal product has been inserted to the desired depth, the injection site, needle and angle at which the needle is inserted must be correctly selected.

The injection site should be chosen so as not to injure the periosteum, nerves and blood vessels.

Subcutaneous injections. Due to the fact that the subcutaneous fat layer is rich in blood vessels, for faster action medicinal substance Subcutaneous injections are used. When administered subcutaneously, medicinal substances act faster than when administered orally, since they are quickly absorbed into the loose subcutaneous tissue and do not have a harmful effect on it. Subcutaneous injections are performed with a needle of the smallest diameter to a depth of 15 mm and up to 2 ml of medications are administered.

Oxygen and oil solutions of medicinal substances (camphor oil solution), suspensions (long-acting forms of insulin) are injected subcutaneously. In this case, a drug depot is formed in the subcutaneous tissue, from where it is gradually absorbed into the blood. The therapeutic effect when administered subcutaneously begins faster than when administered orally, but slower than when administered into the muscle (on average after 10-30 minutes). It must be taken into account that in shock and collaptoid conditions, the absorption of drugs from the subcutaneous tissue can slow down sharply.

The most convenient sites for subcutaneous injection are:

Outer surface of the shoulder;

Subscapular space;

Anterior outer surface of the thigh, side surface abdominal wall;

Lower part of the armpit

In these places, the skin is easily caught in the fold and there is no danger of damage to blood vessels, nerves and periosteum.

Performing a subcutaneous injection:

Wash your hands (wear gloves)

Treat the injection site sequentially with two cotton balls with alcohol: first the large area, then the injection site itself;

Place the third ball of alcohol under the 5th finger of your left hand;

Take the syringe in your right hand (hold the needle cannula with the 2nd finger of your right hand, hold the syringe piston with the 5th finger, hold the cylinder from the bottom with the 3-4th fingers, and hold the top with the 1st finger);

With your left hand, grab the skin in a triangular fold, base down;

Insert the needle at an angle of 45° into the base of the skin fold to a depth of 1-2 cm (2/3 of the needle length), hold the needle cannula with your index finger;

Place your left hand on the plunger and inject the medicine (do not transfer the syringe from one hand to the other);

Attention! If there is a small air bubble in the syringe, slowly inject the medicine, leaving a small amount of it along with the air bubble in the syringe, pull the needle out, holding it by the cannula;

Press the injection site with a cotton ball and alcohol;

Intramuscular injections. Some drugs, when administered subcutaneously, cause pain and are poorly absorbed, which leads to the formation of an infiltrate. When using such drugs, and also when they want to get a faster effect, subcutaneous administration is replaced by intramuscular administration. Muscles contain a wider network of blood and lymphatic vessels, which creates conditions for rapid and complete absorption of medications. At intramuscular injection a depot is created from which the drug slowly enters the bloodstream. This maintains the required concentration of the drug in the body, which is especially important in relation to antibiotics. The intramuscular method of drug administration ensures rapid entry of the substance into the general circulation (after 10-15 minutes). The magnitude of the pharmacological effect in this case is greater and the duration is shorter than with oral administration. The volume of one intramuscular injection should not exceed 10 ml. If an oil solution or suspension is injected into a muscle, you must always make sure that the needle does not enter the vessel. To do this, pull the syringe plunger slightly towards you. If no blood appears in the syringe, the drug is administered. Substances that can cause necrosis of surrounding tissues (norepinephrine, calcium chloride) or have a significant irritant effect are not injected under the skin and into the muscle.

To perform intramuscular injections, certain areas of the body are used that contain a significant layer of muscle tissue in the absence of large vessels and nerve trunks. The length of the needle depends on the thickness of the subcutaneous fat, since the needle must pass through the subcutaneous fat and enter the thickness of the muscles. So, with an excess subcutaneous fat layer, the needle length is 60 mm, with a moderate layer - 40 mm. The most suitable places for intramuscular injections are the muscles of the buttock (only the upper-outer part!), shoulder and thigh (anterior-outer surface).

It should be remembered that accidental hit a needle into the gluteal nerve can cause partial or complete paralysis of the limb. In addition, there is a bone (sacrum) and large vessels nearby.

When performing injections in young children and malnourished patients, you should take the skin and muscle in a fold to be sure that the drug gets into the muscle.

Intramuscular injection can also be performed into the deltoid muscle. The brachial artery, veins and nerves run along the shoulder, so this area is used only when other injection sites are not available, or when multiple intramuscular injections are performed daily.

An intramuscular injection into the vastus lateralis muscle is performed in the middle third of the anterior outer surface.

Performing an intramuscular injection Determining the injection site.

A) into the muscles of the buttocks:

Place the patient on his stomach with his toes turned inward, or on his side with the leg on top should be bent at the hip and knee joints so that the gluteal muscle is in a relaxed state.

Palpate the following anatomical structures: the superior posterior iliac spine and the greater trochanter of the femur.

Draw one line perpendicularly down from the middle of the spine to the middle of the popliteal fossa, the other horizontally from the greater trochanter to the spine (the projection of the gluteal nerve runs slightly lower

horizontal line along the perpendicular)

Determine the injection site, located in the upper outer

quadrant, approximately 5-8 cm below the iliac crest.

When performing repeated injections, it is necessary to alternate the right and left sides and injection sites, which reduces the pain of the procedure and prevents complications.

B) into the vastus lateralis muscle.

Place your right hand 1-2 cm below the trochanter of the femur, your left hand 1-2 cm above the patella, the thumbs of both hands should be on the same line.

Locate the injection site, located in the center of the area formed by the index fingers and thumbs of both hands.

B) into the deltoid muscle of the shoulder:

Free the patient's shoulder and shoulder blade from clothing.

Ask the patient to relax his arm and bend it at the elbow joint.

Feel the edge of the acromion process of the scapula, which is the base of the triangle, the apex of which is in the center of the shoulder.

Determine the injection site - in the center of the triangle, approximately 2.5 - 5 cm below the acromion process. Another way to locate the injection site is to place four fingers across the deltoid muscle below the acromion process.

Help the patient take a comfortable position: when injecting the drug into the muscles of the gluteal region, lying on his stomach or side; into the thigh muscles - lying on your back with the leg slightly bent at the knee joint or sitting; into the shoulder muscles - lying or sitting; determine the injection site, wash your hands (wear gloves). The injection is carried out as follows:

Treat the injection site sequentially with two cotton balls moistened with alcohol: first a large area, then the injection site itself;

Place the third ball moistened with alcohol under the 5th finger of your left hand;

Take the syringe in your right hand (place the 5th finger on the needle cannula, the 2nd finger on the syringe plunger 4, 1st, 3rd, 4th fingers on the cylinder);

Stretch and fix the skin with the first and second fingers of your left hand.

injection site;

Insert the needle into the muscle tissue at a right angle, leaving 2-3 mm of the needle above

Place your left hand on the piston, grasping the syringe barrel with your 2nd and 3rd fingers, press the piston with your first finger and inject the drug;

Press the injection site with your left hand with a cotton ball moistened with alcohol;

Pull the needle out with your right hand;

Lightly massage the injection site without removing the cotton from the skin;

Place the cap on the disposable needle and dispose of the syringe in a container for used syringes.

Performing intravenous injections. Intravenous injections involve the introduction of a medicinal substance directly into the bloodstream. The first and indispensable condition for this method of administering drugs is strict adherence to the rules of asepsis (washing and treating hands, the patient’s skin, etc.)

For intravenous injections, the veins of the antecubital fossa are most often used, since they have a large diameter, are superficial and move relatively little, as well as the superficial veins of the hand, forearm, and, less commonly, the veins of the lower extremities.

The saphenous veins of the upper limb are the radial and ulnar saphenous veins. Both of these veins, passing along the entire surface of the upper limb, form many connections, the largest of which, the median ulnar vein, is most often used for intravenous punctures. In newborns, these injections are given into the superficial veins of the head.

The intravenous route of drug administration is used in urgent cases when it is necessary for the drug to act as quickly as possible. In this case, drugs enter the blood with the right atrium and ventricle of the heart, into the vessels of the lungs, into the left atrium and ventricle, and from there into the general circulation to all organs and tissues. Oil solutions and suspensions are never administered in this way, so as not to cause embolism in the blood vessels of vital organs - lungs, heart, brain, etc.<■

Medicines can be injected into a vein at different rates. With the “bolus” method, the entire amount of the drug, for example, cititon, is quickly administered to stimulate breathing. Often, drugs are pre-dissolved in 10-20 ml of isotonic sodium chloride or glucose solution, and then injected into a vein slowly (over 3-5 minutes). This is how strophanthin, corglycone, and digoxin are used for heart failure.

When administered intravenously by drip, the drug is first dissolved in 200-500 ml or more of an isotonic solution. In this way, oxytocin is infused to stimulate labor, ganglion blockers for controlled hypotension, and the like.

Depending on how clearly the vein is visible under the skin and palpated, three types of veins are distinguished:

1- y type - a vein with a good contour. The vein is clearly visible, clearly protrudes above the skin, and is voluminous. The side and front walls are clearly visible. Upon palpation, almost the entire circumference of the vein is determined, with the exception of the inner wall.

2- y type - a vein with a weak contour. Only the anterior wall of the vessel is clearly visible and palpable; the vein does not protrude above the skin.

3- th type - a vein without a definable contour. The vein is not visible, it can only be palpated in the depths of the subcutaneous tissue by an experienced nurse, or the vein is not visible and cannot be palpated at all.

The next indicator by which veins can be differentiated is fixation in the subcutaneous tissue (how freely the vein moves along the plane). The following options are available:

Fixed vein - the vein moves along the plane slightly, it is almost impossible to move it to a distance the width of the vessel;

Sliding vein - a vein easily moves in the subcutaneous tissue along a plane; it can be displaced to a distance greater than its diameter; the lower wall of such a vein, as a rule, is not fixed.

Based on wall thickness, the following types of veins can be distinguished.

