Indicate the parenteral method of introducing drugs into the body. Parenteral routes of drug administration. What it is

The parenteral route is the introduction of drugs into the body, bypassing the gastrointestinal tract.

The following types of parenteral administration of drugs are distinguished.

Intravenous administration ensures a rapid onset of the therapeutic effect, allowing you to immediately stop the development adverse reactions and carry out accurate dosing of drugs. Drugs that are poorly absorbed from the gastrointestinal tract or have an irritating effect on it are administered intravenously.

Methods intravenous administration injection solutions:

Bolus administration(from Greek bolos- lump) - rapid intravenous administration of the drug over 3-6 minutes. The dose of the administered drug is indicated in milligrams of the drug or in milliliters of a solution of a certain concentration.

Infusion administration(usually intravenous, but sometimes intra-arterial or intracoronary) is carried out at a certain speed, and the dose is calculated quantitatively (for example, ml / min, mcg / min, mcg / [kg × min]) or less accurately (in the form of the number of drops of solution , administered in 1 min). For more accurate continuous infusion, it is preferable, and in some cases, strictly necessary (for example, intravenous administration of sodium nitroprusside), to use special dispensing syringes, systems for infusion of micro quantities of the drug, special connecting tubes to prevent the loss of drugs in the system due to its adsorption on the walls of the tubes (for example, when administering nitroglycerin).

Combined intravenous administration allows you to quickly achieve a constant therapeutic concentration of the drug in the blood. For example, a bolus is administered intravenously and a maintenance intravenous infusion or regular intramuscular administration of the same drug (for example, lidocaine) is immediately started at certain intervals.

When performing intravenous administration, you should make sure that the needle is in the vein: penetration of the drug into the perivenous space can lead to irritation or tissue necrosis. Some drugs, especially with long-term use, have an irritating effect on the walls of the veins, which may be accompanied by the development of thrombophlebitis and venous thrombosis. When administered intravenously, there is a risk of infection with hepatitis B, C and HIV viruses.

Depending on the clinical situation and the characteristics of the drug’s PK, medicinal substances are injected into the vein at different rates. For example, if you need to quickly create a therapeutic concentration of a drug in the blood that is subject to intensive metabolism or binding to proteins, use rapid (bolus) administration (verapamil, lidocaine, etc.). If there is a danger of overdose with rapid administration and there is a high risk of developing undesirable and toxic effects (cardiac glycosides, procainamide), the drug is administered slowly and in dilution (with isotonic solutions of dextrose or sodium chloride). To create and maintain therapeutic concentrations in the blood for a certain time (several hours), drip administration of drugs is used using blood transfusion systems (aminophylline, glucocorticoids, etc.).

Intra-arterial administration used to create high concentrations of drugs in the corresponding organ (for example, in the liver or limb). Most often this concerns drugs that are rapidly metabolized or bound by tissues. The systemic effect of drugs with this method of administration is practically absent. Arterial thrombosis is considered the most serious complication of intra-arterial drug administration.

Intramuscular administration- one of the most common methods of parenteral administration of drugs, providing a rapid onset of effect (within 10-30 minutes). Depot drugs are administered intramuscularly, oil solutions and some drugs with moderate local and irritating effects. Inappropriate

figuratively inject more than 10 ml of the drug at a time and perform injections near the nerve fibers. Intramuscular administration is accompanied by local pain; Abscesses often develop at the injection site. Penetration of a needle into a blood vessel is dangerous.

Subcutaneous administration. Compared to intramuscular injection, with this method the therapeutic effect develops more slowly, but lasts longer. It is not advisable to use it when in a state of shock when, due to insufficiency of peripheral circulation, drug absorption is minimal.

Recently, the method of subcutaneous implantation of certain drugs has become very common, providing a long-term therapeutic effect (disulfiram - for the treatment of alcoholism, naltrexone - for the treatment of drug addiction, some other drugs).

Inhalation administration- method of using drugs produced in the form of aerosols (salbutamol and other β 2 -adrenergic agonists) and powders (cromoglycic acid). In addition, volatile (anesthesia ether, chloroform) or gaseous (cyclopropane) anesthetics are used by inhalation. This route of administration provides both local β 2 -adrenomimetics) and systemic (anesthetic) effects. Do not administer drugs with irritating properties by inhalation. It must be remembered that as a result of inhalation, the drug immediately enters through pulmonary veins into the left parts of the heart, which creates conditions for the development of a cardiotoxic effect.

Inhalation administration of drugs allows you to accelerate absorption and ensure selectivity of action on respiratory system.

Achieving a particular result depends on the degree of penetration of the drug into the bronchial tree (bronchi, bronchioles, alveoli). When administered by inhalation, absorption will increase if the particles of the drug penetrate into its most distal parts, i.e. into the alveoli, where absorption occurs through thin walls and over a larger area. For example, nitroglycerin, when administered by inhalation, enters directly into the systemic circulation (as opposed to the enteral route of administration).

To achieve a selective effect of a drug on the respiratory system, for example in the treatment of asthma, it is necessary to distribute the bulk of the drug in the bronchi of medium and small caliber. The likelihood of systemic effects depends on the amount of the substance entering the general bloodstream.

For inhalation administration, special delivery systems are used:

A metered-dose aerosol inhaler containing a propellant gas;

Breath-activated dry powder inhaler (turbuhaler);

Nebulizer.

The penetration of drugs into the body depends on the size of the drug particles, inhalation technique and inhalation volumetric flow rate. When using most aerosol inhalers, no more than 20-30% of the total dose enters the respiratory system medicinal substance(respirable fraction). The rest of the drug is retained in the oral cavity and pharynx, and then swallowed by the patient, causing the development of systemic effects (more often undesirable).

The creation of inhalation forms of delivery - powder inhalers - makes it possible to increase the respirable fraction of the drug to 30-50%. Such inhalers are based on the formation of turbulent air flows, which crush large particles of dry drug substance, as a result of which drugs better reach the distal parts of the respiratory tract. The advantage of powder inhalers is the absence of propellant gas, which has a negative impact on the environment. Inhalers for administering a dry powder substance are divided according to the method of using the drug: it is either built into the inhaler or attached to it in the form of a special dosage form.

