Intravenous drip of solutions is used in medicine for the injection of large volumes of medicinal fluids into the bloodstream of a patient. This method of administering drugs has many advantages: the medication enters the blood unchanged, the dosage accuracy, the speed at which the therapeutic concentration is reached, and the drug saturates all tissues, especially organs with plentiful blood supply (brain, kidneys, lungs, liver). In this way, drugs are introduced that are not absorbed in the intestine or have a strong local irritating effect.
Indications and contraindications
Intravenous drip of drugs is indicated to restore the volume of circulating blood, remove signs of intoxication, normalize the balance of electrolytes, restore acid-base balance in the blood, parenteral nutrition, general anesthesia.
Using a special device for the drip supply of fluids (system), it is possible to ensure the flow of solutions into the bloodstream at a speed of 20 to 60 drops per minute.
Contraindications to the installation of droppers are lesions of the skin and subcutaneous tissue at the site of venipuncture, phlebitis, intended for injection of a vein. If there are local contraindications for an intravenous injection, another vein is chosen.
The market for medical supplies offers various kits for intravenous drip administration of medicinal solutions. When choosing a system, consider the size of the filter cells. Distinguish between a macro-kit that is labeled “PC” and a micro-kit that is labeled “PR”.
The PC system is used for transfusion of whole blood, blood substitutes or blood products. Blood cells and large molecules pass through large filter cells without problems. If the PR system is used for transfusion of blood products, the filter will quickly thrombose and the infusion will stop.
For the drip introduction of solutions of electrolytes, amino acids, glucose and other finely dispersed solutions, PR systems are used. The small size of the filter cells (diameter no more than 15 microns) prevents the entry of harmful impurities from the solution into the circulatory system, but does not prevent the passage of drug components.
In addition to the size of the filter cells, the material from which the needles are made and their diameter is of great importance when choosing an infusion set. If prolonged or repeated intravenous drip of low molecular weight medicinal fluids is required during the day, preference should be given to polymer needles and catheters. For the introduction of solutions from glass containers, closed with dense rubber stoppers, you need to choose a system with metal needles.
When choosing the diameter of the needle, remember that the larger the needle in diameter, the lower the number it will be marked. So, for example, the thickest needle, which is used in intensive care to relieve shock symptoms, is marked 14, and the “children's” needle is marked 22.
For the procedure, you need to prepare everything you need. The diaper should be sterile for covering the handling table, two trays (the first for sterile instruments and materials, the second for used ones), tweezers, scissors, gloves, cotton balls, a kit for intravenous drip administration.
To hang up a bottle with a solution for a dropper, you need a tripod. At home, you can use portable collapsible tripods or home-made devices (for example, a transparent plastic bottle with a device for hanging it).
In addition to the above, for manipulation you will need a pad or roller (under the elbow joint), a tourniquet for compressing veins, an adhesive plaster, and medical alcohol (70 °) as a disinfectant solution.
Preparation for the procedure
In order for the manipulation to be safe, the personnel performing it must strictly follow the algorithm of actions when setting droppers.
Preparation for the procedure is performed in the control room, observing the rules of asepsis and infectious safety:
- Check the tightness of the packaging of the dropper kit, its shelf life, the presence of caps on the needles. If the bag is leaky or the expiration date has expired, this kit cannot be used because its sterility has been compromised.
- Before unpacking the dropper kit, personnel need to thoroughly wash their hands with warm water and soap, dry them, and put on sterile gloves. On the surface of the injection preparation table, it is necessary to spread a sterile diaper. Treat the bag with the dropper kit with a sterile ball moistened with medical alcohol, then open it and put the contents of the package on a sterile diaper.
- The medicine vial should be carefully examined. It should have a label with the name of the drug inside and the expiration date. Shake the bottle to make sure that the appearance of the solution has not changed. If additional medicines must be introduced into the vial with the solution, you need to examine the ampoules or vials with these medicines, make sure that their names correspond to the prescription list. They must be suitable for use. The absence of names and / or shelf life of drugs in ampoules is the basis for refusing to use them.
- Remove the aluminum cap from the vial. To do this, it must be treated with a cotton ball soaked in alcohol, and then remove the cover with sterile tweezers or scissors. To process a rubber stopper on a bottle moistened with an alcohol ball.
- The cap is removed from the duct needle and the needle is inserted into the stopper of the bottle until it stops. It is not necessary to additionally process the needle: if the conditions for opening the bag with the dropper kit are met, the needle is sterile. Do the same with the needle of the infusion tube. Check that the clamp (wheel) on the infusion tube is closed. The bottle is turned over and mounted on a tripod.
- Double-click on the drip chamber to half fill it with a solution from the bottle. To displace air from the infusion tube, open the clamp, remove the cap from the second needle of the tube and slowly fill the entire system with solution from the vial. After complete displacement of air, the clamp on the tube is closed, and a cap is put on the needle. The system for the drip solution is considered ready for use.
The procedure for the drip of the drug can not be carried out without the knowledge of the patient or his relatives. Therefore, immediately before its implementation, they need to take consent to the manipulation.