Thick-walled vein - a vein with thick, dense walls;

Thin-walled vein - a vein with a thin wall that is prone to injury.

Using all of the listed anatomical parameters, the following clinical parameters are determined:

Fixed thick-walled vein with a clear contour; such a vein occurs in 35% of cases;

Sliding thick-walled vein with a clear contour; occurs in 14% of cases;

Thick-walled vein, with a weak contour, fixed; occurs in 21% of cases;

Sliding vein with a weak contour; occurs in 12% of cases;

Fixed vein without a definable contour; occurs in 18% of cases.

The veins most suitable for puncture are the first two clinical options. Clear contours and a thick wall make it easy to puncture the vein.

Less convenient veins are the third and fourth options, for puncture of which a thin needle is suitable. You just need to remember that when puncturing a “sliding” vein, it must be fixed with the finger of your free hand.

The veins of the fifth option are the most unfavorable for puncture. When working with such a vein, you should remember that you must first palpate it well; you cannot puncture it blindly.

One of the most common anatomical features of veins is the so-called fragility. This pathology occurs quite often. Visually and palpably, fragile veins are no different from ordinary ones. Their puncture, as a rule, also does not cause difficulties, but sometimes a hematoma appears literally before our eyes at the puncture site. All control methods show that the needle is in the vein, however, the hematoma is growing. It is believed that the following happens: the needle injures the vein, and in some cases the puncture of the vein wall corresponds to the diameter of the needle, while in others, due to anatomical features, a rupture occurs along the vein. In addition, violations of the technique of fixing the needle in the vein play an important role here. A weakly fixed needle rotates both axially and in a plane, causing additional trauma to the vessel. This complication occurs exclusively in elderly people. If such a complication is observed, then there is no point in continuing to administer the drug into this vein. Another vein should be punctured and infused, fixing the needle in the vessel. A tight bandage must be applied to the area of ​​the hematoma.

A fairly common complication is the infusion of the infusion solution into the subcutaneous tissue. Most often, this complication occurs after puncture of a vein in the elbow and insufficient fixation of the needle. When the patient moves his hand, the needle leaves the vein and the solution enters under the skin. The needle in the bend of the elbow must be fixed in at least two places, and in restless patients, the vein must be fixed throughout the limb, excluding the area of ​​the joints.

Another reason for the infusion solution to enter under the skin is a through puncture of a vein. This is more often observed when using disposable needles, which are sharper than reusable ones. In this case, the solution enters partly into the vein, partly under the skin.

It is necessary to remember one more feature of veins. When central and peripheral circulation is impaired, the veins collapse. Puncture of such a vein is very difficult. In this case, the patient should be asked to clench and unclench his fingers more vigorously and at the same time pat the skin, looking through the vein in the puncture area. As a rule, this technique more or less helps with puncture of a collapsed vein. It must be remembered that primary study on such veins is unacceptable.

Performing an intravenous injection. Prepare:

1) on a sterile tray: a syringe (10.0 - 20.0 ml) with a medicinal product and a needle 40 - 60 mm long, cotton balls;

2) tourniquet, roller, gloves; 3) 70% ethyl alcohol;

4) a tray for used ampoules and vials;

5) a container with a disinfectant solution for used cotton balls.

Sequencing:

Wash and dry your hands;

Draw up medicine;

Help the patient find a comfortable position - lying on his back or sitting;

Give the limb, eyelid, into which the injection will be carried out, the required position: the arm is in an extended state, palm up;

Place an oilcloth pad under your elbow (for maximum extension of the limb at the elbow joint);

Wash your hands, put on gloves:

Place a rubber band (on a shirt or napkin) on the middle third of the shoulder so that the free ends are directed upward and the loop is directed downward; the pulse on the radial artery should not change;

Ask the patient to work with the hand, squeezing and unclenching it in a fist (to better pump blood into the vein);

Find the appropriate vein for puncture,

Treat the skin of the elbow area with the first cotton ball with alcohol in the direction from the periphery to the center, throw it away (the skin is disinfected);

take the syringe in your right hand with your index finger and fix the cannula

needles, last to cover the cylinder from above;

Check that there is no air in the syringe; if there are a lot of bubbles in the syringe, you need to shake it, and the small bubbles will merge into one large one, which can be easily pushed through the needle into the tray;

Again, with your left hand, treat the venipuncture site with a second cotton ball moistened with alcohol, throw it into a container with disinfectant. solution;

Fix the skin in the puncture area with your left hand, stretching the skin in the elbow bend with your left hand and slightly shifting it to the periphery;

Holding the needle almost parallel to the vein, pierce the skin and carefully insert the needle 1/3 of the length with the cut up (with the patient’s hand clenched into a fist);

Continuing to fix the vein with your left hand, slightly change the direction of the needle and carefully puncture the vein until you feel “entering the void”;

Pull the plunger towards you - blood should appear in the syringe (confirmation that the needle has entered a vein);

Untie the tourniquet with your left hand by pulling one of the free ends, ask the patient to unclench his fist;

Without changing the position of the syringe, press the plunger with your left hand and slowly inject the medicinal solution, leaving 0.5 -0.2 ml in the syringe;

Apply a cotton ball moistened with alcohol to the injection site and gently pull the needle out of the vein (hematoma prevention);

Bend the patient's arm at the elbow, leave the alcohol ball in place, ask the patient to fix the arm in this position for 5 minutes (to prevent bleeding);

Dump the syringe into a disinfectant solution or cap the needle (disposable);

After 5-7 minutes, take the cotton ball from the patient and throw it into a disinfectant solution or into a bag from a disposable syringe;

Remove gloves, throw them into a disinfectant solution;

Wash your hands.

Injection complications.

Violation of aseptic rules: infiltration, abscess, sepsis, serum hepatitis, AIDS.

Wrong choice of injection site: infiltrate, poorly absorbable, damage to the periosteum (periostitis), blood vessels (necrosis, embolism), nerves (paralysis, neuritis).

Incorrect injection technique: needle breakage, air or drug embolism, allergic reactions, tissue necrosis, hematoma.

Infiltration is the most common complication after subcutaneous and intramuscular injections. Most often, infiltration occurs if:

a) the injection was performed with a blunt needle;

b) for intramuscular injection, a short needle intended for intradermal or subcutaneous injections is used.

c) the injection site was chosen incorrectly

d) frequent injections are carried out in the same place

e) the rules of asepsis are violated.

An abscess is a purulent inflammation of soft tissues with the formation of a cavity filled with pus. The reasons for the formation of abscesses are the same as for infiltration. In this case, infection of soft tissues occurs as a result of violation of asepsis rules.

Breakage of the needle during injection is possible if there is a sharp contraction of the buttock muscles during an intramuscular injection, if a preliminary conversation about behavior during the injection was not held with the patient before the injection or the injection was given to the patient in a standing position.

Drug embolism can occur when oil solutions are injected subcutaneously or intramuscularly (oil solutions are not administered intravenously!) and the needle enters the vessel. Oil, once in the artery, clogs it, and this leads to malnutrition of the surrounding tissues and their necrosis. Signs of necrosis: increased pain in the injection area, swelling, redness or red-bluish color of the skin, increased local and general temperature. If the oil ends up in a vein, it will enter the pulmonary vessels through the bloodstream. Symptoms of pulmonary embolism: a sudden attack of suffocation, cough, cyanosis of the upper half of the body, a feeling of tightness in the chest.

Air embolism during intravenous injections is the same dangerous complication as oil embolism. The signs of embolism are the same, but they appear very quickly, within a minute.

Damage to nerve trunks can occur during intramuscular and intravenous injections, mechanically (if the injection site is chosen incorrectly), or chemically when the drug depot is located next to the nerve, as well as when the vessel supplying the nerve is blocked. The severity of the complication can vary - from neuritis to limb paralysis.

Thrombophlebitis - inflammation of a vein with the formation of a blood clot - is observed with frequent venipunctures of the same vein, or with the use of blunt needles. Signs of thrombophlebitis are pain, skin hyperemia and the formation of infiltrate along the vein. The temperature may be low-grade.

Tissue necrosis can develop when a vein puncture is unsuccessful and a significant amount of an irritating agent is mistakenly introduced under the skin. Getting drugs under the skin during venipuncture is possible as a result of: piercing the vein “through and through”; failure to enter the vein during venipuncture. Most often this happens with inept intravenous administration of a 10% calcium chloride solution. If the solution does get under the skin, you should immediately apply a tourniquet above the injection site, then inject a 0.9% sodium chloride solution into the injection site and around it, up to 50-80 ml (reduce the concentration of the drug).

A hematoma can also occur during inept venipuncture: a purple spot appears under the skin because the needle has pierced both walls of the vein and blood has penetrated into the tissue. In this case, the vein puncture should be stopped and pressed for several minutes with cotton wool moistened with alcohol. In this case, an intravenous injection is given into another vein, and a local warming compress is placed on the area of ​​the hematoma.

Allergic reactions to the administration of one or another drug by injection can occur in the form of urticaria, acute runny nose, acute conjunctivitis, Quincke's edema, occurring after 20-30 minutes. after administration of the drug. The most severe form of an allergic reaction is anaphylactic shock.

Anaphylactic shock develops within a few seconds or minutes from the moment the drug is administered. The faster the shock develops, the worse the prognosis.

The main symptoms of anaphylactic shock: a feeling of heat in the body, a feeling of tightness in the chest, suffocation, dizziness, headache, anxiety, severe weakness, decreased blood pressure, heart rhythm disturbances. In severe cases, these signs are accompanied by symptoms of collapse, and death can occur a few minutes after the first symptoms of anaphylactic shock appear. Treatment for anaphylactic shock should be carried out immediately after detecting a feeling of heat in the body.

Long-term complications that occur 2-4 months after the injection are viral hepatitis B, O, C, as well as HIV infection.

