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Emergency tetanus prophylaxis

Intramuscular injection (V / m) Is a parenteral route of drug administration, in which a drug enters the body by injecting an injection solution through a syringe into the muscle tissue.

After an intramuscular injection, the drug enters the bloodstream by absorption of the drug in the vascular bed of skeletal muscle.

The muscular system is better supplied with blood than subcutaneous tissue, then, with intramuscular administration, the effect of the drug usually begins faster than with subcutaneous, but slower than with intravenous.

Intramuscular injections are used when it is necessary to introduce into the muscle both an aqueous and an oil solution of drugs, or suspensions, in volume no more than 10 ml. Vaccines against infectious diseases are also administered intramuscularly by administering a vaccine or toxoid to the body.

Intramuscular injection

The use of intramuscular injection is the most common type of parenteral administration of drugs due to the good vascularization of skeletal muscles, it contributes to the rapid absorption of drugs, and also due to the simplicity of the administration technique, which allows this method to be used by people without special medical training after mastering the relevant skills.

Intramuscular injection can also be used to administer oily solutions of drugs or suspensions (subject to the condition that the oil solution or suspension does not enter the bloodstream) Typically, a drug is administered intramuscularly when there is no need for an immediate effect from the administration of the drug (drug absorption after intramuscular injection occurs within 10-30 minutes after administration), when the administration causes phlebitis or thrombophlebitis, and subcutaneous administration causes the formation of infiltrates and abscesses at the injection site.

Intramuscular injections are also mainly used in the provision of emergency medical care to patients in a state of excitement or to patients with seizures (due to the difficulty in carrying out subcutaneous or intravenous administration of drugs in such patients).

During the injection, medications are recommended to be administered in a volume of not more than 10 ml, in order to avoid overstretching of muscle tissue and the formation of infiltrate.

Do not intramuscularly administer drugs that have a locally irritating effect or are capable of causing necrosis (necrosis) and abscesses at the injection site. Intramuscular injection is also not used to administer a heparin solution due to the formation of hematomas at the injection site.

Intramuscular injection of drugs is not recommended for patients undergoing continuous dialysis.

For intramuscular injection, it is necessary to have a sterile medical instrument - (syringe) and a sterile form of the drug.

By intramuscular injection, drugs can be administered both in the conditions of medical institutions (outpatient and inpatient departments), and at home (in the absence of appropriate skills in the patient, the medical worker is invited to the house), as well as in emergency medical care - in an ambulance assistance, including.

Tetanus injection for cuts, animal bites, frostbite, burns (emergency prevention)

The scheme for the selection of prophylactic agents during emergency specific prophylaxis depends on the age and period elapsed since the last vaccination, taking into account the nature of the injury.

Previous tetanus shotsAgeDates past the last vaccinationPreparations
AC-toxoid 1IPSC 2Pss
If there is documented evidence of vaccinations
Full course of routine vaccinations according to ageChildren and teensRegardless of the termDo not enter 3Do not enter
Routine vaccinations without last age revaccinationChildren and teensRegardless of the term0.5 mlDo not enterDo not enter
Full course of immunizationAdultsNo more than 5 yearsDo not enterDo not enterDo not enter
More than 5 years0.5 ml
Only two vaccinations receivedChildren, teens, adultsNo more than 5 years0.5 mlDo not enterDo not enter
More than 5 years1.0 ml250 IU3000 IU
Only one vaccine receivedChildren, teens, adultsNo more than 2 years0.5 mlDo not enter 4Do not enter 4
More than 2 years1.0 ml250 IU3000 IU
Not vaccinatedChildren under 5 months-Do not enter250 IU3000 IU
Other ages-0.5 ml250 IU3000 IU
No vaccination confirmation
There were no contraindications to vaccinationsChildren under 5 months-Do not enter250 IU3000 IU
Children from 5 months, teenagers-0.5 mlDo not enter 4Do not enter 4
1 place of 0.5 ml of AC-toxoid can be used ADS-M-toxoid if immunization against diphtheria with this drug is necessary. If the localization of the wound allows, AC-toxoid is preferably introduced into the area of ​​its location by subcutaneous chipping.
2 Use one of these drugs: iPSC or PSS (it is preferable to introduce iPSC).
3 For "infected" wounds, 0.5 ml of AC-toxoid is administered if 5 or more years have passed since the last revaccination.
4 For “infected” wounds, PSI or PSS are administered.

