Intravenous drip infusion of solutions is used in medicine to introduce large volumes of medicinal fluids into the patient’s bloodstream. This method of drug administration has many advantages: the drug enters the blood unchanged, the dosage is accurate, the speed at which therapeutic concentrations are achieved, and the drug saturates all tissues, especially organs with abundant blood supply (brain, kidneys, lungs, liver). In this way, medications are administered that are not absorbed in the intestines or have a strong local irritant effect.
Indications and contraindications
Intravenous drip administration of drugs is indicated for restoring the volume of circulating blood, relieving signs of intoxication, normalizing the balance of electrolytes, restoring the acid-base balance in the blood, parenteral nutrition, and general anesthesia.
Content:
- Indications and contraindications
- System selection
- Necessary equipment
- Preparation for the procedure
- Carrying out manipulation
- End of the procedure
- Possible complications
Using a special device for drip supply of liquids (system), it is possible to ensure that solutions enter the bloodstream at a rate of 20 to 60 drops per minute.
Contraindications to placing IVs are lesions of the skin and subcutaneous tissue at the site of venipuncture, phlebitis of the vein proposed for injection. If there are local contraindications for an intravenous injection, another vein is chosen.
Intravenous drip administration of drugs
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Introduction of drugs or blood products/components into a venous vessel.
When is intravenous drip administration of drugs needed?
Drip infusions are used for intravenous administration of large volumes of fluid. The main advantages of this method are the speed of action and dosage accuracy. The medicine enters the blood unchanged. This method of administration has a number of advantages: patients tolerate it better, the injected liquid is slowly absorbed and remains in the body longer, does not cause large fluctuations in blood pressure and does not complicate the work of the heart.
Contraindications:
- Any damage to the skin and subcutaneous fat at the intended injection site.
- Muscle tissue atrophy.
- Phlebitis of the punctured vein.
- Some types of medications (such as human immunoglobulin) are administered with caution or not at all in cases of high blood pressure.
Preparation for intravenous drip administration of drugs
No special preparation is required.
For IVs with immunoglobulin, see special conditions for the procedure.
Immunoglobulin therapy is carried out only as prescribed by a doctor at the Center for Disease Control and Prevention if the results of blood tests for Syphilis, HBS Ag, HBC, HIV are available (must be taken only at the Center for Disease Control and Prevention, and with a passport), shelf life of the tests: 3 months.
Procedure and evaluation of results of intravenous drip administration of drugs
The veins of the ulnar fossa are most often used, since they have a large diameter, lie superficially and move relatively little, as well as the superficial veins of the hand, forearm, and elbow.
To administer large volumes of liquid, an intravenous drip system is used, which is a system of tubes and adapters. This system is connected at one end to a container (bottle or bag) with the drug, and on the other side there is a sterile needle, which is inserted directly into the patient’s vein after pre-treatment of the skin at the intended injection site. During the procedure, the needle is securely fixed to the skin using a patch to avoid injury to the vein wall and surrounding tissues. The rate of administration of the medicine is regulated by the nurse performing the procedure using a flow regulator, and depends on the type of medicine and the patient's condition.
Tips and tricks
Before the procedure, be sure to tell the nurse if you have previously had reactions to any medications. During the procedure, it is advisable to maintain relative immobility of the limb to which the system is connected.
During the procedure, immediately tell the nurse if you experience any discomfort at the injection site or any sudden change in your condition.
Note
Intravenous drip infusions at the Center are carried out by appointment, in the afternoon.
You must have the medicine with you and a referral from a doctor indicating the name of the medicine, dosage, route of administration and the number of procedures required. The referral must bear the seal of the doctor who prescribed the procedure and the seal of the medical institution.
System selection
The medical goods market offers various kits for intravenous drip administration of medicinal solutions. When choosing a system, you should consider the size of the filter cells. There is a macro-set, which is marked “PC”, and a micro-set, marked “PR”.
The PC system is used for transfusion of whole blood, blood substitutes or blood products. Blood cells and large molecules pass through the large filter cells without problems. If a PR system is used to transfuse blood products, the filter will quickly clot and the infusion will stop.
For the drip administration 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 medicinal components.
In addition to the size of the filter cells, the material from which the needles are made and their diameter are of great importance when choosing an infusion set. If long-term or repeated intravenous drip administration of low-molecular medicinal liquids throughout the day is required, preference should be given to polymer needles and catheters. To administer solutions from glass containers closed with thick rubber stoppers, you need to choose systems with metal needles.