Parenteral hepatitis viruses are found in significant concentrations in blood and semen; are found in lower concentrations in saliva,

urine, bile and other secretions, both in patients suffering from hepatitis and in healthy virus carriers. The method of transmission of the virus can be blood transfusions and blood substitutes, medical and diagnostic manipulations, accompanied by a violation of the integrity of the skin and mucous membranes.

The group at greatest risk of contracting the hepatitis virus includes people who inject. In first place among the methods of transmission of viral hepatitis B are needle pricks or tissue damage with sharp instruments (88%). Moreover, these cases are usually caused by careless attitude towards used needles and their reuse. Transmission of the pathogen can also occur through the hands of the person who performs the manipulation and has warts that bleed and other hand diseases that are accompanied by exudative manifestations. The high reliability of infection is due to:

High resistance of the virus in the external environment;

The length of the incubation period (six months or more);

Large number of asymptomatic carriers.

At this time, specific prevention of viral hepatitis B is carried out, which is carried out through vaccination.

Both hepatitis B and HIV infection, which ultimately leads to AIDS (acquired immunodeficiency syndrome), are life-threatening diseases. Almost all cases of infection occur as a result of careless, negligent actions during medical procedures: needle pricks, cuts from fragments of test tubes and syringes, contact with damaged skin areas that are not protected by gloves. In order to protect yourself from HIV infection, each patient should be considered as potentially HIV-infected, since even a negative result of testing the patient's blood serum for the presence of antibodies to HIV may be a false negative. This is explained by the fact that there is an asymptomatic period from 3 weeks to 6 months, during which antibodies in the blood serum of an HIV-infected person are not detected.

Features of the use of eye and ear drops in children.

For eye diseases, as prescribed by a doctor, drops are instilled or ointments are applied (see Fig. 2-3). Before the procedure, the nurse thoroughly washes her hands with a brush and soap, wipes them with alcohol (or a special hand sanitizer). If the bottle of medicine is not equipped with a special
a device for instilling drops into the eyes, the medicine is drawn into a pipette.

Technique: use your index finger to slightly pull down the lower eyelid, and with the other hand, slowly release one drop from the pipette (closer to the nose). If the sick child is able to understand the request, you should ask him to look in the opposite direction. After some time, instill a second drop and ask the child to close his eyes. After use, the pipette is washed with warm water and placed in a special case.

When applying eye ointment, the lower eyelid is pulled back and the ointment is placed on the conjunctiva, the child closes his eyes, after which the ointment is distributed over the eyelid with careful movements of the fingers.

Fig.3 Putting ointment in the eyes.

If necessary, special glass eye rods are used to perform this procedure. Pipettes and eye droppers should be used individually for each patient.

When instilling drops into the left ear, the patient's head is turned to the right or tilted towards the right shoulder. With the left hand, the earlobe is pulled back and down for young children, and back and up for older children (Fig. 4-5). This is due to the anatomical features of the external auditory canal in children. With your right hand, instill a few drops into the ear canal (according to the instructions for use of the medicine 1 o). After this, a small cotton swab is placed in the ear

Features of inhalation therapy in children.

Inhalation therapy is one of the treatment methods in pediatric practice and is a parenteral means of administering drugs. There are steam inhalations, warm wet inhalations, oil inhalations, and aerosol inhalations. The effect of inhalation therapy is determined by the direct influence of the active substance on the mucous membranes of the respiratory tract and depends on the degree of grinding of the aerosol.

In a hospital setting, inhalations are carried out using aerosol, steam, universal (designed to conduct warmly moist
inhalations with solutions of liquid and powdery substances), ultrasonic aerosol devices. The steam inhaler is equipped with a heat regulator to heat the aerosols to body temperature. In ultrasonic inhalers, the grinding of drugs is carried out by ultrasonic vibrations; Air flow and temperature are adjustable (see Fig. 6-7). For inhalations, special mask attachments are used for young children.

Inhalations are performed as prescribed by a doctor in a specially equipped room.

Rules for using pocket and stationary inhalers

Pocket inhalers are usually used by patients with bronchial asthma. If the child’s age does not allow him to use the inhaler independently, the use of the inhaler is carried out by the child’s parents, and medical personnel must teach the mother how to use it before discharging the child from the hospital. For young children, inhalers with special attachments - spacerags are used, which avoid loss of the drug during inhalation (see Fig. 8).

Checking the inhaler. Before using the inhaler for the first time or after a break in use of more than one week, it must be checked. To do this, remove the cap of the mouthpiece, pressing lightly on the sides, shake the inhaler well and spray one spray into the air to make sure it is working properly. The inhaler should be used in the following order:

1. Remove the mouthpiece cap and, lightly pressing on the sides, make sure that the inner and outer surfaces of the mouthpiece are clean.

2. Shake the inhaler thoroughly.

3. Take the inhaler, holding it vertically between the thumb and all other fingers, and the thumb should be on the body of the inhaler, below the mouthpiece.

4 Exhale as deeply as possible, then take the mouthpiece into your mouth between your teeth and cover it with your lips without biting.

5. Start inhaling through your mouth at the same moment and press the top of the inhaler (the medication will begin to atomize). In this case, the patient should inhale slowly and deeply. One press on the top of the inhaler corresponds to one dose.

6. Hold your breath, pull the inhaler out of your mouth and remove your finger from the top of the inhaler. The child must hold his breath as long as he can.

7. If you need to perform the next spray, you need to wait approximately 30 seconds, holding the inhaler vertically. After this, you need to follow the steps described in paragraphs 2-6.

In recent years, nebulizer inhalation therapy has been widely introduced in pediatrics, which is based on fine atomization of the medicinal substance using

The advantages of this method of inhalation therapy compared to others are that the drugs that are sprayed directly act on the area of ​​inflammation in the mucous membranes of the respiratory tract; the medicinal substance that enters during inhalation is not absorbed into the blood, but penetrates deeply into the lungs. Nebulizer therapy does not require coordination of inhalation with inhalation and therefore is the only possible method of aerosol therapy in children under 5 years of age with bronchial asthma (Fig. 11)

Methods and techniques for supplying humidified oxygen and using an oxygen cushion. Oxygen therapy is used to eliminate or reduce arterial hypoxemia. This is a fairly effective method that allows you to increase the oxygen content in the patient’s blood. Oxygen is prescribed in cases of insufficient oxygen supply to organs and tissues, arising from various diseases of the respiratory system, circulatory system, poisoning, shock, pulmonary edema, and after complex surgical interventions.

The duration of oxygen therapy ranges from several hours to several days, depending on the patient’s condition. The oxygen that is supplied to a sick child must be humidified, and its constant concentration in the air inhaled by the patient is 24-44%. The supply of humidified oxygen is carried out by various means. For this, plastic nasal catheters are used, which are inserted directly into the nasal passages and fixed with a plaster. Catheters, as well as the water through which oxygen is supplied, must be sterile. In addition to catheters, humidified oxygen is supplied through face masks (Fig. 12), plastic caps or head tents, in which, unlike oxygen tents, the required oxygen concentration is maintained using an oxygen therapy apparatus.

Figure 12. Supply of humidified oxygen through a face mask

One of the means of oxygen delivery is the use of an oxygen cushion.

An oxygen bag is a quadrangular rubberized bag connected by a rubber tube to a tap and a mouthpiece or watering can. The pillow, which can hold up to 10 liters of oxygen, is filled in a pharmacy or centrally at an oxygen station. Before using oxygen, Fig. 13, wrap the mouthpiece with 2-3 layers of gauze moistened with water. Then they place it against the sick child’s mouth and open the tap, which is used to regulate the oxygen supply.

When the amount of oxygen decreases significantly, it is squeezed out with your free hand. Before use, the mouthpiece is treated with disinfectant solutions, boiled or wiped with alcohol.

The use of oxygen and an oxygen cushion is possible only as prescribed by a doctor. An overdose of oxygen is just as dangerous as an insufficient amount. Particularly severe complications from oxygen overdose develop in young children.

In some cases, it is advisable to administer drugs into the body by inhalation (by inhalation). However, they mainly affect the bronchi. This is how isadrin is used for bronchospasm, and crystalline trypsin for chronic bronchitis. Substances that are well absorbed through the mucous membrane of the alveoli and exhibit a systemic effect, for example, agents for inhalation anesthesia - fluorothane, nitric oxide, are also administered by inhalation.

Sometimes it is advisable to administer drugs by electrophoresis. This is how analgin is used, novocaine for radiculitis, heparin for increased blood clotting.

FEATURES OF NUTRITIONAL ORGANIZATION FOR HEALTHY EARLY CHILDREN.

ORGANIZATION OF NUTRITION FOR CHILDREN IN A HOSPITAL CONDITION

Types of feeding in the first year of life

Rational nutrition that meets the physiological needs of a growing organism is the most important condition for the harmonious development of a child. Qualitative and quantitative deviations in a child’s nutrition easily cause metabolic changes, can suppress or activate anabolic processes and lead to diseases such as rickets, anemia, atypical dermatitis, malnutrition, etc. Nutritional defects at an early age contribute to the development of later pathology: obesity, endocrine dysfunction, allergic diseases, chronic diseases of the gastrointestinal tract, etc. The psychological comfort that arises during feeding of the child and contributes to his full mental development should also be taken into account.

The best type of feeding a child under 6 months of age is exclusive breastfeeding, that is, feeding with breast milk without the use of other foods and/or liquids in the child’s diet. I ore feeding must begin immediately (within the first hour) after the birth of the child and continue until 1-1.5 years, and longer in conditions of sufficient lactation in the mother.

Mother's milk is an ideal food product for a child in the first year of life; it contains not only all the nutrients necessary for the child in a balanced ratio, but also a complex of protective factors and biologically active substances that contribute to the timely and complete formation of the immune system. Children who are breastfed are less likely to suffer from infectious and allergic diseases, have a lower risk of developing otitis media, diarrhea, sudden death syndrome, bronchial asthma, obesity, etc. and have better mental development indicators. Breast milk contains about 90% water, which fully satisfies the baby's fluid needs. Its additional administration can reduce the need for breast milk and lead to insufficient weight gain of the child, increase the risk of acute intestinal infections and reduce the duration of breastfeeding. However, for various reasons, which may be due to both the state of health of the mother or child and other factors, the child may receive breast milk substitutes - infant formula.

