RU2341298C1 - Method of hypodermic heparin injections - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: at first intact body region safely distant from previous injection is detected. Skin site is processed with alcohol and gathered with left hand to form triangular fold with base downwards. The second finger of right hand holds injection needle, the fifth finger of the right hand holds piston with the other fingers of the right hand holding cylinder. Then needle is quickly inserted into base point of formed triangle at the angle 45° between the first and the second fingers of the left hand, 0.5 cm deep. 2% lydocaine hydrochloride in amount 0.1-0.2 ml is injected. Then syringe is disconnected, and mandrin made of heat-conductive material and protruding from needle is inserted into the needle. Protruding part of mandrin is heated up with open flame until whitish ring is shown on skin round the needle. Then mandarin is pulled from the needle which is attached to the second syringe with heparin. Solution is slowly injected, and the needle is quickly pulled out. After that injection point is wiped with alcohol and pressed with sterile cottonwool tampon for short time.

EFFECT: allows for higher safety of plural heparin injections.

1 ex

Description

The invention relates to medicine, in particular to therapy, surgery and clinical pharmacology, and can be used for intravenous and subcutaneous injections of heparin preparations.

A known method of subcutaneous injection, including treating a selected area of skin with alcohol, collecting this area of skin with the left hand into a triangular fold with the base down, holding the injection needle with the second finger of the right hand, the piston with the fifth finger of the right hand, the cylinder with the other fingers of the right hand, quickly inserting the needle into the base triangle at an angle of 45 ° to a depth of 1-2 cm between the first and second fingers of the left hand, slow injection of the solution and quick removal of the needle, after which rubbing alcohol at the injection site and pressing it on a short time of a sterile cotton swab moistened with alcohol (Kostina V.V., Menkov N.V. Patient care in a therapeutic clinic. - N. Novgorod: Publishing House of the Nizhny Novgorod State Medical Academy, 2000. - S.51-53).

The disadvantage of this method is the low post-injection safety of subcutaneous administration of heparin preparations. Quick insertion of the needle into the base of the triangle at an angle of 45 ° to a depth of 1-2 cm between the first and second fingers of the left hand, slow introduction of the solution, subsequent quick removal of the needle, rubbing the injection site with alcohol and holding a sterile cotton swab moistened with alcohol for a short time they do not exclude mechanical damage to the blood vessels of the subcutaneous fat caused by the injection needle, and they do not provide quick blockage of the blood vessels. Due to vascular injury and the absence of conditions conducive to thrombosis, a hematoma is formed in the subcutaneous fat. In this case, the amount of blood flowing out of the gaping vessels is determined by the value of the intravascular pressure and the coagulation time of the blood. Considering that heparin is an anticoagulant and prevents thrombosis, its presence in subcutaneous fat prevents clotting of wounded vessels with blood clots and lengthens the process of blood flowing into the tissue. Excessively prolonged bleeding leads to an increase in the volume of bleeding blood, which forms a hematoma in the tissue. This leads to the imbibition of a significant amount of fiber in the blood and the formation of an excessively large bruise.

Since heparin is often used for long term injection, the likelihood of damage to blood vessels, excessive interstitial bleeding, and blood tissue imbibition increases with each subsequent injection as the number of injections made by this method increases.

In addition, exchange rate subcutaneous injections of heparin, carried out after 4-6-12 hours by this method, do not exclude the next injection of the drug into the hematoma arising from the previous injection. With a course of administration, the method does not exclude the repeated injection of heparin into the area of the previous hematoma or bloody tissue infiltrate and does not ensure the exact injection of the drug into the intact tissue located at a sufficient distance from the previous injection site, excluding additional or repeated heparin infiltration of the same area subcutaneously fatty tissue.

In addition, the method does not provide timely and effective blockage of gaping blood vessels damaged by the injection needle during the subcutaneous injection. Moreover, the method eliminates the stopping of bleeding from gaping vessels damaged by an injection needle through which the tissue is infiltrated with heparin.

Since the method does not exclude single and / or multiple, as well as single and / or multiple damage to the blood vessels in the subcutaneous fat caused by the injection needle during subcutaneous injections, exchange rate subcutaneous heparin injections in this way lead to multiple interstitial bleeding in the subcutaneous fat . Since the method does not provide sufficient remoteness of the injection sites from each other, repeated injections of heparin are carried out at a small distance from each other. This preserves and prolongs the conditions for interstitial bleeding in the initially selected part of the body, which ends with the formation of an extensive interstitial hematoma in it. Moreover, the formation of a hematoma is accompanied by a feeling of pain.

Low post-injection safety and low accuracy of repeated subcutaneous injections of heparin increase the likelihood of repeated injection of the drug into the hematoma region, which causes non-specific physico-chemical inflammation and infection of this region. The resulting local inflammation and blood imbibition of subcutaneous fat slow down the absorption of heparin in the area of bloody infiltrate. This leads to a slowdown in the resorption of heparin and to a decrease in its resorptive effect, as well as to the formation of a long-lasting chronic infiltration inflammation, manifested by a change in skin color. The change in skin color in the injection area can be significant, which has an additional aesthetic negative effect on the patient.