Breath-activated inhalers (turbuhalers) facilitate the entry of drugs into the respiratory tract, as they do not require coordination of inhalation and pressing on the inhaler canister. The drug enters Airways when inhaling less effort, which increases the effect of treatment.

Another way to increase the respirable fraction when using inhalers is to use auxiliary devices such as spacers and nebulizers.

Spacers are used in conjunction with metered aerosol inhalers. They help to increase the distance between the latter and the patient’s oral cavity. As a result, the time interval between the release of the drug from the can and its entry into the oral cavity increases. Thanks to this, the particles have time to lose excessive speed, and the propellant gas evaporates, leaving

more drug particles of the required size suspended in a spacer. As the speed of the aerosol stream decreases, the impact on back wall throats. Patients feel the cold effect of freon to a lesser extent, and they are less likely to experience a reflex cough. The main characteristics of a spacer are volume and the presence of valves. The greatest effect is achieved when using larger volume spacers; valves prevent loss of aerosol.

Nebulizers are devices that operate by passing a powerful jet of air or oxygen under pressure through a drug solution, or by ultrasonic vibration of the latter. In both cases, a fine aerosol suspension of drug particles is formed, and the patient inhales it through a mouthpiece or face mask. The dose of the drug is delivered over 10-15 minutes while the patient is breathing normally. Nebulizers provide the maximum therapeutic effect with the best ratio of local and systemic effects. The drug reaches the respiratory tract as much as possible, no additional effort is required to inhale. It is possible to administer drugs to children from the first days of life and to patients with varying degrees of disease severity. In addition, nebulizers can be used both in hospitals and at home.

Irritating drugs should not be administered by inhalation. When using gaseous substances, stopping inhalation leads to a rapid cessation of their effect.

Local application- application of drugs to the surface of the skin or mucous membranes to obtain effects at the site of application. When applied to the mucous membranes of the nose, eyes and skin (for example, patches containing nitroglycerin), the active components of many drugs are absorbed and have a systemic effect. In this case, the effects can be desirable (prevention of angina attacks using nitroglycerin patches) and undesirable (side effects of glucocorticoids administered by inhalation).

Other routes of administration. Sometimes, for a direct effect on the central nervous system, drugs are injected into the subarachnoid space. This is how spinal anesthesia is performed and antibacterial drugs are administered for meningitis. To transfer drugs from the surface of the skin to deep tissues, the method of electro- or phonophoresis is used.

Any drug purchased at a pharmacy is accompanied by special instructions for use. Meanwhile, compliance (non-compliance) with the rules of administration can have a large and sometimes decisive impact on the effect of the drug. For example, when ingested, food, gastric juice, digestive enzymes and bile, which are released during digestion, can interact with the drug and change its properties. That is why the connection between taking the medicine and eating is important: on an empty stomach, during or after a meal.

4 hours after or 30 minutes before the next meal (on an empty stomach), the stomach is empty, the amount of digestive juice in it is minimal (a few tablespoons). Gastric juice (a product secreted by the stomach glands during digestion) at this time contains little hydrochloric acid. As breakfast, lunch or dinner approaches, the amount gastric juice And of hydrochloric acid it increases, and with the first portions of food their secretion becomes especially abundant. As food enters the stomach, the acidity of gastric juice decreases as a result of neutralization by food (especially when consuming eggs or milk). Within 1-2 hours after eating, it increases again, since by this time the stomach is empty of food, and the secretion of juice still continues. Particularly pronounced secondary acidity is found after eating fatty fried meat or black bread. In addition, when eating fatty foods, its exit from the stomach is delayed and sometimes pancreatic juice produced by the pancreas is refluxed from the intestines into the stomach (reflux).

Food mixed with gastric juice passes into the initial part of the small intestine - duodenum. Bile produced by the liver and pancreatic juice secreted by the pancreas also begin to flow there. Due to the content of a large number of digestive enzymes in pancreatic juice and biologically active substances in bile, the active process of food digestion begins. Unlike pancreatic juice, bile is secreted constantly (including between meals). Its excess quantity enters gallbladder, where a reserve is created for the needs of the body.

If there are no instructions in the instructions or doctor’s prescriptions, it is better to take the drug on an empty stomach (30 minutes before meals), since interaction with food and digestive juices can disrupt the absorption mechanism or lead to a change in the properties of the drug.

Take on an empty stomach:

All tinctures, infusions, decoctions and similar preparations made from plant materials, since they contain active substances, some of which, under the influence of hydrochloric acid of the stomach, can be digested and converted into inactive forms; in addition, in the presence of food, the absorption of individual components of such drugs may be impaired and, as a result, an insufficient or distorted effect may occur;

All calcium preparations (for example, calcium chloride) that have a pronounced irritant effect; calcium, binding to fatty and other acids, forms insoluble compounds; to avoid irritating effects, it is better to drink such drugs with milk, jelly or rice water;

Medicines that are absorbed with food, but for some reason have an adverse effect on digestion or relax smooth muscles (for example, drotaverine - a drug that eliminates or weakens spasms of smooth muscles);

Tetracycline (you cannot take it and other tetracycline antibiotics with milk, as the drugs bind to calcium).

Take all multivitamin preparations during meals or immediately after them. After eating, it is better to take drugs that irritate the gastric mucosa (indomethacin, acetylsalicylic acid, hormonal agents, metronidazole, reserpine, etc.).

A special group consists of drugs that must act directly on the stomach or the digestive process. Thus, drugs that reduce the acidity of gastric juice (antacids), as well as drugs that weaken the irritating effect of food on a sore stomach and prevent excessive secretion of gastric juice, are usually taken 30 minutes before meals. 10-15 minutes before meals, it is recommended to take drugs that stimulate the secretion of digestive glands (bitterness) and choleretic drugs.