According to the “Scheme of terms and definitions of breastfeeding” adopted by WHO in 1993, there are:

Complete breastfeeding, when the baby receives only breast milk from the mother's breast;

Partial breastfeeding (mixed), when, with insufficient lactation, along with breast milk, the child receives supplementary feeding with an artificial adapted formula;

Artificial feeding, when a child receives substitutes (artificial formula) instead of breast milk.

Rules for breastfeeding children in the first year of life

For successful and long-term breastfeeding of a child, it is necessary to follow certain rules regarding both direct feeding of the child and the implementation of basic hygiene rules.

The conditions for successful long-term lactation are:

Early attachment of the baby to the mother's breast (in the first hours after birth):

24-hour joint stay of mother and child, starting from the moment of birth (ward of mother and child staying together);

Correct attachment of the baby to the mother's breast;

Breastfeeding at the baby's request, including at night,

Do not give a child under 6 months of age any other foods or liquids, except for medical reasons.

Do not use pacifiers or pacifiers.

Exclusive breastfeeding up to 6 months.

Mandatory introduction of adequate complementary feeding from 6 months.

Continuation of breastfeeding up to 1 year, and if possible longer.

Signs of proper attachment of the baby to the mother's breast:

The child's head and body are in the same plane;

The baby's body is pressed against the mother's face to the breast, the baby's chin touches the mother's breast, the nose is opposite the nipple;

The mother supports the child's entire body from below, not just his head and shoulders;

The mother supports the breast from below with her fingers, with the index finger on the bottom and the thumb on top (fingers should not be close to the nipple);

At the beginning of feeding, the mother should touch the nipple to the baby's lips and wait until the baby opens his mouth wide, and then quickly bring the baby closer to the breast, directing his lower lip below the nipple so that the baby grasps the lower part of the areola;

The mother's position during feeding should be comfortable for her.

A sign of effective feeding of a baby is slow,

deep sucking with short breaks. The first days after birth, the mother feeds the baby while lying in bed, and later - in a position that is comfortable for both of them, which contributes to complete relaxation of the mother and provides the most comfortable conditions for the child.

The most common position when feeding a baby is sitting

The mother takes the newborn in her hand, turns slightly towards the breast with which she will feed the baby, and with the other hand supports the breast so as not to impede the baby’s nasal breathing, however, without squeezing the lobes of the mammary gland. It is necessary to ensure that when sucking the baby takes it into the mouth not only the nipple, but also the nipple circle (areola). This makes sucking easier for the baby, prevents aerophagia (air entering the stomach), as well as the occurrence of cracked nipples in the mother.

A woman who is breastfeeding must adhere to the usual rules of hygiene. Before feeding, the mother washes her hands thoroughly with soap. Before and after feeding, it is not advisable to wash the mammary glands with soap or other aseptic agents, since in the area of ​​the nipple and areola there are special glands (Montgomery glands) that produce a secretion that keeps the skin healthy, protects it from infection and prevents nipple cracks. Frequently washing your breasts with soap dries out the skin, destroys the natural protective layer and leads to cracks. At the same time, underwear, in particular the bra, must be spotlessly clean. It is advisable to use special disposable pads that keep the bra dry. Before feeding, it is recommended to express the first few drops of milk, as they may be contaminated with germs.

Feeding regimen for a first year child life

Breastfeeding is carried out “at the child’s request,” that is, the child himself determines the number and duration of feedings, depending on individual needs and without restrictions on the part of the mother, but it should be remembered that a child’s crying does not always mean hunger. In the first month of life, a child can be attached to the mother’s breast up to 10-12 times, including night feeding, which contributes to better development of lactation, a longer duration of breastfeeding, and prevents the development of hypogalactia and lactostasis in the mother. However, starting from 2-3 months, most children establish a certain feeding schedule: usually at intervals of 2.5-3.5 hours.

The average duration of feeding is 15-30 minutes, but this depends on the general condition of the child and the structural features of the mother’s mammary gland. Usually in the first 5-7 minutes the baby sucks out about 80% of the milk. If the duration of feeding is more or less than 30 minutes, it is necessary to find the reason; this may indicate various disorders of the feeding process (insufficient lactation, illness of the child, etc.).

Expressing milk. Properly organized feeding and normal lactation, as a rule, do not require expressing breast milk. However, in the first days after birth, it is advisable to express the milk that remains in the breast after feeding the baby so that lactogenesis is not inhibited. Expressed milk can be stored: at I +18-20 0 C for no more than 12 hours; at +4 - -5 0 C up to 48 hours, at minus 18 20 0 C up to 4 months.

An approximate feeding regimen for a breastfed baby:

Up to 2-3 months - upon request or after 3 hours;

From 3 to 5-5.5 months - 6 times every 3.5 hours;

From 5-5.5 months to 1 year - 5 times every 4 hours.

With the introduction of the first complementary foods, the child usually receives five feedings a day, however, to maintain lactation, it is recommended to attach to the breast after complementary feeding

This mode is oriented and must take into account the characteristics of the child’s growth and development. As lactation decreases, it is necessary to put the baby to the breast more often, especially at night.

At certain age periods, a child may require more breast milk (at 3 weeks, 6 weeks, 3 months) and more frequent breastfeeding, which is due to its intensive growth. Reliable signs of breast milk insufficiency are: weight gain of less than 500 g per month; The child urinates less than 6 times a day, and the child’s urine becomes concentrated and has a strong odor.

The concept of complementary feeding

At the age of 6 months, for the further physiological development of the child, there is a need to expand the diet and introduce additional products into it, since, starting from this age, breast milk can no longer satisfy the child’s need for calories, micronutrients (primarily iron) to provide its normal development.

Complementary foods are food products that are introduced in addition to breast milk or formula (with artificial feeding) to a child of the first year of life.

It is necessary that the child is physiologically ready for the introduction of complementary foods. Signs of this include the baby holding his head up; sits almost without support (in a high chair); shows interest in foods that other family members eat; opens his mouth when a spoon with food is brought to him and turns away from it when he is not hungry; does not push food out of the mouth, but swallows it.

Rules for introducing complementary foods. Complementary feeding products should be appropriate for the child's age and gradually change in consistency, taste, smell and appearance, while breastfeeding must be continued. Complementary feeding should be given when the child is active and hungry, preferably during breakfast or lunch, together with other family members. Complementary feeding is given from a spoon, after a short breastfeeding or a small amount of formula in the case of artificial feeding.

During feeding, the baby should be in an upright position

position, in a special highchair or in a comfortable position in the mother’s arms. You should start giving complementary foods by placing a small amount of food on the tip of a teaspoon. Hold the spoon so that the child can see it, then you should touch the spoon to the child’s lips so that the child opens his mouth, put the spoon with food in the middle of the tongue, then the child will easily swallow it.

Each complementary feeding product is introduced starting with 1 teaspoon and is increased gradually over 5-7 days to the full volume. Every time after the baby has received complementary foods, it is advisable to put it to the breast. This will help maintain lactation and the baby will feel satisfied. If a child refuses complementary feeding, you should not force-feed him, as he may refuse other foods. You can offer a different product (of a different taste and/or consistency), or the same one, but on a different day. During feeding, it is necessary for the mother to communicate with the baby.

Each subsequent new complementary food product must consist of one ingredient and be given to the child for at least 5 days, after which mixed complementary foods can be given from these products. To make it easier for a child to get used to new foods, it is recommended to add breast milk to complementary foods. Complementary foods should be freshly prepared, have a soft, homogeneous consistency, and the temperature should be 36-37°C. If signs of poor tolerance to a complementary food product appear (dysfunction of the digestive system, allergic reactions, etc.), you should stop introducing this complementary food product and, when the child’s condition normalizes, gradually introduce another one.

It is important that a child at the age of 6 months begins to receive complementary foods with a high iron content. Complementary feeding products and dishes are introduced gradually, depending on the age of the child, and their volume should not exceed the recommended norms.

Approximate scheme for introducing complementary foods and dishes when breastfeeding children of the first year of life

complementary foods	input, months	6 months	7 months	8 months	9 months	10-12 I months.
Juice (fruit, berry, vegetable), ml		30-50	50-70	50-70		I
fruit puree, ml		40-50	50-70	50-70		90-100 |
Vegetable puree, g		50-100
Milk porridge, g	6-7	50-100	100-150
Milk-cereal porridge, g	7-8		100-150			!
Fermented milk products, ml	8-9	__	__	50-100	100-150	| 150-200 i
Cheese, g	6,5-7,5	5-25	10-30			50 |
Egg yolk, pcs.	7,0-7,5		1/8-1/4	1/4 -1 / 2	1 12	i "/g -1 I
Meat puree, g	6,5-7,0	5-30				i 50-60 |
Fish puree, g	8-10	-	--	10-20	30-50	50-60
Oil, g		1/2 tsp	1/2 tsp.	1 hour L.	1 tsp	1 hour L. |
Butter, g	6-7	1/2 tsp.	1/2 tsp	1 hour L.	1 tsp	1 hour l. (
Wheat bread, g 8-9				10I

Volume depending on the age of the child

Complementary feeding products and dishes.

The first complementary food offered to a child at the age of 6 months can be vegetable or fruit puree, as well as porridge (preference is given to gluten-free cereals - buckwheat, rice, corn). The frequency of administration of these products should be 1-2 times a day, with a gradual increase in serving volume. It is important that a child at the age of 6 months begins to receive complementary foods with a high iron content.

There are certain rules for introducing vegetable and fruit complementary foods to a child.

It is advisable to introduce vegetables before fruits, as some children may not like the taste of vegetables if they become accustomed to the sweet Taste of fruits.

You should start with one type of vegetable or fruit and only after the child has received each of them separately, you can mix them.