When choosing a needle diameter, remember that the larger the needle in diameter, the lower the number it will be marked with. 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.
In what cases is intravenous drip infusion prescribed?
The infusion is prescribed to provide immediate and especially effective assistance to the patient. This is necessary for kidney diseases, liver diseases, poisoning.
Administration in a drip mode helps to quickly and significantly alleviate the condition of patients with severe joint and spinal pain. A dropper is necessary to support the functions of organs/systems in the postoperative period, in case of severe injuries, and in case of intoxication associated with infectious lesions.
In some cases, for example, for diseases of the cardiovascular system, musculoskeletal system, kidneys, liver, infusion is carried out as a preventive measure to prevent the exacerbation of diseases, the development of complications due to them, and the development of degenerative processes.
Intravenous drip administration of the solution helps restore the normal functioning of internal organs and systems, reduce or increase blood pressure, and normalize cholesterol and hemoglobin levels.
Necessary equipment
To carry out the procedure, you need to prepare everything you need. A diaper for covering the manipulation table, two trays (the first for sterile instruments and materials, the second for used materials), tweezers, scissors, gloves, cotton balls, and a set for intravenous drip should be sterile.
A tripod is needed to hang the bottle with the dropper solution. At home, you can use portable, collapsible tripods or homemade devices (for example, a transparent polymer bottle with a device for hanging it).
In addition to the above, for manipulation you will need a pad or cushion (under the elbow joint), a tourniquet for squeezing the 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 placing IVs.
Preparation for the procedure is carried out in the manipulation room, observing the rules of asepsis and infection safety:
- Check the tightness of the packaging of the IV kit, its expiration date, and the presence of caps on the needles. If the package is not sealed or its expiration date has expired, this kit cannot be used as its sterility has been compromised.
- Before unpacking the IV kit, staff should thoroughly wash their hands with warm water and soap, dry them, and wear sterile gloves. It is necessary to spread a sterile diaper on the surface of the table for preparing injections. Treat the package with the IV set with a sterile ball moistened with medical alcohol, then open it and place the contents of the package on a sterile diaper.
- The bottle of medicine should be carefully examined. It should have a label with the name of the medicine inside and the expiration date. The bottle should be shaken to make sure that the appearance of the solution has not changed. If additional medications need to be added to the solution bottle, you need to inspect the ampoules or bottles with these medications and make sure that their names correspond to the prescription sheet. They must be suitable for use. The absence of names and/or expiration dates of drugs on ampoules is grounds for refusal to use them.
- You need to remove the aluminum cap from the bottle. To do this, it must be treated with a cotton ball soaked in alcohol, and then remove the lid with sterile tweezers or scissors. Treat the rubber stopper on the bottle with a ball moistened with alcohol.
- Remove the cap from the air duct needle and insert the needle into the bottle stopper until it stops. There is no need to further process the needle: if the conditions for opening the package with the IV 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 placed on a tripod.
- Press the drip chamber twice to fill it halfway with the solution from the bottle. To force air out of the infusion tube, open the clamp, remove the cap from the second needle of the tube and slowly fill the entire system with the solution from the bottle. After the air has been completely displaced, the clamp on the tube is closed and the cap is put on the needle. The system for drip administration of the solution is considered ready for use.
The procedure for drip administration of medication cannot be carried out without the knowledge of the patient or his relatives. Therefore, immediately before it is carried out, they must consent to the manipulation.
Carrying out manipulation
The patient for the intravenous drip procedure must lie down comfortably: he will have to lie down for a certain period of time with his arm motionless. To install an IV, you need to puncture a vein. It is preferable to puncture the veins on the “non-working” arm. It is better to choose dark venous vessels to make it easier to control the process.
It is better to place the dropper in the median vein of the elbow or the medial saphenous vein. They are also easier to place catheters in. Less commonly, veins on the back of the hand are used for drip administration of solutions. So that the medical staff has the opportunity to puncture the vein a second time (if the first time was unsuccessful), it is better to make the puncture closer to the hand. You cannot inject into the previous puncture site a second time: this is dangerous by rupturing the venous wall.
After selecting a vein for venipuncture and before puncturing the venous wall above the injection site, a tourniquet is applied to the arm. You need to tighten the tourniquet so that the pulsation of the veins in the arm below it stops. After applying the tourniquet, a pad 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 venipuncture, medical staff should wear sterile gloves and treat the skin around the puncture site three times: with the first sterile ball, a large area of skin around, the second - a small area and the third - the venipuncture site itself. This triple skin treatment ensures sufficient disinfection of the skin at the site of the IV.