Gastric juice substitutes are taken with food, and bile substitutes (for example, allochol ♠) - at the end or immediately after meals. Medicines that contain digestive enzymes and help digest food (for example, pancreatin) are usually taken before, during or immediately after meals. Acid suppressants (such as cimetidine) should be taken immediately or shortly after meals, otherwise they block digestion at a very early stage.

Not only the presence of food masses in the stomach and intestines affects the absorption of drugs. The composition of food can also change this process. For example, when eating foods rich in fat, the concentration of vitamin A in the blood increases (the speed and completeness of its absorption in the intestines increases). Milk enhances the absorption of vitamin D, the excess of which is dangerous, first of all, for the central nervous system. With a predominantly protein diet or consumption of pickled, sour and salty foods, the absorption of the anti-tuberculosis drug isoniazid worsens, and with a protein-free diet, on the contrary, it improves.

Absorption

Absorption or absorption of a drug is the process of a substance entering the systemic circulation from the site of administration. The drug must pass through several membranes before reaching a specific receptor. Drugs penetrate cell membranes containing lipoproteins through diffusion, filtration or active transport (Fig. 5).

Diffusion- passive passage of drugs through water channels in the membrane or through dissolution in it. This mechanism is inherent in non-ionized non-polar, lipid-soluble and polar (i.e. represented by an electric dipole) chemical compounds. Most drugs are weak organic acids and bases, so their ionization in aqueous solutions depends on the pH of the medium. In the stomach the pH is about 1.0, in the upper intestine - about 6.8, in the lower small intestine - about 7.6, in the oral mucosa - 6.2-7.2,

in the blood - 7.4? 0.04, in urine - 4.6-8.2. This is why the diffusion mechanism is most important for drug absorption.

Filtration- penetration of drugs through pores in the cell membrane as a result of the difference in hydrostatic or osmotic pressure on both sides. This absorption mechanism is characteristic of many water-soluble polar and non-polar chemical compounds. However, due to the small diameter of pores in cell membranes (from 0.4 nm in erythritol membranes),

rocytes and intestinal epithelium up to 4 nm in the capillary endothelium), this mechanism of drug absorption is of little importance (important only for the passage of drugs through the renal glomeruli).

Active transport. Unlike diffusion, this mechanism of drug absorption requires active energy consumption, since the drug must overcome a chemical or electrochemical gradient with the help of a carrier (membrane component) that forms a specific complex with them. The transporter ensures selective transport and saturation of the cell with the drug, even at a low concentration of the latter outside the cell.

Pinocytosis- absorption of extracellular material by membranes with the formation of vesicles. This process is especially characteristic of drugs with a polypeptide structure with a molecular weight of more than 1000 kilodaltons.

Nowadays, technologies have appeared in medicine that can only be called fantastic. It would seem that against the general background of the triumph of a medical genius, the death of a patient due to non-compliance with sanitary standards in a medical institution should be long forgotten. Why is the artificial route of infection gaining momentum in our prosperous times? Why are staphylococcus, hepatitis, and HIV still “walking” in hospitals and maternity hospitals? Dry statistics say that the frequency of only purulent-septic infections in hospitals over last years increased by 20%, with their share in intensive care units 22%, in surgery up to 22%, in urology over 32%, in gynecology 12%, in maternity hospitals (33%).

Let us clarify that the artificial route of transmission of infection is the so-called artificial infection of humans in medical institutions mainly for invasive procedures. How does it happen that people admitted to the hospital for treatment of one disease also develop other diseases there?

Natural infection

With all the variety of opportunities to catch an infection, there are only two mechanisms for transmitting microbes from a sick person to a healthy one:

1. Natural, depending on the person’s compliance with the norms and rules of hygiene.

2. Artificial or medically artificial route of transmission of infection. This is a mechanism that is almost entirely dependent on medical staff complying with their duties.

In the natural way, implementation pathogenic microorganisms can occur when a person comes into contact with a pathogenic environment. Routes of infection:

Airborne, that is, when sneezing, coughing, talking (flu, tuberculosis);

Fecal-oral, that is, through dirty hands, water and food ( infectious diseases gastrointestinal tract);

Contact household (a very wide range of infections, including sexually transmitted infections, skin infections, helminthiasis, typhus, diphtheria and dozens of others).

Incredibly, this is how you can catch any illness by entering a hospital for treatment.

Artificial infection

In medical institutions, there are two main ways of infecting patients, which are characterized as the official route of transmission. This:

1. Parenteral, that is, associated with a violation skin patient.

2. Enteral, possible during certain types of examination of patients, as well as during certain therapeutic procedures.

In addition, the same natural mechanism of infection transmission is thriving in hospitals, repeatedly aggravating the condition of patients. It turns out that you can catch the infection when medical manipulations doctors and nurses, as well as simply being in the hospital.

Causes of infection of patients in medical institutions

Where do conditions arise in hospitals for patients to become infected naturally, and how does it affect the artificial mechanism of transmission of the infection. The reasons are:

1.There are always a lot of people in hospitals infected people. In addition, about 38% of the population, including healthcare workers, are carriers of various pathogens, but people are not aware that they are carriers.

2. An increase in the number of patients (old people, children) who have a significantly reduced threshold of their body’s resistance.

3. Consolidation of highly specialized hospitals into large complexes, where, willingly or unwillingly, a specific ecological environment is created.

In some cases, the patient is artificially infected during dressing changes if the nurse, who is the carrier, does not perform her work wearing a protective mask and gloves. Conversely, a patient can infect a healthcare worker if he performs medical procedures (blood sampling, dental treatment, etc.) without a protective mask, gloves, or special glasses.

Work of junior medical staff

What in this case determines the artificial route of transmission of infection? This is primarily full or insufficient compliance with sanitary standards. Random checks have shown that in many hospitals, orderlies clean wards, manipulation rooms, and even operating rooms poorly. Namely, all surfaces are treated with one cloth, disinfectant solutions for cleaning premises are prepared in lower concentrations than required by standards, no treatment is carried out in wards and offices quartz lamps, even if they are present and in good condition.