You need to start with mild-tasting vegetables (zucchini, pumpkin, potatoes, cabbage, squash) and fruits (apples, peaches, apricots, plums).

Vegetable/fruit puree, as a low-protein complementary food dish, is given for no more than 2 weeks, then it is necessary to enrich these dishes by adding high-protein foods (soft cheese, meat).

You can give your child pureed fresh vegetables and fruits, which should be thoroughly washed and peeled beforehand. Over time, you can give your child vegetables and fruits in pieces.

Starting from 6 months, it is necessary to teach your child to drink from a cup. It is not recommended to drink any types of tea (black, green, herbal) and coffee for up to two years. These drinks interfere with iron absorption. After two years, drinking tea with meals should be avoided.

Introducing complementary foods to a baby

It is advisable to give juice to a child when she is already receiving other complementary foods. Start introducing the juice with 3-5 drops 1 time per day, monitoring the child’s condition; gradually bringing it to the required volume, making sure that the baby drinks enough breast milk (milk formula - in the case of artificial feeding.

From 6 months, soft cheese is introduced into the child’s diet. The introduction of cereals is suggested as complementary foods at the age of 7 months

In the first 10 days, 5% porridge is given, then, over the course of 2 weeks, its concentration is gradually increased to 10%.

Mixed cereals with several cereals should be introduced only after the child has already received cereals with each cereal separately.

Porridge can be diluted with breast milk

To prepare porridge, you can use milk mixture or diluted cow's milk, to get 200 ml of diluted milk, you need to boil 70 ml of water, add 130 ml of boiled cow or goat milk, add sugar - 1 level teaspoon.

Porridge can be mixed with vegetables or fruits, but only after the child has tried each of these products separately.

Feed your baby only with a spoon.

The introduction of meat is recommended for a child aged 6.5-7.0 months. Veal, chicken, turkey, and rabbit are recommended. You need to start with finely chopped meat (minced meat), gradually moving on to its culinary processing in the form of meatballs, cutlets, etc. The meat should not be dry and retain natural moisture so that the child can easily swallow it.

Fish dishes (minced meat, meatballs, cutlets) are recommended from 8-10 months; egg yolk, which is also a source of iron - from 7 months. Egg white is an allergenic product and should not be given to a child until he is 1 year old.

Whole cow or goat milk should be given to a child no earlier than 9 months of age, and preferably from 1 year, since it has a significant allergenic effect. Diluted cow's milk can be used to prepare complementary foods.

At the age of 1 year, a child should receive a variety of complementary foods from each food group and be able to drink from a cup.

Before each meal, the child must wash his hands.

Partial breastfeeding (mixed feeding). The concept of supplementary feeding

When the mother's lactation decreases, the child is transferred to partial breastfeeding, which involves the introduction of supplementary feeding with artificial formulas. If there is any doubt whether the baby is sucking enough milk from the mother’s breast, control feeding should be carried out. To do this, the baby is weighed before and after feeding (leaving him in the same clothes as before feeding). The difference in weight between the second and first weighing will be an indicator of the amount of milk that the baby sucked. Control feeding must be carried out during each feeding for 1–2 days.

If a child receives less breast milk than needed, the doctor decides on supplementary feeding of the child with an artificial formula. In this case, the required amount of formula is calculated by determining the difference between the required amount of milk and the volume of milk that the child receives during the day (based on the results of control feeding. It is better to supplement feeding at each feeding after the child has received milk from both breasts of the mother. So that the child does not refused to breastfeed, it is better to supplement feeding from a spoon or a baby cup.If the mother has a small amount of milk, it is necessary to supplement the child's feeding using the “alternating” method - one feeding to put the child to the breast, the second - to feed from a bottle (spoon, cup).

For supplementary feeding, adapted milk formulas are used, depending on the age of the child. The type of formula, its volume and frequency of feedings are determined by the doctor.

Artificial feeding of children in the first year of life.

Techniques for preparing milk mixtures.

If it is impossible to feed the child with breast milk (the presence of contraindications on the part of the mother and child or agalactia in the mother), it is necessary to completely transfer it to artificial feeding using breast milk substitutes (adapted formulas). Adapted mixtures are produced mainly from cow’s milk, less often from goat’s or plant milk (soy, coconut). The main principles of changing the composition of cow's milk for the production of adapted milk formulas are: reducing the total amount of protein, enriching with serum albumin, changing the composition of fats, increasing the level of carbohydrates, correcting the mineral composition, enriching with a complex of mineral salts, vitamins and microelements, enriching with biologically active substances, bifidogenic protective factors. Despite the fact that modern formulas used to feed babies are as close in composition as possible to human milk, the negative aspects of artificial feeding should also be noted, namely:

Violation of the principle of species-specific nutrition

Lack of biological protection factors against diseases and allergies

Lack of biologically active components that determine the regulation of maturation rates;

Before administering the injection, it is necessary to psychologically prepare the child, if age allows, that is, over 4 years old; if the child is young, then explain to the mother the process and purpose of the manipulation, and establish friendly contact with the child.

When administering the injection, it is necessary to hold the child tightly, fixing the arms and legs. An assistant is used for this purpose.

In older children, injections are made in the upper outer square of the buttock (as in adults). In children under 3 years of age, injections are made into the anterior outer area of ​​the thigh.

When performing an injection, the proximity of blood vessels, nerve plexuses and bone tissue to the surface of the body should be taken into account.

In children with an insufficiently defined subcutaneous fat layer (low birth weight, premature births and those suffering from malnutrition), a musculocutaneous fold should be formed and the needle should be inserted into the tissue at an angle of 30 degrees. For other children, the angle of insertion remains 90°.

Nursing examination of children with respiratory diseases.

When examining a child, you should pay attention to:

On the color of the skin. There may be general or local diathesis. Young children sometimes experience foamy discharge in the corners of the mouth (penetration of inflammatory exudate from the respiratory tract).

Nose - possible difficulty breathing, participation in the act of breathing of the wings of the nose, the nature of the secretion (mucous, mucopurulent, mucoserous, sanguineous).

Oral cavity - It is necessary to pay attention to the condition of the pharynx and tonsils. With the help of the mother, who secures the child, the health worker quickly moves the spatula to the root of the tongue and, with strong downward pressure, forces the child to open his mouth wide. Determines the degree of hyperemia of the pharynx, the condition of the tonsils, the presence of plaque on them, examines the palatine arches and the back wall of the pharynx.

Breathing type – in children under 2 years of age, the abdominal type of breathing, then thoraco-abdominal, and then from the age of 8 in boys it remains abdominal, and in girls thoracic.

Breathing frequency - counting the breathing rate per minute depending on the type of breathing.

Shortness of breath - with obstruction of the upper respiratory tract, there is difficulty in inhaling (inspiratory dyspnea), and with bronchial asthma, obstructive bronchitis, difficulty in exhaling (expiratory dyspnea) is observed.

Mixed shortness of breath is characteristic of pneumonia.

Cough - paroxysmal, with reprises (for whooping cough), dry, debilitating (for tracheitis), wet, deep (for bronchitis and pneumonia), barking (for laryngitis), painful, short (for pleurisy).

The technique of subcutaneous, intramuscular and intravenous injections in children is basically no different from adults. You should only pay special attention to maintaining asepsis when performing injections in children, especially at an early age, when the body's defenses are not yet sufficiently developed and abscesses and phlegmon can quickly occur.

Syringes must be processed in accordance with the rules (boiling for 45 minutes in distilled or twice boiled water, disassembled and pre-washed). Before the injection, hands are washed with soap and water, dried with sterile wipes, treated with alcohol, and fingertips are lubricated with a 3% alcohol solution of iodine.

Before injection, you should re-check the labels on the ampoules and compare them with the instructions. Empty ampoules are stored for 24 hours for subsequent monitoring of administered medications, especially in case of complications. Ampoules must be treated with a sterile cotton ball soaked in alcohol; The skin at the injection site is also treated last.

Children gradually get used to injections. However, first you should be especially attentive and sensitive and not cause unnecessary negative emotions in the child. Under no circumstances should you deceive a child. He should know before the injection that he will be given an injection and that it will hurt, but not as much as he imagines. Not only the moment of the injection itself is painful, but also the moment of administering the medicine, especially if it is administered quickly. Injections should be done without much haste. After subcutaneous or intramuscular injection of solutions, the skin is treated with alcohol and the injection site is gently rubbed. This helps reduce pain and improve absorption of the drug.

Repeated injections are usually given to other areas of the body. You should not inject medications into the area of ​​the previous injection if inflammation has formed there. In case of unsatisfactory absorption of drugs and the formation of infiltrates, apply a warm heating pad to the injection site.

In young children, the most convenient place for intramuscular and subcutaneous injections is the anterior outer surfaces of the thighs, the upper outer quadrant of the buttocks and the outer surface of the shoulder. For intramuscular and subcutaneous injections, the syringe must be pulled back slightly before administering the medication. For each injection, take a new syringe and a different needle.

Intravenous infusions can be one-time or drip. Drips are produced by venipuncture and venesection.

Venesection is performed by a doctor. It should be treated with special care, strictly observing the rules of asepsis. Neglect of venesection as a minor operation and its performance in the wards, as a rule, leads to suppuration with the development of long-term non-healing wounds, which do not allow the child to be discharged from the hospital.

Currently, the use of the Seldinger method for inserting a catheter into a vein for the purpose of long-term infusion, without performing a venesection, has become widespread. For this purpose, not only large veins such as the subclavian and cervical are used, but also peripheral veins, if they are of sufficient diameter. The simplest catheterization technique is as follows: a peripheral vein is punctured and a thin catheter is inserted into the vein through the lumen of the needle. The needle is removed and the catheter remains in the vein for a long time. Another technique, which makes it possible to insert a wider catheter into the lumen of the vein, is more complicated: a small skin incision (3-4 mm) is made above the projection of the vein. A vein is punctured through it. Pass the line through the lumen of the needle into the vein. The needle is removed, but the fishing line is left. A sterile catheter is threaded onto the fishing line and inserted into the vein with rotational movements.