Differentiation of wounds into "infected" and "uninfected"

Clinical signs"Infected" woundUninfected Wound
Time since wound was receivedmore than 6 hoursless than 6 hours
Wound configurationchipped, abrasion, gap"linear" wounds (narrow, long with smooth edges)
Wound depthmore than 1 cmup to 1 cm
Wounding Mechanismpiercing, burn, frostbitesharp objects (knife, glass, etc.)
(soil, fabric, splinter, etc.)is presentabsent

"Infected" wounds also include - an umbilical wound during childbirth outside the hospital, community-acquired abortion, penetrating wounds of the intestine, abscesses, necrosis, and bites.

The introduction of drugs is NOT carried out:

  • children and adolescents who have documented evidence of planned preventive vaccinations in accordance with their age, regardless of the period that has passed since the next vaccination,
  • adults who have documented a complete immunization course no more than 5 years ago,
  • persons having, according to emergency immunological control, a titer of tetanus antitoxin in blood serum above 0.1 IU / ml (protective titer).

Only 0.5 ml of AC-toxoid is administered:

  • children and adolescents who have documented evidence of a course of planned preventive vaccinations without the last age-related booster vaccination, regardless of the duration of the last vaccination,
  • adults who have documented a complete immunization course more than 5 years ago,
  • persons of all ages who received two vaccinations no more than 5 years ago, or one vaccine no more than 2 years ago, children from 5 months of age, adolescents whose vaccination history is not known, and there were no contraindications for vaccinations,
  • persons having, according to emergency immunological control, a tetanus toxoid titer in the range of 1: 20-1: 80 according to RPHA or in the range of 0.01-0.1 IU / ml according to pH.

Types of injections

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The main types of injections include the following:

  • intradermal (intracutaneous)
  • subcutaneous (subcutaneous)
  • intramuscular (intramuscular)
  • intravenous (intravenous)
  • intraarterial
  • intraosseous
  • parabulbar (the solution is injected into the area under the eyeball)

How does a hematoma occur after an injection?

Bruising or bruising can occur after the injection. In fact, these are different versions of the same phenomenon. The mechanism of the phenomenon is simple - a metal needle, when inserted into the body, injures soft tissues and blood vessels, as a result, subcutaneous or intramuscular hemorrhage occurs.

Bruising differs from a hematoma in that it causes hemorrhage in the soft tissue of the subcutaneous tissue or muscle tissue. And with a hematoma, the spilled blood separates the tissues and collects in the formed cavity.

Where can postinjection hematomas appear?

On the human body there are many areas where injections can be made. But, most often, the following are used for this purpose: the buttock and shoulder area (for intramuscular injection), the ulnar fossa (for intravenous), the anterior external surface of the thigh, the lateral surface of the abdomen, the external surface of the shoulder (for subcutaneous injection). Other options are used much less often. It is in these places that hematomas can form.

What is the danger of hematomas formed after injections?

If after an injection there was a damage to a blood vessel and a hemorrhage formed in the form of a hematoma, then as simple as a normal bruise, it will not disappear. Depending on which vessel was damaged and how large the hematoma is, it can manifest itself in different ways.

The main danger is that blood, in the cavity between the tissues, can become infected and fester. Even if it coagulates, the clot will not go anywhere. It will compress soft tissues, disrupting their functions, and then it can also fester or petrify.

But, in most cases, hematoma after injection, especially small, is just a temporary cosmetic inconvenience that does not pose a threat to the health and life of the patient.

How long does the hematoma last after injection?

A hematoma, especially if the amount of blood in the tissues is significant, will not disappear as quickly as the usual interstitial hemorrhage that occurs with injuries.