The situation is especially sad in maternity hospitals. Artificial infection of the fetus or woman in labor, for example, with purulent-septic infections, can occur due to violation of antiseptic rules when treating the umbilical cord, during obstetrics and further care. The reason may be the simple absence of a mask on the face of a nurse or orderly, who is a carrier of pathogenic microbes, not to mention poorly sterilized instruments, diapers, and so on.

Antibiotics

As noted above, people are often admitted to the hospital with an unclear diagnosis. The patient is prescribed laboratory examinations, and modern methods diagnostics in which the enteral route of introduction (through the mouth) of the corresponding equipment into the body cavity is used. While test results are being prepared, the practice has become to prescribe antibiotics with wide range actions. This in a small part causes positive dynamics, and in a large part leads to the creation of strains of pathogens inside the hospital that do not respond to influences directed against them (disinfection, quartzization, drug therapy). Thanks to natural ways spread, these strains spread throughout the hospital. Unjustified prescription of antibiotics was observed in 72% of patients. In 42% of cases this was in vain. In the country as a whole, due to unjustified antibiotic treatment, the infection rate in hospitals reached 13%.

Diagnosis and treatment

It would seem that new diagnostic methods should help quickly and accurately identify all ailments. This is all true, but to prevent artificial infection of patients, diagnostic equipment must be handled correctly. For example, a bronchoscope must be disinfected for ¾ hours after each patient. Checks have shown that this is rarely observed, because doctors must examine not 5-8 patients according to the norm, but 10-15 according to the list. It is clear that they do not have enough time to process the equipment. The same applies to gastroscopy, colonoscopy, installation of catheters, puncture, instrumental examination, carrying out inhalations.

But the enteral route of drug administration reduces the level of infection. Here, only the duodenal method poses a threat, when the medicine is administered using a probe directly into the duodenum. But oral (taking medicines and tablets by mouth, with or without water), sublingual (under the tongue) and buccal (sticking special pharmaceutical films to the mucous membranes of the gums and cheeks) are practically safe.

Parenteral route of transmission of infection

This transmission mechanism is the leader in the spread of AIDS and hepatitis. It means the peranteral route - infection through the blood and when the integrity of the mucous membranes and skin is violated. In a hospital setting this is possible in the following cases:

Blood/plasma transfusion;

Infection through a syringe during injections;

Surgical intervention;

Carrying out medical procedures.

Artificial infection often occurs in dental clinics and when visiting a gynecologist due to the fact that doctors use improperly processed instruments to examine the mucous membranes of their patients, as well as because doctors work in unsterile gloves.

Injections

This type of therapy has been used for a long time. When the syringes were reusable, they were subject to mandatory sterilization before use. In practice, unfortunately, it was they that led to infection of patients dangerous diseases, including AIDS, due to the flagrant negligence of doctors. Now and for treatment (intravenous and intramuscular injections), and for collecting blood for analysis, only disposable syringes, therefore the risk of artificial infection is minimized here. Before the procedure, healthcare workers are required to check the tightness of the syringe packaging and under no circumstances reuse it or the needle for further manipulations. The situation is different with instruments for endoscopes (needles, biopsy syringes, etc.), which in practice are not processed at all. IN best case scenario they are simply immersed in disinfectant solutions.

Operations

A high percentage of infections occur during surgical intervention. It is curious that in 1941-1945, 8% of infections of the wounded were recorded, and in our time postoperative rates purulent-septic infections increased to 15%. This happens for reasons:

Use of poorly sterilized dressings during or after surgery;

Insufficient sterilization of cutting or non-cutting instruments;

Widespread use of various implants (in orthopedics, dentistry, cardiology). Many microorganisms are able to exist inside these structures; in addition, they cover themselves with a special protective film, making them inaccessible to antibiotics.

Disinfection should be carried out in special containers, autoclaves or chambers, which depends on the sterilization method. Now in operating rooms they are trying to use disposable sterile sheets, clothes for surgeons and patients, which should reduce the level of artificial infection. To exclude infection through implants, after surgery, patients are given enhanced antibacterial therapy.

Blood transfusion

It is believed that through blood transfusion you can only catch syphilis, AIDS and two hepatitis viruses, B and C. It is these pathogens that donated blood is tested for at collection points. But practice shows that even using only disposable syringes, hepatitis viruses D, G, TTV, toxoplasmosis, cytomegalovirus, listeriosis and other infections can be transmitted through blood transfusion. Before donating blood, doctors are required to check all donors for infection. In fact, there is often not enough time to carry out analyzes or there is simply negligence. Therefore it is necessary to mandatory carefully check the blood taken from the donor. But this is not always done, so to this day, even in Moscow clinics, cases of infection of patients during blood transfusion occur. The second problem is that there are many mutated strains that even the latest test systems do not recognize. The same situation with infection occurs during donor organ transplantation.

There are 5 main routes of transmission, which will be listed below.

The artificial route of transmission is...

The artificial route of transmission of infection is an artificial infection in which the spread of an infectious agent occurs as a result of iatrogenic human activity. An example is infection with HIV infection or hepatitis during operations or blood plasma transfusion.

The vector-borne route of infection is...

The vector-borne route of transmission of infection is infection through insects:

flies (Botkin's disease, typhoid fever, dysentery, anthrax), lice (typhus), bedbugs ( relapsing fever), fleas (plague), mosquitoes - anopheles (tropical malaria).

It is necessary to destroy these insects, prevent them from entering living quarters and prevent flies from coming into contact with water and food.

The parenteral route of transmission is...

The parenteral route of transmission of infection is a type of artificial infection mechanism in which the pathogen enters directly into the blood.

Airborne transmission of infection is...

The airborne route of transmission of infection is infection through the air into which tiny splashes and drops of saliva and nasal mucus containing pathogens - droplet infection (flu, sore throat, diphtheria, whooping cough, measles, scarlet fever, tuberculosis). When these splashes and drops dry, the pathogens remain in the dust for a long time (tuberculosis) - a dust infection. Infection occurs through inhalation of pathogens.

The contact route of transmission of infection is...