CHAPTER 27 TECHNIQUES FOR PARENTERAL ADMINISTRATION OF DRUGS

CHAPTER 27 TECHNIQUES FOR PARENTERAL ADMINISTRATION OF DRUGS

Parenteral administration of drugs is carried out by injection, for which syringes and hollow needles are used (Fig. 77). The syringe consists of a cylinder and a piston, the latter must fit tightly to the inner surface of the cylinder, ensuring tightness, but at the same time slide completely freely over the surface. Injection cylinder capacities: 1, 2, 5, 10, 20, 50 ml. The choice of syringe depends on the type of injection and the amount of drug administered. So, up to 0.5 ml of solution is injected intradermally, 0.5-2 ml subcutaneously, intramuscularly - 1.0-10 ml, intravenously - 10-20 ml, into the cavity - 10-50 ml.

Rice. 77. Types of syringes:

a - disposable; b - “Record”; c - combined; g - Janet syringe; d - a set of needles for syringes

In recent years, syringes for single use made of plastic have been used in medical practice; to every such

Each syringe comes with 1-2 needles. They are in special packaging, sterile and ready to use. The use of disposable syringes is an effective way to prevent infection with viral serum hepatitis and HIV infection

In the practice of children's medical institutions, disposable 2- and 5-gram syringes are mainly used. In some cases, it becomes necessary to use reusable syringes. For this purpose, use a “Record” type syringe with a glass cylinder with metal tips and a piston, and its analogues. The combination syringe has a metal tip on only one side. An insulin syringe is intended for administering small doses, and a syringe pen is intended for the same purposes (Fig. 78). The Janet syringe is intended for administering large doses of medicinal substances with a capacity of up to 150 ml.

Rice. 78.Insulin syringes: disposable (a), pen syringe (b)

Reuse of disposable and unsterilized reusable syringes is not permitted.

Hollow needles come in 10 gauges depending on the diameter. The choice of needle diameter depends on the intended nature of the injection. Intradermal injections are made with needles of the smallest diameter; for intravenous injections, larger diameter needles are usually used; needles for subcutaneous and intramuscular administration occupy an intermediate position. In addition, the choice of needle gauge depends on the consistency of the drug to be administered. For injection of oil solutions, larger diameter needles are used than for injection of aqueous solutions, etc.

Remember: the medicine, its dose, method and interval of administration are prescribed by the attending physician.

Injection site is chosen so as not to injure the vessels, nerves, and periosteum. Injections are not performed in places where the skin is affected by pustular diseases, scars, hemangiomas and nevi. Before the injection, the skin is disinfected with alcohol or 5% iodine tincture. In children, a more concentrated iodine tincture cannot be used, as it can cause skin burns.

Before assembling sterile instruments, the nurse should treat your hands: Wash them thoroughly with soap; if there are scratches, hangnails, or sores, disinfect them with alcohol. It is unacceptable to have rings or bracelets on your hands. After hand treatment, sterile gloves are put on them, and the sleeves of the robe are first rolled up to the middle of the forearms.

Before you give the injection,

Make sure that the ampoule contains the medicine that needs to be administered;

See if its expiration date has expired, if the packaging is intact, pay attention to the dose and concentration expressed as a percentage;

Before use, wipe the cap of the bottle or ampoule with ethyl alcohol, and use it on your gloves if you have touched any object before.

Needles used to draw the contents of the ampoule into a syringe or pierce the rubber stopper of the bottle cannot be used for injections. For injections use a different needle. When putting a medicine into a syringe, each time you carefully study the label first to avoid any mistakes.

Before injection, the air must be removed from the syringe. To do this, you need to turn the syringe with the needle up, and the air collects above the liquid in the outlet part of the cylinder, from where it is forced out through the needle by the movement of the piston. Usually, a certain amount of the drug is also squeezed out. Therefore, it is recommended to fill the syringe with a slightly larger amount of the drug than is necessary for injection.

When washing syringes and needles, use solutions containing hydrogen peroxide in combination with detergents (“Novost”, “Progress”, “Sulfanol”), taken in a 1:1 ratio. To prepare the washing solution, take 20 ml of 30-33% perhydrol (or 40 ml of 1% hydrogen peroxide solution), 975 ml of water (in the second case - 950 ml), 5 g of detergent (in the second case - 10 g). After disassembling, the syringes and needles are washed and rinsed in running water, then soaked for 15 minutes in a hot (50-60 ° C) washing solution, immersing them so as to fill the cavities. After soaking, syringes and other instruments are washed in the same solution with brushes or gauze swabs, each separately. The solution is used once. Washed syringes and needles are rinsed again in running water, then in distilled water. Disassembled syringes and needles are stored in a dry place.

Most hospitals have centralized sterilization facilities for instruments, including syringes and needles.

Children gradually get used to the injections. However, when administering the first injection, the healthcare worker should be especially attentive and sensitive and not cause unnecessary stress in the child. You should never deceive a child. He must know that he will be given an injection and that it will hurt, but not as much as he imagines. Not only the puncture of the skin is painful, but also the moment of administration of the drug, especially if it is administered quickly. The procedure should not be delayed and at the same time the injection itself should be done without much haste.

Anesthesia methods used for subcutaneous and intramuscular injections:

Finger pressure - the tip of the index finger with cotton wool is immersed at the site of the intended injection to a depth of at least 1 cm, mentally counting for 10 seconds, then the cotton wool is removed and at the same time the needle is inserted into the formed dimple;

Stretching the skin - the closed tips of the thumb and index fingers are pressed into the site of the intended injection to a depth of at least 1 cm, mentally counted for 10 s, then the immersed fingers are moved apart to 2 cm, the resulting dimple is treated with alcohol and a needle is inserted at a given angle to the required depth;

Using plastic tubes with rounded ends - they are pressed at a given angle to a depth of at least 1 cm, mentally counted for 10 seconds, a needle is inserted into the tube to the required depth, after the injection the tube is removed along with the needle.

In pediatric practice, needleless injectors that do not cause pain can be used. They are used primarily for vaccination, when it is necessary to vaccinate a large number of children in a short time. Restrictions on the introduction of needle-free injectors into widespread practice are associated with difficulties in ensuring safety during their use, the impossibility of administering a variety of medications, etc. In addition, when using highly purified insulin, the drug is administered using a pen syringe with a sterile microneedle and dispenser.

Intradermal injections. With intradermal injection, the drug is injected into the thickness of the skin itself, usually on the flexor surface of the forearm or the outer surface of the shoulder.

For intradermal injection, choose the thinnest needles and a syringe with a volume of 1 cm 3. The site of the intended injection is disinfected with alcohol (it is advisable for children to use 70% ethyl alcohol). The needle is placed with the cut upward in relation to the skin and inserted at an acute angle into the skin so that the needle hole disappears into the stratum corneum. When the injection is carried out correctly, the injected substance forms a whitish elevation in the skin, the so-called “lemon peel”. Once the solution is administered, the needle is removed and the puncture site is wiped with alcohol.

More often, intradermal injection is done for the purpose of immunodiagnosis and to determine the hydrophilicity of tissues (McClure-Aldrich test).

Immunodiagnostics. Usually the test is placed on the inner surface of the forearm. After treating the skin with alcohol, 0.1 ml of the allergen is injected strictly intradermally with a thin needle to obtain a “lemon”

naya crust.” Due to the use of small volumes of the drug, only tuberculin syringes are used for skin allergy tests. At the same time, for control, 0.1 ml of allergen solvent (saline solution) is also injected intradermally on the other forearm.

The name of the allergen drugs used, as a rule, corresponds to the name of the disease: for example, tuberculin is used to diagnose tuberculosis, brucellin - brucellin, tularemia - tularin, anthrax (anthrax) - anthraxin. If a child has a corresponding disease at the site of drug administration, a local allergic reaction develops, manifested in the form of hyperemia, infiltration and edema. Using the Mantoux test with 2 tuberculin units, both infectious and post-vaccination allergies are detected. Unlike post-vaccination allergies, infectious allergies are more persistent and should tend to intensify. The appearance of a positive reaction after previously negative ones, as well as an increase in sensitivity to tuberculin by 6-10 mm, especially by 10-15 mm, indicates a probable infection. The appearance of a positive tuberculin reaction

in a child who has been in contact with a tuberculosis patient is usually regarded as being infected with tuberculosis.

McClure-Aldrich test. To carry it out, 0.2 ml of 0.85% sodium chloride solution (isotonic solution) is injected intradermally and the resorption time of the papule is monitored (normally, in children under 1 year of age, the blister resolves in 15-20 minutes, in children 1-5 years old - in 20-25 minutes, for older children - 40 minutes).

Subcutaneous injections. For subcutaneous injections, syringes with a volume of 1 to 10 cm 3 and needles of various calibers are used. The most convenient places for subcutaneous injections are

Rice. 79.Areas of the body used for subcutaneous injections (shaded)

outer posterior surface of the shoulder, subscapular region, subcutaneous fatty tissue of the abdomen or thighs (Fig. 79).

The skin is pre-lubricated with alcohol or 5% iodine tincture. Hold the syringe with the thumb and middle fingers of the right hand, with the index and thumb of the left hand, grab the skin with subcutaneous fat in a fold, pull it upward and towards the needle tip. Then, with a short, quick movement, the needle is inserted into the skin, moving it into the subcutaneous fatty tissue to a depth of 1-2 cm. After this, intercepting the syringe with the left hand, the right hand pulls the plunger back slightly to check whether blood has appeared (if the needle is in the vessel, injection is not performed). In the absence of blood, the medicinal solution is injected under the skin. At the end of the injection, the syringe is removed, holding the needle with a finger, and the injection site is re-treated with alcohol.

Insulin administration. Daily multiple subcutaneous injections of insulin are an integral part of the lives of children suffering from insulin-dependent diabetes. The most convenient and practical are plastic insulin syringes, packaged with a needle. A thin, sharp needle practically does not injure the skin. You need to be able to correctly use other modern means of insulin administration, which include syringe pens and wearable insulin pumps.