After disinfecting the skin, remove the cap from the free needle of the infusion tube, turn the needle with the bevel upward, and fix the vein with the thumb of your left hand to immobilize it as much as possible. A puncture of the skin and venous wall is made at an angle of 30-45°. With proper manipulation, blood should appear from the cannula of the needle.
A sterile ball is placed under the needle cannula, the tourniquet is removed, the clamp on the infusion tube of the system is opened, a few drops of the solution are drained, and the system is connected to the needle cannula. The ball with drops of blood is removed. To fix the needle in the vein, it is attached to the skin with an adhesive tape.
The bottle with the medicinal solution and the drip chamber should be located higher than the lower cannula of the system. Violating this rule may result in air entering the bloodstream. The required flow rate of the medicine is adjusted using a clamp on the infusion tube of the dropper. The rate of delivery of the medicine is determined by a clock with a second hand. As the medicinal solution is drip-fed, the patient’s well-being and the place where the drip is installed must be constantly monitored.
If during the procedure the patient needs to administer any other medication intravenously, this is done by puncturing the infusion tube, having previously treated it with a disinfectant solution.
End of the procedure
After completing the procedure, close the clamp on the infusion tube, remove the adhesive tape, cover the venipuncture site with a sterile cotton ball and remove the needle from the vein and skin. After this, the patient should bend his arm at the elbow, holding the cotton ball at the site of the skin puncture. The hand must be held in this position for at least 3-5 minutes to prevent the formation of a hematoma at the site of vein puncture.
In order to maintain infection safety, you need to disconnect the dropper system from the bottle of medicine, cut it with scissors and place it in a container with a disinfectant solution (needles - separately, cut tube - separately). After this, medical staff can remove gloves, wash and dry their hands.
In the journal of manipulations and procedures, as well as in the appointment sheet, a note should be made about the manipulation performed.
Intravenous infusion: performing the procedure
- Change gloves to sterile ones.
- Make sure the patient's position is comfortable.
- Place a pillow for intravenous injections under the site of the intended venipuncture.
- Palpate the site of the proposed venipuncture to ensure there are no injuries, hematomas or infiltrates. If any, inform the doctor about this and choose another venipuncture site.
- Apply a venous tourniquet to the middle third of the shoulder through a shirt or diaper so that the pulse is palpable on the radial artery.
- Ask the patient to make a fist and hold it in this position.
- Treat the area of the elbow bend with antiseptic wipes (at least 2) using movements from the center to the periphery. Place used wipes in the waste tray.
- Remove the cap from the needle, fix the vein with the thumb of one hand, stretching the skin. With the other hand, puncture the vein with a needle with a system connected to it, holding the needle with the bevel upward parallel to the skin. When a needle enters a vein, you will feel like you are entering a void. Insert the needle into the vein no more than 1/2 of the length.
- If blood appears in the cannula, ask the patient to unclench his fist and relax his hand. At the same time, remove or loosen the tourniquet.
- Open the screw clamp and adjust the drip rate as prescribed by the doctor.
- Secure the needle and tube of the system to the patient’s skin using a narrow adhesive tape. Cover the needle with a dry sterile cloth.
- Remove gloves and place them in a Class B waste container. Wash your hands hygienically and dry with a disposable towel.
Observe the patient: his appearance, behavior, well-being throughout the entire infusion period.
- Wash your hands with soap and water in a hygienic manner, dry them with a towel, and treat them with a skin antiseptic. When your hands are dry, put on gloves.
- Close the screw clamp, apply an aseptic napkin to the venipuncture site, and remove the needle from the vein as painlessly as possible.
- Place the needle with the connected system in the tray with waste material.
- Change the aseptic napkin to a sterile gauze napkin, on which apply a fixing bandage, like a dry pressure bandage.
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- Make sure there is no external bleeding from the venipuncture site.
- Place the used needle in a puncture-proof Class B sharps waste container, the system and other waste materials that have been in contact with the patient's skin, and all gloves in a Class B waste container.
- The empty bottle and other waste materials not in contact with the patient's skin are placed in a Class A waste container.
- Trays used during the procedure are subject to disinfection, pre-sterilization cleaning and then sterilization.
- After completing the procedure, wash your hands and dry them with a towel.