Contact transmission of infection is, as the name suggests, the spread of an infectious agent through direct contact. It can be carried out by several mechanisms:

Contact with a sick person (natural smallpox, chickenpox, measles, scarlet fever, mumps, Botkin's disease, etc.). Therefore, it is prohibited to enter an apartment where there are sick people. Infection from bacilli carriers. The causative agents of some infectious diseases (typhoid fever, diphtheria, scarlet fever) continue to live in the body of a recovered person for a long time. Bacillary carriers can also be people who have not had this infectious disease, but carry its causative agent, for example, during a diphtheria epidemic up to 7% healthy schoolchildren have diphtheria bacilli in the throat or nose. Bacilli carriers are distributors of pathogens.

The fecal-oral route of transmission is...

The fecal-oral route of transmission of infection is a mechanism of infection in which the pathogen enters the gastrointestinal tract. Infectious disease specialists identify three main mechanisms of infection transmission:

Through the discharge of patients: feces (typhoid fever, dysentery), urine (gonorrhea, scarlet fever, typhoid fever), saliva, nasal mucus. Infection also occurs when pathogens enter the mouth, so it is imperative to instill in children the habit of thoroughly washing their hands before eating. Contact with objects touched by an infectious patient (underwear, water, food products, dishes, toys, books, furniture, room walls). Therefore, disinfection is carried out and it is recommended to use only your own dishes and things. Through unboiled water and milk, unwashed fruits and vegetables, pathogens of gastrointestinal diseases (paratyphoid fever, typhoid fever, dysentery, Botkin's disease) and tuberculosis. Water and milk must be boiled, and fruits and vegetables must be doused with boiling water or peeled.

Parenteral- - “bypassing the gastrointestinal tract.”

Parenteral administration medicines - these are ways of introducing drugs into the body in which they bypass the gastrointestinal tract, in contrast to oral way of using drugs.

There are other, more rare, parenteral methods of administration: transdermal, subarachnoid, intraosseous, intranasal, subconjunctival - however, these methods of drug penetration into the body are used only in special cases.

Parenteral route of transmission of infections- infection through blood or mucous membranes as a result of transfusion of infected blood or blood products or as a result of the use of contaminated needles, syringes or other instruments that damage the skin.

No complications with parenteral nutrition, as a rule, does not happen, as with the administration of other drugs through central veins. It can be accessed through the subclavian or jugular vein into the superior vena cava.

Since this procedure is safe, the technology of parenteral drug administration is widely used in medicine.

What it is

Our body is able to absorb and process substances that enter it through the gastrointestinal tract, skin and mucous membranes. Of course, there are many medicines in the form of tablets, suppositories, ointments, but their use is not always effective, since it is impossible to accurately determine the dosage for each substance, determine the time of entry and exit, as well as the concentration.

Multivitamins and iron supplements are used as drugs for parenteral administration:

• Protein hydrolysates;
• Fat emulsions;
• Energy solutions – carbohydrates in the form of glucose solution, alcohols, fats.

Many drugs are poorly absorbed from the skin or from the intestines, others are destroyed when passing through the liver, so the peculiarities of parenteral administration of drugs have long been of interest to doctors. Parenteral administration of drugs, what does it mean?

Kinds

The technique involves parenteral injection of the drug directly into the tissues, vessels, and cavities of the body. This is done using a syringe, an infusion system. There are a few different types ways in which drugs are introduced into the body:

• Intravenous (it is most advisable to administer drugs through the central veins);
• Intraosseous (very rarely used)

The most commonly used parenteral intravenous or intramuscular method for injecting medications.

Advantages and disadvantages

There are advantages and disadvantages of parenteral drug administration compared to other methods:

• medicinal product quickly enters the body, its intake is not related to work gastrointestinal tract(absorption, destruction by digestive enzymes);
• the drug does not pass through the liver barrier, which ensures dosage accuracy;
• the method of entry into the body does not depend on the patient’s condition, which makes it possible to use it in seriously ill patients and in emergency situations;
• solutions for parenteral administration are easy to dose.

Disadvantages include the possibility of developing complications, for example:

• formation of infiltrate, abscess, hematoma, tissue necrosis at the injection site;
• air or oil embolism;
• phlebitis or vein thrombosis;
• infection with the development of sepsis, hepatitis, AIDS;
• allergy to the drug with development allergic reactions, up to allergic shock;
• lipodystrophy;
• errors when injecting medications.

Of course, such complications are possible, but many of them can be avoided if the technology is followed correctly.

How to administer medications correctly

Each medicine must be used according to the instructions and follow the algorithm for parenteral administration of drugs:

• You cannot administer a medicine intended for intramuscular administration (for example, oil preparations - intravenously);
• you need to follow the rules of antiseptics: wash your hands, use sterile instruments, treat the injection site;
• when giving intravenous injections, you need to be careful not to let air get into the vein;
• Before administering the drug, it is necessary to check the expiration date and dosage;
• before prescribing a medicine, it is necessary to take into account individual intolerance and allergies in patients;
• If complications develop, the patient must be given immediate assistance.

Without the possibility of injections medications, many serious conditions and diseases cannot be cured, but they must be used correctly so as not to cause complications in the patient.

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Parenteral administration of drugs and solutions is carried out:

• ? in tissue (intradermal, subcutaneous, intramuscular, painful focus, bone tissue);
• ? vessels (intravenous, intraarterial, lymphatic vessels- performed by a doctor);
• ? cavities (abdominal, pleural intracardiac, into the spinal canal), procedures are performed by a doctor;
• ? intraosseously (primarily for children under one year of age or more, as well as for severe conditions, convulsions, when intravenous administration is not possible). Performed by a doctor;
• ? into the subarachnoid space through the membranes of the brain, under the arachnoid membrane of the brain in cerebrospinal fluid (sub- under; arachnoidea - arachnoid brain). Performed by a doctor. It is important that medications do not have an irritating effect.

To avoid errors when using injectable dosage forms, it is necessary to follow the triple control rule: first, the nurse reads the doctor’s prescription (first stage), then the label on the package (second stage), and finally, the name of the drug on the ampoule (third stage). Only if all three names match can an injection be given.