Regular disposable syringes are not suitable for insulin injections. Only special insulin syringes allow you to take the specified volume of medication. And in insulin-dependent diabetes, the exact dose is one of the conditions for successful treatment.

The technique for subcutaneous injection of insulin is as follows: when injecting, the needle should enter the subcutaneous fatty tissue. If you inject superficially, a “bruise” or slight swelling may form, and the medicine will take longer to be absorbed. If the needle is inserted too deeply, insulin will enter the muscle. This is not dangerous, but the drug is absorbed faster from muscle tissue. You need to be especially careful when performing an injection in the arm or thigh of adolescents with well-developed muscles.

Insulin syringes. We recommend plastic syringes with a built-in needle, which eliminates the so-called dead space, in which a certain amount of solution remains in a regular syringe with a removable needle after injection. Plastic syringes can be reused - provided they are used correctly

handling them. It is desirable that the dividing price of an insulin syringe for children should be 0.5 units, but not more than 1 unit.

Insulin concentration. Plastic syringes for insulin are available in concentrations of 40 U/ml and 100 U/ml.

Mixing insulins in one syringe. The advisability of mixing insulin is explained by the possibility of reducing the number of injections. However, the ability to mix short- and long-acting insulins in one syringe depends on the type of long-acting insulin. Only insulins that contain protein (NPH insulins) can be mixed. Do not mix so-called human insulin analogues. The sequence of actions when drawing two insulins into one syringe: first, draw short-acting insulin (clear), then long-acting insulin (cloudy). They act carefully so that part of the already collected “short-acting” insulin does not end up in the bottle with the extended-release drug.

Insulin injection technique. The rate at which insulin is absorbed depends on where the needle is inserted. Insulin injections should always be given into subcutaneous fat, but not intradermally or intramuscularly. Often patients do not form a fold and inject at a right angle, which leads to insulin entering the muscle and unpredictable fluctuations in glycemic levels.

The thickness of the subcutaneous tissue in children is often less than the length of a standard insulin needle (12-13 mm). To avoid the possibility of intramuscular injection, use short insulin needles - 8 mm long (Becton Dickinson Microfine, Novofine, Disetronic). They are the thinnest needles and “painless”: the diameter of the shortened needle is only 0.3 or 0.25 mm (the diameter of standard needles is 0.4, 0.36 or 0.33 mm). Shorter (5-6 mm) needles are also available, but further reduction in length increases the likelihood of intradermal penetration.

Insulin injection sites. Several areas are used for insulin injections: the front surfaces of the abdomen, thighs, outer surface of the shoulders, buttocks. The rate at which insulin is absorbed depends on which area of ​​the body it was injected into (the fastest is from the abdomen). Before eating, it is better to inject short-acting insulin into the anterior surface of the abdomen. Long-acting insulin injections can be given in the thighs or buttocks. The injection site should be changed daily to avoid fluctuations

blood sugar levels. When alternating injection sites, it is necessary to deviate from the previous injection site by more than 2 cm.

Syringe pens. In addition to plastic insulin syringes, semi-automatic dispensers - the so-called insulin syringe pens - are increasingly being used. Their device resembles an ink fountain pen, in which instead of an ink reservoir there is an insulin cartridge, and instead of a pen there is a disposable needle. Almost all foreign insulin manufacturers produce syringe pens: Novo Nordisk, Eli Lily, Aventis, etc. They can improve the patient’s quality of life: there is no need to carry a bottle of insulin with you and draw it with a syringe. This is especially significant in intensive insulin therapy regimens, when the patient has to take many injections during the day.

The latest generations of syringe pens allow you to administer the entire dose at once, and not discretely, as with the first generations of pens, when only 1 or 2 units could be administered. In Russia, syringe pens are now used, into which a 3 ml cartridge (300 units of insulin) is inserted: “Novopen 3”, “Humapen”, “Opti-pen”, “Innovo”.

The disadvantage of syringe pens is the inability to simultaneously mix and inject short- and long-acting insulins in an individually selected ratio (for example, as in a syringe for intensified insulin therapy); in this case, you have to make injections twice, using two “pens” separately.

The Novopen 3 syringe pen is designed for administering insulin from Novo Nordisk. It has a body made of plastic and metal; allows you to simultaneously administer up to 70 units of insulin, with an injection step of 1 unit. In order to avoid confusion when using different insulins, multi-colored syringe pens are produced. For children, there is a modification “Novopen 3 Demi” with an insulin dose rate of 0.5 units.

Humapen syringe pen from Eli Lily. The pen is easy to use: the cartridge allows you to inject up to 60 units of insulin at a time, it is easily recharged, and you can correct an incorrect dose. Colored inserts on the body are designed for the use of various insulins. The dose increment is 1 unit.

Syringe pen "Optipen" from Aventis. Its main difference is the presence of a liquid crystal display, which displays the dose to be administered. The Optipen Pro 1 model allows one-

instantly administer up to 60 units of the drug, the number “1” means that the dose increment is 1 unit. It is impossible to set a dose greater than the amount of insulin left in the cartridge.

Syringe pen "Innovo" from Novo Nordisk. Like Optipen, the dose is displayed on the liquid crystal display; The length of the device has been reduced. An electronic control system guarantees accurate administration of the dialed dose. The range of administered doses is from 1 to 70 units, the dosing step is 1 unit. The set dose can be increased or decreased by simply turning the doser forward or backward without losing insulin. The main difference between Innovo and other syringe pens is that it shows the time that has passed since the last injection and “remembers” the last dose of insulin.

Changing needles The quality of insulin needles ensures comfortable insulin administration. Ideally, single use of insulin needles should be recommended; in addition, after each injection of insulin, the needle must be removed immediately. The needle point is specially sharpened and lubricated using the latest technology. Repeated use of the insulin needle will damage the tip and wear away the lubricant coating. The main argument against repeated use of a needle is not even an increase in pain, but microtrauma to the tissue. Repeated use of the needle can cause insulin crystals to clog the channel, which in turn makes delivery of the drug difficult and the dose inaccurate. The same thing happens if you do not remove the needle after the injection, resulting in insulin leakage and air entering the vial.

Intramuscular injections. With intramuscular injections, drugs are absorbed faster than with subcutaneous injections, due to the abundance of lymphatic and blood vessels in the muscles.

For intramuscular injections, the area of ​​the upper outer quadrant of the buttock or the anterior outer area of ​​the thigh is usually chosen (Fig. 80). Intramuscular injection is performed according to certain rules.

Using a file or emery cutter, file down the narrow part of the ampoule and break it off. The lid of the bottle is pierced with a needle. The medicine is drawn in slowly by pulling back the piston. The amount of solution is determined by the divisions marked on the walls of the cylinder (Fig. 81, a). The needle used to draw up the medicine is removed and an injection needle is put on. The syringe is installed vertically with a needle

Rice. 80.Intramuscular injections into the upper outer quadrant of the buttock (a) and the anterior outer region of the thigh (b)

upward, carefully remove air from it until a few drops of medicine appear at the end of the needle (Fig. 81, b). Mentally, the surface of the buttock is divided into four equal parts. The middle of the uppermost square will be the area into which the medicine is injected. They treat it with cotton wool and alcohol and ask the sick child to relax his muscles (Fig. 81, c).

Hold the syringe in your right hand (like a pen) with the needle down, perpendicular to the surface of the body. With the left hand, collect the skin and muscles into a wide fold and vigorously insert the needle (Fig. 81, d). For intramuscular injections, the needle (its length is 60 mm, diameter is 0.8-1 mm) is inserted to a depth of 3-4 cm. To prevent it from entering the vessel, the piston is slightly pulled up and then the drug is injected (Fig. 81, d). The needle is removed quickly, in one movement, the injection site is lightly pressed with cotton wool, which was used to treat the skin before injection (Fig. 81, e). You should not clap or massage the injection site.

It is better to give an intramuscular injection while the patient is lying down. Sometimes it happens that the hand trembles, the needle enters a tense muscle or damages a vessel. You should remove the needle, change the needle to a sterile one and repeat the procedure, inserting the needle next to it in another place.

Rice. 81.Rules for performing intramuscular injection. Explanation in the text

Repeated injections are usually not given in the same place.

To facilitate intramuscular injections, especially at home, a Kalashnikov syringe pistol is used. The device allows you to fix the syringe and independently regulate the force and depth of needle penetration. The needle exactly follows the nurse’s movements, so the injection does not cause any pain to the child.

Attention: the Kalashnikov syringe pistol is intended only for intramuscular injections with 5 ml syringes.

With intramuscular injections the following are possible: complications:

a) infiltrates may form, which is associated with non-compliance with aseptic rules. In this regard, it is necessary to periodically palpate the injection sites and, if an infiltrate is detected, treatment methods such as distraction procedures should be used without delay. The simplest measures are applying an “iodine” mesh to the skin in the area of ​​infiltration, applying a semi-alcohol compress, and among physiotherapeutic measures - ozokerite applications, UHF electric field. All these procedures are aimed at preventing the development of an abscess, the treatment of which is only possible through surgery;

b) the needle may break, the end of which remains in the fabric. The needle is removed surgically;

c) nerve trunks may be damaged as a result of incorrect choice of injection site.

Intravenous injections and intravenous drips(Fig. 82, a, b). When administered intravenously, drugs immediately enter the general bloodstream and have a rapid effect on the body.

For intravenous infusions, large-capacity syringes (10 and 20 cm3) and larger diameter needles with a short bevel are used. Infusions are given into peripheral veins. For children in the first year of life, intravenous injections are given into the saphenous veins of the head, for older children - more often into the ulnar veins, less often - into the veins of the hand or foot. Intravenous infusions into the veins of the neck and subclavian veins are done in extreme and exceptional cases with extreme caution. This is due to the fact that the pressure in the neck veins is lower than atmospheric pressure, there is a danger of air being sucked in and air bubbles entering the bloodstream (air embolism).