If the bruise goes through all stages of “flowering” in 7-14 days, then with post-injection hematomas these stages are much longer. It all depends on the amount of blood in the formed cavity and the structure of the subcutaneous tissue or muscle at the injection site. In some cases, special treatment cannot be dispensed with.

Why do hematomas appear after an injection?

There are several causes of hemorrhage after an injection or collection of shelter, here are the main ones:

  1. Incorrect injection technique and medical personnel errors. In case of violation of the procedure or improperly performed injection, there is a high probability of the formation of a hematoma after an injection. This happens if you pierce the vein through or make an injection in the wrong place where it is recommended to give an injection.
  2. Reuse of a disposable injection syringe. After the first injection, the needle of a disposable syringe becomes dull, which means that with each subsequent use it injures soft tissues more and more.
  3. Individual characteristics of the vessels of the patient. Some veins are very poorly visible and palpable, and they can also have a thin wall and be slipping. This makes it difficult to hit them with a needle. Some veins may be brittle. When the needle enters such a vessel, a crack forms on its surface, due to which a hematoma occurs.
  4. General circulatory disorders. In some diseases, disorders of both general and peripheral blood circulation occur. Because of this, the veins collapse, which makes it more difficult to inject drugs or take blood. Also in this case, there is an increased likelihood of damaging the vessel wall and provoking the formation of a hematoma after an injection.

How to prevent hematoma formation after injection?

  1. It is necessary to correctly assess the condition of the patient, taking into account the individual structural features of his vascular network. It is necessary to choose a place for an injection, taking into account these data.
  2. A puncture should be done, observing the rules of the procedure, in the necessary order.
  3. Before the injection, and after it, it is necessary to treat the injection site with alcohol. And you do not need to rub it and massage, just put a cotton wool and press it.
  4. It is necessary to use only high-quality syringes (for example, three-component), which allow the piston to move smoothly without injuring soft tissues. In no case should you re-inject with a disposable syringe!
  5. Injection should only be done by experienced and trained people with a medical background.

How to treat hematoma after an injection?

Treatment is selected depending on the location and type of hematoma. The treatment of hematoma should be done only by a doctor. Self-medication is not recommended, because of the risk of complications. If the hemorrhage in the tissue is large, a puncture or incision may be required, with the contents removed. It is important that the bleeding stops at the site of hematoma formation.

If hematoma after injection small, at the injection site there is a slight swelling, which does not increase, you can limit yourself to conservative treatment. With this method of therapy, ointments with heparin or troxerutin are popular, which contribute to the rapid absorption of hemorrhages. Ointments with arnica, gingerbread or badagi are also used.

Intramuscular injection technique

The algorithm (technique) for performing intramuscular injection may vary depending on the situation. This section describes the general rules.

Intramuscular injection of the drug is most often carried out in the outer upper quadrant of the gluteal region, since it is in this region that the muscle layer is well developed, and the network of lymphatic and blood vessels is well developed, in addition, large vessels are removed from this area (primarily the upper gluteal artery) and sciatic nerve, which makes it impossible for them to be damaged.

Intramuscularly, injection can be performed in the middle third of the anterior outer thigh, in the area with a well-developed layer of muscles and missing large vessels and nerve trunks in this area, as well as in the deltoid muscle (2.5-5 cm below the acromial process of the scapula) and subscapular plot R03, (drugs such as toxoids and vaccines used for the prevention and treatment of infectious diseases are most often injected into the same plot).

Before performing intramuscular injection, medications (especially in the form of an oil solution) must be heated to a temperature of 30-37 ° C.

Before starting the procedure for intramuscular injection of a drug, a medical professional treats the hands with a disinfectant solution, and then puts on rubber gloves. The injection site is treated with an antiseptic solution (usually ethyl alcohol).