Intradermal administration more often used for intradermal tests - Mantoux test, allergy test, anesthesia and other tests. Injection solutions are injected under the epidermis, into the stratum corneum of the skin.

Subcutaneously Drugs are often administered for a faster effect than oral administration. The disadvantages of subcutaneous administration are the introduction of a small volume of the drug and the rate of absorption (resorption). Resorption depends both on local (the degree of development of subcutaneous fat, which is well supplied blood vessels, compactions due to tissue sclerosis), and general factors (condition of the vessels of the circulatory system, their sclerosis). Injection solutions are injected into the subcutaneous fat.

Intramuscularly drugs are administered that are slowly absorbed and cause less irritation of the subcutaneous fat and pain, therefore antibiotic solutions, poorly soluble suspensions (bicillin), oil solutions, etc. are predominantly administered.

Intravenous administration in the form of venous puncture or catheterization requires practical experience introduction. Intravenous administration of the drug is carried out by venipuncture or venesection (dissection of access to the vein and vein, performed by a doctor). Large volumes are administered intravenously medicinal solutions for blood loss, blood products for blood transfusions. In this case, the rate of administration of solutions parenterally has clinical significance. When administered intravenously, medicinal solutions achieve the highest bioavailability. Blood is drawn from a vein for laboratory research and bloodletting.

Intra-arterial introduced a small amount of medicinal solutions that have a vasodilating effect in terminal conditions (shock, electrical trauma, asphyxia and others emergency conditions). The administration is performed by a doctor.

Currently, there are new non-standard ways of introducing a drug into the body. These include microcapsules, long-acting drugs, dosage forms intended purpose, etc.

The advantages of the parenteral route of administration are:

• ? speed of action;
• ? dosage accuracy;
• ? the drug enters the blood unchanged, bypassing the liver.

Flaws:

• ? mandatory participation of a trained medical personnel;
• ? availability of a sterile injection device;
• ? compliance with asepsis and antisepsis, since infection is possible during administration;
• ? difficulty or impossibility of administering the drug in case of bleeding;
• ? skin damage at the injection site.

Knowledge of the technology and features of parenteral administration is the key to successful professional activity medical worker. Indispensable requirements for the professional activity of a paramedical worker when using medicines are:

• ? compliance with labor safety requirements (implementation regulatory documents, hand washing standards, use of gloves and protective clothing, etc.);
• ? compliance with the conditions for performing procedures (stationary, emergency care at home or in conditions of ambulance transportation, outpatient clinics or sanatoriums);
• ? the ability to use material resources, medicines in accordance with the instructions and prescriptions of a doctor, the use of other consumable materials within the limits indicated by approved standards, technologies for performing simple medical services.

Parenteral (bypassing digestive tract) the administration of drugs is carried out by injection.

Injection– introduction of medicinal substances using special injection under pressure into various environments of the body. Injections can be performed in tissue (skin, subcutaneous tissue, muscles, bones), in vessels (veins, arteries, lymphatic vessels), in cavities (abdominal, pleural, cardiac cavity, pericardium, joints), in the subarachnoid space (under the meninges) , into the paraorbital space, spinal (epidural and subarachnoid) administration is also used.

Injections are indispensable in providing first aid when a quick effect is needed, and the administration of the drug is not hampered by vomiting, difficulty swallowing, the patient’s reluctance or unconsciousness.

Speed ​​of action and greater accuracy of dosage, elimination of the barrier function of the liver and, as a result, the drug enters the blood unchanged, maintaining the required concentration of drugs in the blood - these are the main advantages of the parenteral route of drug administration.

Syringes and needles are used for injections. Injections are performed with syringes of various capacities - 1, 2, 5, 10, 20 milliliters. Currently, disposable syringes made of pyrogen-free plastic and factory sterilized are widely used. So-called needle-free injectors are also used, which allow you to administer a medicinal substance intradermally, subcutaneously and intramuscularly without the use of needles. The action of a needleless injector is based on the ability of a jet of liquid supplied under a certain pressure to penetrate the skin. This method is widely used in mass vaccinations.

Injection needles are made of stainless chromium-nickel steel, one end of the needle is obliquely cut and sharpened, and a brass (plastic) cannula is attached to the other end, which fits tightly onto the needle cone of the syringe. Needles for intradermal, subcutaneous, intramuscular, and intravenous injections differ significantly in length, cross-section, sharpening shape and must be used strictly for their intended purpose. The needle for intravenous injections has a cut at an angle of 45 degrees, since with a blunter cut it is difficult to puncture the skin, and therefore the vein slips away from the needle, and with a needle with a sharper cut it is easy to pierce both the front and back walls of the vein at once. For subcutaneous and intramuscular injections, the cutting angle is sharper.

Intradermal injection - the most superficial, used for diagnostic purposes to perform the tuberculin Mantoux reaction, various allergy tests, as well as at the initial stage of local anesthesia. The place for intradermal injection is the inner surface of the forearm. After disinfecting the area with an antiseptic solution (70% ethyl alcohol, alcohol solution of chlorhexidine bigluconate), the end of the needle, cut upward, is inserted at an acute angle, almost parallel to the skin, to a shallow depth so that only its lumen is hidden. At correct technique When it is completed, a “lemon peel”-shaped bump remains at the site of the intradermal injection.

Subcutaneous injection - deeper, it is performed to a depth of 15 mm. With its help, medicinal substances are introduced that are well absorbed into the loose tissue. subcutaneous tissue. The most convenient place for performing subcutaneous injections is the outer surface of the shoulder and thigh, the subscapular region and the anterior abdominal wall (injection of heparin). The surface of the skin where the injection is going to be made is treated twice with sterile cotton balls with alcohol, first a large area, and then the injection site itself. With your left hand, take the skin at the injection site into a fold, right hand a needle is inserted under the skin into the base of the resulting triangle to a depth of 10-15 mm at an angle of 45 degrees to the skin, with the cut facing upward. After administering the medicinal substance, the needle is quickly removed, the injection site is again wiped with alcohol and pressed cotton ball.