Rice. 82.Peripheral venous puncture:

a - the most convenient places for venous puncture; b - puncture of the head vein and fixation of the needle; c - puncture of the vein using a butterfly needle and fixation of the needle; d - fixation of the limb during venipuncture

Before intravenous infusion, wash your hands thoroughly and wear disposable gloves. The child's position is usually lying on his back. The skin is disinfected with alcohol. To better fill the vein, it is recommended to clamp it above the intended injection site. This can be done with your finger (for better filling of the veins of the head in young children) or by applying a tourniquet (on the limbs).

A vein is punctured with a needle without a syringe (except for the neck veins) or with a needle attached to a syringe. The direction of the needle is along the blood flow, at an acute angle to the surface of the skin. The skin is punctured with a quick movement and to a shallow depth. Then, by briefly moving the needle forward, the vein is pierced, being careful not to pass through its opposite wall. Then the needle is advanced along the vein. When it enters a vein, dark venous blood appears at the outer end of the needle.

Lack of blood is usually due to the needle missing a vein. In premature babies and seriously ill infants, due to changes in blood viscosity, the latter does not always flow out of the needle, even when the needle is in the vein. To clarify the location of the needle tip, sterile cotton wool rolled into a flagellum is inserted into the cannula. Staining of the flagellum with blood indicates that the needle has entered a vein. If the needle does not get into the vein, then it is returned back without removing it from under the skin, and another attempt is made to get into the lumen of the vein. If the puncture is successful, blood is collected from a vein for laboratory testing or a medicinal solution is administered intravenously.

The administration of drugs into a vein (infusion) is carried out slowly, taking into account the rapid action of the injected substance. Care must be taken to ensure that the injected substance only enters the vein. If the syringe plunger does not move forward well or swelling appears at the infusion site, then the needle has left the vein and the substance is entering the tissue surrounding the vein. In this case, the infusion must be stopped and the vein puncture repeated in another place. After the procedure, the needle is quickly removed from the vein parallel to the surface of the skin so as not to damage the vein wall. The puncture site is re-treated with alcohol and a sterile pressure bandage is applied. If the injection is performed correctly, there should be no bleeding. The doctor administers the intravenous injections and is assisted by the nurse.

The following complications are possible during venipuncture:

a) hematoma, which is formed when the wall of a vein is punctured. It can be moderately painful, but quickly resolves when a pressure bandage is applied;

b) bleeding from the puncture site of the vein, which is observed with blood clotting disorders. It usually stops quickly when a pressure bandage is applied. It is less common to use special methods to stop bleeding;

c) tissue inflammation and the formation of infiltrates at the injection site, which are observed in cases where the drug

the solution enters the surrounding tissue. The rapid resorption of infiltrates is facilitated by the application of warm compresses.

In order to prevent complications, you should be especially careful about sterilizing instruments, treating the hands of a medical worker and the patient’s skin, as well as the sterility of injected solutions.

No more than 50-300 ml of liquid can be injected at a time, depending on the body weight and age of the child. With the jet injection of a large amount of fluid, heart failure may develop due to overload of the right side of the heart.

If it is necessary to introduce a significant amount of liquid, then use the drip method. Venous puncture is carried out in the usual way. The needle is connected to a special dropper, which allows you to regulate the speed of droplet fall in the dropper socket. For drip infusions, especially those designed for a long time, butterfly needles and special catheters for intravenous infusions are also used (Fig. 82, c).

Tubes for the drip infusion system can be plastic or rubber. In a disposable system, a special tap or clamp allows you to adjust the infusion rate (based on the number of falling drops per minute). The cylinder with the medicinal solution is suspended on a special tripod. Pressure regulation is achieved by raising or lowering the tripod. It is necessary to create a so-called “stagnant lake” of liquid in the dropper. Before connecting the system to the needle, liquid is passed through the entire system, then a tube is clamped near the cannula, due to which a “stagnation lake” is formed. Before connecting the drip system to a needle or catheter, check to see if there is any air left in the system.

To temporarily interrupt the drip infusion, you can insert a sterile mandrel into the needle or simply clamp the catheter. To preserve the vein for further infusions, a cannula inserted into a catheter is widely used (in the absence of special catheters). A rubber tube 3-4 cm long is put on the cannula, folded in half and tied. A seal is also created at the junction of the rubber tube and the cannula.

To maintain the patency of the needle or catheter (preventing blood clotting), a so-called heparin lock is made. Mix 1 ml of heparin and 9 ml of isotonic chloride solution

sodium, then 1 ml of the mixture is injected through a cannula or needle and the catheter is clamped or a mandrel is inserted into the needle.

Drip administration of medications requires time, which requires fixation of the limb and ensuring long-term rest. The needle is fixed in the vein as follows: a sterile cotton swab is placed under the needle, and on top it is attached to the skin with an adhesive plaster. It is recommended to use transparent film dressings of the ZM Tegaderm type, specially designed for catheterization of peripheral and central veins. Film dressings eliminate the risk of infections associated with catheter installation.

Immobility of the limb is imparted by immobilizing it in a splint or splint; sometimes the hand is fixed to the bed (Fig. 82, d).

When performing intravenous drip infusions, the following complications are possible:

a) air embolism, which occurs when air enters a vein from a syringe or dropper, especially at the time of jet injection of liquid. If pyrogenic or allergic reactions occur, which are expressed in chills, fever, skin rashes, nausea or vomiting, it is necessary to stop further administration of solutions into the vein and inform the doctor about this, since special treatment measures are required;

b) the development of phlebitis, to reduce the risk of which the following rules must be followed:

The temperature of the fluid administered intravenously should be equal to the patient’s body temperature or at least correspond to room temperature;

Droppers must be changed daily;

Strict sterility must be observed;

Hypertonic solutions are administered through other veins. If signs of phlebitis appear, a bandage with Vishnevsky ointment or heparin ointment is applied to the affected area, and the dropper is removed;

c) the formation of blood clots, which can also cause an inflammatory process; in the absence of contraindications, small doses of heparin are administered to prevent thrombosis. It is noted that when the rate of administration of the drug is less than 7-8 drops per 1 minute, the vein quickly thromboses.

Fixation of catheters and needles. Various techniques are used to secure silicone feeding catheters, peripheral intravenous catheters, nasal cannulas and electrodes:

Fixing patch;

Special semi-permeable films;

Pectin barriers;

Special hydrocolloid coatings;

Hydrogels (when taking electrocardiograms and conducting

Ultrasound).

It is recommended to secure catheters, needles, and endotracheal tubes using special medical films to protect the skin. The use of a medical adhesive plaster as a skin fixation poses a certain danger, since even minor damage to the skin, especially in newborns, allows hospital strains of microorganisms to penetrate into the soft tissues of the child; in addition, excessive compression is possible, leading to soft tissue necrosis.

The child's skin is damaged when the adhesive plaster is roughly removed, so you should carefully and slowly remove the adhesive plaster strips, after moistening them with water, liquid soap, mineral oil or Vaseline. If, when stretched horizontally, the strip does not peel off from the skin, you need to moisten it again with a gauze swab.

Drip infusions must be carried out strictly in accordance with the doctor's prescription. It is recommended to use devices for intravenous dosing of fluids (Fig. 83). In their absence, the nurse constantly monitors the rate of fluid administration (by the number of drops per minute) and the good condition of the entire system as a whole.

Often there is a need for sequential administration of medicinal solutions from several bottles. In these cases, they do this: when a small amount of solution remains in the first bottle, close the clamp, quickly remove the air duct from the bottle and insert it into the stopper of the second bottle, which is previously mounted on a stand. Quickly rearrange the needle for the bottle on the short part of the drip system. Open the clamp and regulate the rate at which drops enter the “stagnant lake.”

If additional administration of the drug is necessary during drip infusion, it is administered through the “node for

Rice. 83.Devices for intravenous dosed administration of liquids: a - jet; b - drip

injection" - a rubber tube in the system, using a needle with a cross-section of up to 1.2 mm. The tube is pre-treated with alcohol.

Long-term drip infusions with parenteral nutrition require distribution of the dose of administered substances over 24 hours.

Parenteral administration of drugs in newborns. The administration of drugs in newborns has its own characteristics. Thus, when using various drugs orally, undesirable effects are possible due to the vulnerability of the mucous membrane of the gastrointestinal tract of an immature organism. Newborn babies are prone to regurgitation, gas formation in the stomach, and they often develop intestinal dysbiosis. The rectal route of drug administration to newborns is gaining increasing popularity, although it does not provide sufficient concentrations of some drugs in the blood. The inhalation method of administering drugs is used primarily for oxygen inhalation, as well as for inhalation of aerosols in the treatment of bronchopulmonary diseases.

Any injection in newborns requires the strictest asepsis and antiseptics; For intravenous infusions, polyvinyl chloride catheters are used. Intramuscular injections in newborns, especially premature ones, should be kept to a minimum due to their traumatic nature - only underdeveloped muscles can suffer (necrosis may occur), but also the child’s extremely vulnerable nervous system. Anesthetic creams have been developed especially for newborns and infants to prepare the skin area for injection - EMLA or 2% lidocaine gel. Intramuscular injections are made into the quadriceps femoris muscle, as it is the most developed muscle in children of this age; with injections into the gluteal muscles, severe complications may develop (neuritis, thrombosis).

Intravenous administration should be carried out slowly (1-2 ml/min with simultaneous administration). During drip infusion, it is necessary to monitor the level of the administered drug in plasma. The use of intravascular lines requires careful care of them, since during infusions there is always a threat of complications: infection of catheters, development of thrombosis, thrombophlebitis, peripheral necrosis, hemorrhage, etc.

The rate of drug elimination, as a rule, is significantly reduced in premature infants, which requires strict regulation of the doses of administered drugs.

General child care: Zaprudnov A. M., Grigoriev K. I. textbook. allowance. - 4th ed., revised. and additional - M. 2009. - 416 p. : ill.