When injecting the drug into the outer upper quadrant of the gluteal region, the syringe is installed 90 ° to the surface of the body, when a drug or vaccine is injected into the femoral region, the subscapular region or into the deltoid muscle, the syringe is installed at an angle of 70 °. After a puncture of the skin, the syringe needle is inserted into the muscle approximately 2/3 of the length (to prevent needle breakage, it is recommended to leave it above the skin surface no less 1 cm needle). After puncture of the skin, immediately before the injection of the drug, the syringe plunger must be pulled back to check for the needle getting into the vessel. After checking the correct location of the needle, the drug is introduced into the muscle in full.

After completion of the drug administration procedure, the injection site is treated with an antiseptic again.

Advantages and disadvantages of intramuscular use of drugs

The advantages of the intramuscular use of drugs is that the active substances, when introduced into the body, do not change at the site of contact with tissues, therefore, drugs that are destroyed by the action of digestive system enzymes can be used intramuscularly.

In most cases, the use of intramuscular injection provides an advantage in the form of a rapid onset of action of the drug.

If prolonged action is necessary, the drugs are usually administered precisely intramuscularly in the form of oil solutions or suspensions, which cannot be done with intravenous administration.

The advantage of intramuscular injection is that the absorption rate of the drug is not affected by food intake and the individual characteristics of the biochemical reactions of the organism of a particular person, the state of the enzymatic activity of the human body, and the intake of other drugs are significantly less. The procedure for performing intramuscular injection is relatively simple, which makes it possible to carry out this manipulation even to a layman.

The disadvantages of intramuscular use is that often with the introduction of drugs intramuscularly there is pain and the formation of infiltrates at the injection site (less often - the formation of abscesses) (although less often than with subcutaneous injections). With poor development of blood vessels at the injection site, the absorption rate of the drug may decrease. With intramuscular administration of drugs, as with other types of parenteral use of drugs, there is a risk of infection of a medical worker or patient by pathogens of infectious diseases transmitted through the blood.

The disadvantages of intramuscular administration include an increased likelihood of side effects of drugs due to the high rate of entry into the body and the absence of biological filters of the body - the mucous membrane of the gastrointestinal tract and hepatocytes (although the rate is lower than when administered intravenously).

When using intramuscular injections, it is not allowed to administer more than 10 ml of the drug once due to the likelihood of overstretching of muscle tissue and a decrease in the likelihood of the formation of infiltrate. Medicines with a local irritant effect can also cause the formation of necrosis and abscesses at the injection site.

Possible complications with intramuscular injection

The most common complication of intramuscular injection is the formation of infiltrates at the injection site. Usually, infiltrates are formed with the introduction of the drug into the area of ​​compaction or edema formed after previous injections. Infiltrates can also form with the introduction of oil solutions that are not warmed up to the optimum temperature, as well as when exceeding the maximum injection volume (10 ml).

If infiltrates appear, it is recommended to apply a warming half-alcohol compress or heparin ointment to the site of the infiltrate formation, apply iodine mesh to the affected area, and conduct physiotherapeutic procedures.

One of the possible complications arising from a violation of the technique of intramuscular injection is the formation of abscesses and phlegmon. These complications most often occur against the background of improperly treated post-injection infiltrates, or in violation of aseptic and antiseptic rules during the injection.


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The treatment of such abscesses or phlegmon is carried out by a surgeon.

In case of violation of the rules of asepsis and antiseptics during intramuscular injections, it is possible to infect patients or medical workers with pathogens of infectious diseases transmitted through the blood, as well as the occurrence of a septic reaction as a result of bacterial infection of the blood.

When conducting an intramuscular injection with a blunt or deformed needle, subcutaneous hemorrhage may form. If bleeding occurs during the injection, it is recommended to apply a cotton swab moistened with alcohol to the injection site, and later a half-alcohol compress.

If the injection site is incorrectly selected, drug injuries can be observed during drug administration. This complication can lead to paresis and paralysis.

The treatment of this complication is carried out by a doctor depending on the symptoms and severity of the lesion.

If the needle is inserted very deeply into the tissue, damage to the periosteum (connective tissue covering the bone) is possible. With this complication, steady pain is observed at the injection site. If damage to the periosteum occurs, it is recommended to pull the needle away from the damage site by at least 1/3 of the length, and put the heating pad in place of the damage.