It should be remembered that some solutions (for example, calcium chloride, hypertonic sodium chloride solution) when administered subcutaneously cause necrosis of subcutaneous fat.

Intramuscular injection performed in places where the muscle layer: in the upper outer quadrant of the buttock, the anterior outer surface of the thigh, the subscapular region. When administered intramuscularly, the drug quickly penetrates into the blood due to a greater number of blood vessels and muscle contraction than in the subcutaneous tissue.

The gluteal region is conventionally divided into 4 quadrants. Intramuscular injection is recommended to be performed only in the upper outer quadrant, which includes the gluteus maximus, medius and minimus muscles. Injections cannot be made into the upper-inner and lower-outer quadrants, since most of the quadrants are occupied by bone formations (sacrum, head, respectively). femur), and the muscle layer here is insignificant. The neurovascular bundle passes through the lower outer quadrant, and therefore intramuscular injection There is no drug testing in this area.

The patient's position during the injection is lying on his stomach or side. The skin is treated twice with a cotton ball moistened with alcohol, first on a large area of ​​the upper outer quadrant, then directly on the injection site. The skin in the injection area is stretched, and a needle 8-10 cm long with a wide lumen perpendicular to its surface is quickly inserted into the muscle to a depth of 70-80 mm. Immediately before administering the drug, you need to slightly pull the syringe plunger towards you and make sure that the needle does not fall into the blood vessel. If there is no blood flow into the syringe, the solution is slowly injected, after which the needle is removed. In order to improve the absorption of the drug, it is recommended to lightly massage the injection site or apply a warm heating pad.

Intravenous injection more often used in emergency medical care. Intravenous injections are most often performed using venipuncture (percutaneous insertion of a needle into a vein), less often using venosection (surgical opening of the lumen of a vein). These manipulations are the most responsible, since the concentration of drugs in the blood after intravenous administration increases much faster than when using other methods of administering drugs; at the same time, errors when performing intravenous injections can have very serious consequences for the patient.

Venipuncture is carried out for the purpose of drawing blood for various studies and for bloodletting, for intravenous administration of drugs, blood transfusions and blood substitutes. It is most convenient to perform intravenous injections into the veins of the elbow; in some cases, the superficial veins of the forearm, hand, popliteal area, temporal region (in children), and sometimes the veins of the lower leg are used.

When performing an intravenous injection, you must always remember that the drug goes directly into the blood, and any mistake (violation of asepsis, drug overdose, air or oil drug entering the vein, erroneous administration of the drug) can be fatal for the patient.

Needle length for intravenous injection 40 mm, internal diameter - 0.8 mm, while the needle cut should be at an angle of 45 degrees to minimize the likelihood of injury or puncture of the opposite wall of the vein.

During venipuncture, the patient sits or lies. The arm should have firm support and lie on a table or couch in the position of maximum extension at the elbow joint, for which an oilcloth pillow is placed under the elbow, and during bloodletting, a diaper is placed.

Preparation of the vein is very important for the success of venipuncture. It is easiest to puncture a vein that is well filled with blood. To do this, 1-3 minutes before the puncture, apply a rubber tourniquet in the middle third of the shoulder and block the outflow of blood from the vein, while the pulse on the radial artery should not change. The tourniquet is tied so that its free ends point up and the loop points down. When the pulse on the radial artery weakens, the tourniquet should be loosened slightly. If the ulnar vein is difficult to palpate and the skin below the tourniquet does not acquire a cyanotic color, the tourniquet should be tightened. To increase the filling of the veins, the patient is asked to squeeze and unclench the hand several times.

Before venipuncture, the nurse performs hygienic hand disinfection. She carefully treats the skin of the patient's elbow with sterile cotton wool moistened with alcohol until slight hyperemia appears, moving from the periphery to the center, determining the filling of the vessels with blood and choosing the most filled and superficially located vein. It is better to choose the injection site in the zones of bifurcation branches, since in this zone the vein is most fixed, especially for elderly patients with processes of sclerosis of the vascular bed.

The vein puncture can be performed in two stages or simultaneously. For beginners, it is better to use the two-step method. Holding the needle with the right hand with the cut up parallel to the intended vein and under a sharp angle, only the skin is pierced - the needle will lie next to the vein and parallel to it, then the vein itself is pierced from the side; this creates a feeling of falling into emptiness. When the needle is in the vein, droplets of blood will appear from the cannula, then the tourniquet is removed, and the needle is moved a few millimeters forward along the vessel. Attach a syringe to the needle and slowly inject the medicinal solution, leaving 1-2 ml in the syringe. If the needle is already connected to the syringe, to control its position, you should pull the syringe plunger towards you several times, and the appearance of blood in the syringe will confirm correct position needles. The one-stage venipuncture method requires great skill. In this case, the skin is pierced above the vein and simultaneously with it. The angle between the needle and the skin, acute at the beginning of the puncture, decreases as the needle enters, and its advancement into the vein after entering occurs when the needle moves almost parallel to the skin. By pulling the plunger, as soon as blood appears in the syringe, they are convinced that it is in a vein, and, after removing the tourniquet, the drug is injected.

After completing the administration of the drug, the needle is quickly removed, the skin of the injection site is treated with alcohol again and a sterile cotton ball is pressed against it for 2-3 minutes or a pressure bandage is applied to this area.

METHODS FOR COLLECTING BIOLOGICAL

MATERIAL

When instructing the patient about the procedure for taking biological material Instructions for research must be given clearly, intelligibly and slowly. If the patient finds it difficult to repeat them, you should make short notes for him “as a keepsake” on a piece of paper. It is necessary to convince the patient that only careful, scrupulous adherence to the rules for collecting material for analysis is the key to a correct diagnosis.

When collecting biological material, precautions should be taken. Direct contact with biological material must be avoided. You only need to work in rubber gloves, try not to break laboratory glassware and not injure yourself with glass fragments. Patient waste must be decontaminated before being discharged into the sewer. Laboratory glassware, vessels and urinals, stool collection loops, etc. should be thoroughly disinfected.