The patient for an intravenous drip procedure should lie down comfortably: he will have to lie with a motionless hand for some period of time. To install a dropper, you need to puncture a vein. It is preferable to puncture veins on a "non-working" hand. It is better to choose dark venous vessels to make it easier to control the process.
A dropper is best placed in the median vein of the elbow or medial saphenous vein. They are also easier to place catheters. Less commonly, veins on the back of the hand are used to drip the solutions. So that the medical staff had the opportunity to puncture a vein a second time (if the first time was unsuccessful), it is better to make a puncture closer to the hand. The second time it is impossible to stab into the previous puncture site: it is dangerous to rupture the venous wall.
After choosing a vein for venipuncture and before puncture of the venous wall above the injection site, a tourniquet is applied to the arm. Tighten the tourniquet so that the pulsation of the veins on the arm below it stops. After applying the tourniquet, a small pillow is placed under the patient's elbow to achieve maximum extension of the joint. The patient must "work with his fist" to create artificial venous stasis.
Before the venipuncture, the medical staff should put on sterile gloves and treat the skin around the puncture site three times: with the first sterile ball there is a large field of skin around, the second with a small field and the third with the venipuncture site. Such a triple treatment of the skin provides sufficient disinfection of the skin at the site of the dropper.
After disinfection of the skin, remove the cap from the free needle of the infusion tube, rotate the needle with the cut up, and fix the vein with the thumb of your left hand to immobilize it as much as possible. At an angle of 30-45 ° they puncture the skin and venous wall. From the cannula of the needle, with proper manipulation, blood should appear.
A sterile ball is placed under the cannula of the needle, the tourniquet is removed, the clamp on the infusion tube of the system is opened, several drops of the solution are drained, the system is connected to the needle cannula. The ball with the drops of blood is removed. To fix the needle in a vein, it is attached to the skin with a band-aid.
The drug vial and drip chamber should be higher than the lower cannula of the system. Violation of this rule can lead to air entering the bloodstream. The required drug delivery rate is controlled by clamping on the infusion tube of the dropper. The speed of the drug is determined by the clock with a second hand. As the drug solution is dripped, the patient's well-being and the place of installation of the dropper must be constantly monitored.
If during the procedure the patient needs to inject another medication intravenously, this is done by puncture of the infusion tube, having previously treated it with a disinfectant solution.
End of procedure
After the procedure, close the clamp on the infusion tube, remove the adhesive plaster, cover the venipuncture site with a sterile cotton ball and pull the needle out of the vein and skin. After this, the patient should bend his arm at the elbow, holding a cotton ball at the site of skin puncture. In this position, the hand must be held for at least 3-5 minutes to prevent the formation of a hematoma at the site of the puncture of the vein.
In order to maintain infectious safety, you need to disconnect the dropper system from the medicine vial, cut it with scissors and place it in a container with a disinfectant solution (needles - separately, cut tube - separately). After that, the medical staff can take off their gloves, wash and dry their hands.
In the register of manipulations and procedures, as well as in the list of appointments, a note should be made about the manipulation.
When setting an intravenous dropper, complications are possible. These include:
- spasm of a vein during venipuncture;
- painful swelling and hematoma at the site of skin puncture;
- air and fat embolism;
- damage to tendons, nerves and arteries;
- pyrogenic and allergic reactions;
- dizziness, cardiac arrhythmias, collapse.
If vein spasm occurs during venipuncture, its opposite wall may be damaged. As a result, blood and drug enter the paravasal space. Blood shedding is fraught with swelling and the formation of a hematoma at the puncture site, and some types of medications, such as calcium chloride or aminophylline, have a local irritant effect on the circulatory tissues.
Extravasation refers to the ingress of a large volume of a medicinal product into the perivascular space, which is due to a violation of the technique of manipulation. The most dangerous consequence of extravasation is tissue necrosis.
Phlebitis (inflammation of the venous walls) develops from irritation of the vascular walls with drug solutions. May result in thrombosis of a damaged vein. Sepsis is the result of violations of the rules of asepsis and antiseptics during the manipulation.
Fat embolism develops as a result of erroneous injection of fat emulsions into a vein, and air embolism as a result of air bubbles entering the bloodstream in violation of the algorithm for preparing and setting the dropper.
If the puncture of the median vein of the elbow is too deep, damage to the tendon of the biceps of the shoulder or brachial artery is possible.
Pyrogenic reactions (a sharp increase in body temperature, chills) can occur when expired medicines are used for infusion or if some drugs are intolerant to patients. Too rapid administration of drugs can provoke dizziness, heart rhythm failure, or collapse in a patient.
Allergic reactions to intravenous drip of therapeutic solutions develop when they are intolerant to patients and can occur in the form of skin allergies, rash, itching, Quincke's edema and anaphylactic shock.
With local complications, patients require local treatment (absorbable compresses, iodine nets). In case of severe general complications, it is necessary to stop the procedure and provide emergency care to patients, for example, with anaphylactic shock or collapse.
Intravenous drip of solutions is often used in medicine, but insufficient qualification of the medical personnel who perform the manipulation, and violation of the instructions for its implementation can lead to the development of complications that are dangerous to the patient’s health and life.