With the erroneous introduction into the muscle of a hypertonic solution (10% solution of sodium chloride or calcium chloride) or other locally irritating substances, the formation of tissue necrosis is possible. When this complication occurs, the affected area should be chipped with a solution of adrenaline, 0.9% sodium chloride solution and novocaine solution. After chipping, a cold pressing dry dressing is applied to the injection site, later (after 2-3 days) - a heating pad is applied.

When using a needle for injection with a defect, if the needle is inserted too deep into the muscle tissue, or if the technique for administering the drug is impaired, the needle may break. With this complication, it is necessary to try to independently remove the needle fragment from the tissues; if the attempt fails, the chip is removed surgically.

When performing intramuscular injections (most often in a standing position), the patient may lose consciousness (fainting). If this complication occurs, it is recommended to lay the patient with his head slightly down and legs raised, unfasten his clothes, give a sniff solution of ammonia, and if necessary, inject a solution of caffeine or cordiamine parenterally.

An extremely serious complication of intramuscular injection is medication. This complication occurs rarely, its appearance is associated with a violation of the injection technique. A complication arises in cases where the medical worker, during an injection of an oil solution of a drug or suspension, did not check the position of the needle and the possibility of the drug entering the vessel. This complication can manifest itself with attacks of shortness of breath, the appearance of cyanosis, and often ends with the death of the patient. Treatment in such cases is symptomatic.

Denial of responsibility

The article on intramuscular injections of drugs of the My Pills medical portal is a compilation of materials obtained from reputable sources, a list of which is available in the Notes section. Despite the fact that the reliability of the information presented in the article “Intramuscular injection of drugs"Checked by qualified specialists, the contents of the article are for reference only, is not guidance for self (without contacting a qualified medical specialist, doctor) diagnosis, diagnosis, choice of means and methods of treatment.

The editors of the portal “My Pills” do not guarantee the truth and relevance of the materials presented, since the methods of diagnosis, prevention and treatment of diseases are constantly being improved. To receive full medical care, you should make an appointment with a doctor, a qualified medical specialist.

Notes

Notes and explanations to the article "Intramuscular injection of drugs."