If the patient's discharge comes into contact with bare hands, it is necessary to perform hygienic disinfection using one of the methods used in this medical institution. Compliance with these rules will prevent the transmission of various infectious agents, including HIV infection, from patients.

In general, the algorithm for collecting, marking and transporting biological materials can be presented as follows:

Prepare the work site in compliance with aseptic rules;

Perform hygienic hand disinfection, wear sterile gloves;

Take a sufficient amount of biological material in compliance with the rules of asepsis; it is not recommended to talk, sneeze, or cough;

Place the biological material in a sterile container;

Attach a label indicating the patient’s name, diagnosis, department, ward, date and time of receipt of the material, purpose of the study;

Properly store and promptly transport biological material to the laboratory.

1. Blood is taken for clinical, biochemical, bacteriological, immunological tests, as well as for sugar, in the morning on an empty stomach. The test tube must be dry, chemically clean, and have a ground-in rubber cap. It is prohibited to draw blood without a syringe, using only one needle.

2. General urine analysis: a morning average urine sample of 100-200 ml is used after preliminary thorough toileting of the external genitalia. If it is necessary to establish the source of possible changes in urine, a two- or three-glass test is used (the patient urinates successively in three vessels in the morning).

3. Kakovsky-Addis test: the day before the patient urinates for the last time in the evening, and the next day at 8.00 all urine is collected (in women with a catheter) and immediately sent to the laboratory.

4. Nechiporenko test: only an average disposable portion of freshly released urine is used.

5. Zimnitsky test: used to assess the concentration function of the kidneys during normal eating and drinking conditions. Urine is collected every 3 hours in a separate container, and daytime (from 6.00 to 18.00) and nighttime (from 18.00 to 6.00) diuresis are taken into account separately.

6. Urinalysis for 17-ketosteroids: taken from a daily amount of 200 ml of urine in a 500 ml sterile jar with a plastic lid. The direction indicates the daily amount of urine.

7. Bacteriological examination of urine: a sterile test tube is filled with an average portion of freshly released urine in the amount of 10 ml and sent to the bacteriological laboratory.

8. Laboratory examination of stool: stool for examination should be collected in the morning after sleep. The patient empties his bowels into a clean container, then places a small amount of stool with a spatula into a clean, dry glass jar, which is sent to the laboratory. To test stool for worm eggs, you need to take warm stool from three places.

9. Taking a smear from the throat: use a sterile cotton swab to pass along the arches and palatine tonsils, without touching the mucous membrane of the mouth and tongue. Then carefully insert a sterile swab into the test tube, without touching its walls, and label the test tube.

10. Taking a nasal swab: using light translational and rotational movements, sequentially insert a sterile cotton swab into the lower nasal passage on one side and then on the other. Next, place the swab into the test tube and label it. The test tube should be immediately delivered to the bacteriological laboratory.

11. Collection of sputum for general analysis: sputum is collected in the morning on an empty stomach. Before collecting it, the patient must brush his teeth and rinse his mouth with boiled water. It is necessary to collect sputum after coughing into a spittoon, close the lid and deliver it to the laboratory no later than 1 hour after collection.

PREPARATION OF PATIENTS FOR X-RAY SURVEYS,

ENDOSCOPIC AND ULTRASONIC

RESEARCH

The reliability and effectiveness of the results of additional research methods largely depends on the quality of patient preparation for these research methods.

X-ray examination stomach and duodenum plays an important role in the diagnosis of pathology of the upper gastrointestinal tract. Currently, it is generally accepted that patients with normal gastrointestinal function do not need special preparation for gastric X-ray examination, which is performed on an empty stomach. Only if the patient has organic stenosis of the pyloric part of the stomach, the stomach should be rinsed 2-3 hours before the study. The preparation for conducting endoscopic examination of the stomach and duodenum . Routine esophagogastroduodenoscopy is performed in the morning on an empty stomach; An emergency study is performed at any time of the day; if necessary, before endoscopy, the stomach is washed to “clean” lavage water.

X-ray and endoscopic examination colon (irrigoscopy and colonoscopy, respectively) are the leading methods for diagnosing diseases of the colon and rectum and require careful preparation of the distal gastrointestinal tract. Classic way Preparing the colon for the study is as follows. On the eve of the study, the patient is given 30 g of castor oil before lunch, and in the evening they are given a cleansing enema twice with an interval of 1 hour. The patient does not eat dinner. In the morning, two cleansing enemas are given again.

Currently, the drugs Duphalac and Fortrans are increasingly used to prepare the colon for examination (as well as for surgery).

On the eve of the study, the patient must follow a special “cleansing” slag-free diet. You cannot eat meat products, poultry, fish, cereals and cereals, bread and pasta, vegetables and fruits in any form throughout the day; You are only allowed to consume it during the day clear liquids– mineral water, tea without sugar, clear broth.

When using the drug "Duphalac" at 13:00, dilute 100 ml of the drug in 1-2 liters of water, and drink this first portion over the next 4 hours. The patient should experience mild, painless diarrhea. At 19-20 hours, dilute 100 ml of Duphalac in 1-2 liters of water, and also drink this portion. Moderate, painless diarrhea will continue, and the lavage fluid released should gradually become clearer and free of additional symptoms.

When using the drug "Fortrans", the contents of 4 sachets should be dissolved in 1 liter of water each and stirred until completely dissolved. The resulting solution should be taken in a dosage equal to 1 liter per 15-20 kg of body weight, which approximately corresponds to 3-4 liters. The solution can be taken once, 4 liters the day before the test, or divided into 2 doses (2 liters the night before and 2 liters in the morning), and the drug should be completed 3-4 hours before the test.

The amount of liquid the patient drinks, taking into account the volume of broths or juices drunk, should not be less than 4 liters!

Ultrasound examination (echography) has found wide application in the diagnosis of organ diseases abdominal cavity and retroperitoneal space. This study is usually carried out in the morning on an empty stomach, preparation usually comes down to combating flatulence, which is achieved by prescribing the above-mentioned diet and using activated carbon or carbolene (0.5-1 g 3-4 times a day) before the ultrasound examination.

FIRST AND PRE-HOSPITAL MEDICAL AID