  • Suspension - a liquid dosage form, which is a dispersed system containing one or more solid drug substances suspended in a liquid. Suspensions are used for internal (oral) and external use, as well as for injection.
  • Vaccine - A medical or veterinary drug designed to create immunity to infectious diseases. Vaccination is usually given by injection.
  • Anatoxin, toxoid - a drug based on a toxin (a poison of biological origin) that does not have pronounced toxic properties, but is capable of inducing the production of antibodies to the initial toxin. Anatoxins are used for the active immunoprophylaxis of toxinemic infections: poisoning with staphylococcus toxin, gas gangrene, tetanus, diphtheria including.
  • Vascularization - This is the supply of blood vessels and, as a result, organs, areas and parts of the body with blood.
  • Phlebitis - An inflammatory disease affecting the walls of blood vessels.
  • Thrombophlebitis - inflammation of the venous walls with the formation in the lumen of an inflamed vein of blood clots. Thrombophlebitis affects only the veins of the lower extremities and, as a rule, is a complication of varicose veins of the legs.
  • Infiltrate - the accumulation in the tissues of the human body of cellular elements with an admixture of lymph and blood. The most common tumor and inflammatory infiltrate.
  • Abscess - purulent inflammation of the tissues with their melting and the formation of a purulent cavity, developing in the subcutaneous tissue, bones, muscles, as well as in organs or between them. An abscess can occur both independently and can be a complication of another disease. A classic example of an abscess is a sore throat (pharyngeal abscess).
  • Heparin - direct anticoagulant, a substance that prevents blood coagulation.
  • Dialysis - purification of colloidal solutions and substances of high molecular weight substances from low molecular weight compounds dissolved in them using a semipermeable membrane. Dialysis in medicine, hemodialysis - method of extrarenal blood purification in acute and chronic renal failure. With hemodialysis, toxic metabolic products are removed from the body, and electrolyte and water balance disorders are normalized.
  • Superior gluteal artery - the most powerful branch of the internal iliac artery, divided into two branches - the superficial (located between the large and middle gluteus muscles, supplying them with blood) and the deep (lying between the middle and small gluteus muscles, supplying them with blood) branches.
  • Sciatic nerve - a nerve that fully provides leg mobility. The sciatic nerve is the largest nerve in the human body, starting at five different levels of the spinal cord. Branches of the sciatic nerve extend into the thigh, knee, lower leg, feet and phalanges of the fingers.
  • Enzymes, enzymes - as a rule, protein molecules or ribozymes (RNA molecules) or their complexes that catalyze (accelerate) chemical reactions in living systems. Enzymes, like all proteins, are synthesized in the form of a linear chain of amino acids that coagulate in a specific way. Each amino acid sequence is folded in a special way, as a result of which, the resulting protein globule (molecule) has unique properties. Enzymes are present in all living cells and contribute to the conversion of some substances to others. Enzymatic activity can be regulated by inhibitors and activators (inhibitors decrease, activators increase). According to the type of catalyzed reactions, enzymes are divided into six classes: oxidoreductases, transferases, hydrolases, lyases, isomerases and ligases.
  • Hepatocytes - cells of the liver parenchyma, comprising from 60% to 80% of the mass of the liver. Hepatocytes are involved in the synthesis and storage of proteins, the synthesis of phospholipids of bile salts and cholesterol, the transformation of carbohydrates, the modification and removal of endogenous substances from the body, and detoxification.
  • Phlegmon (from the ancient Greek `6, _5, ^ 9, ^ 7, _6, _9, _7, ^ 2, -" inflammation, heat ") - acute diffuse purulent inflammation of cellular spaces. Phlegmon, unlike an abscess, has no pronounced boundaries.
  • Paresis - partial paralysis, neurological syndrome, decreased strength due to damage to the motor path of the nervous system.
  • Caffeine - purine alkaloid, a psychostimulant that stimulates the central nervous system, enhances cardiac activity, accelerates the pulse, causes the narrowing of blood vessels, enhances urination.
  • Cordiamine - a drug that stimulates metabolism in the central nervous system.
  • Embolism (from the ancient Greek O52, _6, ^ 6, _9, _5, ^ 2, “invasion”) is a typical pathological process due to the presence and circulation in the blood or lymph of particles not found in them under normal conditions (embolus). Embolism often causes a blockage of the vessel (occlusion), followed by a violation of the local blood supply. Medical embolism may occur with subcutaneous or intramuscular injections of oily solutions if the needle accidentally enters a blood vessel. Oil trapped in the artery clogs it, which leads to malnutrition of surrounding tissues and necrosis.

When writing an article about intramuscular injection of drugs (drugs), materials of information and reference Internet portals, news sites Drugs.com, BD.com, HealthLine.com, ScienceDaily.com, RSMU.ru, KurskMed.com, Wikipedia were used as sources as well as the following print media:

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  • Medina F. (compiler) "Big Medical Encyclopedia". AST Publishing House, 2002, Moscow,
  • Abaev Yu. K. "Surgeon's Handbook. Wounds and wound infection. Medicine is for you. ” Phoenix Publishing House, 2006, Rostov-on-Don,
  • Pokrovsky V. M., Korotko G. F. (editors) “Human physiology. Textbooks for medical students. " Publishing house "Medicine", 2007, Moscow,
  • Erofeeva L. G., Urakova G. N. "A popular directory of female diseases." Phoenix Publishing House, 2010, Rostov-on-Don,
  • Sokolova N. G., Obukhovets T. P., Chernova O. V., Barykina N. V. “Pocket nurse reference book”. Phoenix Publishing House, 2015, Rostov-on-Don,
  • Tolmacheva E. (editor) "Vidal 2015. Reference Vidal. Medicines in Russia. ” Vidal Rus Publishing House, 2015, Moscow.