All of the above leads to a decrease in postinjection safety and the accuracy of multiple subcutaneous injections of heparin.

The objective of the invention is to increase the safety of post-injection drug tissue infiltration during subcutaneous injections of heparin.

The essence of the method of subcutaneous injections of heparin, which includes treating a selected area of the skin with alcohol, collecting this area of the skin with the left hand in a triangular fold with the base down, holding the injection needle with the second finger of the right hand, the piston with the fifth finger of the right hand, the other fingers of the right hand of the cylinder, quickly inserting the needle into the base of the triangle at an angle of 45 ° between the first and second fingers of the left hand, the slow introduction of the solution and the rapid removal of the needle, after which rubbing the injection site with alcohol and pressing it on the cortex The only time for a sterile cotton swab moistened with alcohol is that the needle is inserted into the intact area of the body at a safe distance from the previous injection to a depth of 0.5 cm, 0.1-0.2 ml of a solution of 2% lidocaine hydrochloride is injected, the syringe is disconnected, mandrels are inserted into the needle over its entire length from a material that easily conducts heat and protrudes from the needle to the outside, the protruding part of the mandrel is heated with an open flame until a whitish ring appears on the skin around the needle, after which the mandrin is removed from the needle, attached to the needle in the second syringe with heparin and inject it.

For the introduction of heparin into intact areas of subcutaneous fat, repeated injections are performed at a safe distance from the place of the previous puncture.

In the proposed method, due to the introduction of heparin into the intact area of the body at a safe distance from the place of the previous injection, an excessively long local anticoagulant effect of the drug is eliminated, which, when introduced into the tissue with damaged blood vessels and in the presence of bleeding, can prolong the period of bloody tissue infiltration. By introducing an injection needle to a depth of 0.5 cm, an effective reduction in the likelihood of damage to blood vessels is provided by reducing the length of the injection channel and the number of blood vessels encountered in the path of the injection needle. By injecting 0.1-0.2 ml of a solution of 2% lidocaine hydrochloride into the subcutaneous fat, an effective infiltration anesthesia of the injection area is ensured and the development of the resorptive action of the anesthetic is eliminated, which prevents the sensation of pain during subsequent heating of the injection needle over an open flame and with subsequent injection heparin, and also eliminates the development of sedative, hypnotic, intoxicating and narcotic effects of local anesthetic. Moreover, the range of the volume of the drug from 0.1-0.2 ml provides effective anesthesia of the injection area without excessive infiltration with an aqueous solution of local anesthetic. The use of a solution of 2% lidocaine hydrochloride ensures the creation of effective anesthesia when using the drug with an indicator of osmotic activity within the isosmotic range. The disconnection of the syringe ensures the subsequent introduction of the coolant into the needle and intensive heating of the injection needle by eliminating the heat intake by the syringe. The introduction of a mandrel into the needle over its entire length from a material that easily conducts heat and protrudes from the needle to the outside ensures effective heating of the protruding part of the mandrel and uniform, intense heat transfer to it along the entire length of the needle, which increases the temperature of the injection needle along the entire length of the injection channel. Heating the protruding part of the mandrel above an open flame provides an intensive and rapid increase in temperature along the entire length of the injection needle, which allows the denaturation of proteins, including blood proteins, poured into the subcutaneous fat from perforated blood vessels. Heating the protruding part of the mandrel until a whitish ring appears on the skin around the needle ensures the necessary level of local hyperthermia in the tissue at a distance of 1-2 mm from the needle, which is sufficient for effective denaturation and coagulation of blood poured from damaged blood vessels, without excessive burns to tissues. Removing the mandrel from the needle ensures the timely termination of the heating process of the needle and the tissues surrounding it, which provides blood compaction by thermal denaturation and eliminates excessive hyperthermic tissue damage. Attaching a second syringe with heparin to the needle and introducing it into the tissue after thermal denaturation and blood compaction, which occurs in the case of blood vessel injuries and blood tissue infiltration, eliminates interstitial bleeding, since heparin does not dissolve blood denatured by hyperthermia.

The implementation of each regular injection of heparin under the skin of the intact region (tissue devoid of post-injection drug and bloody infiltrates) during the course of application due to skin puncture at a safe distance from the previous injection eliminates the summation of the post-injection drug anticoagulant aggressiveness of heparin in the area of infiltrate, and increases postinjection excessive interstitial bleeding and bloody infiltration (imbibition) of tissue.

Example 1. Patient P., 14 years old, suffering from drug addiction, complicated by acute thrombophlebitis of the saphenous veins of the left leg, was prescribed subcutaneous heparin injections of 2500 units 4 times a day in the abdomen. When performing subcutaneous injection in the traditional way after the second injection of the drug in the evening, the doctor suspected the development of post-injection bloody infiltrate in the subcutaneous fat. On the morning of the next day, a bloody infiltrate was revealed in the abdomen at the site of the previous heparin injection, which was manifested by the presence of a red-cyanotic round-shaped spot on the skin with a diameter of about 1.5 cm.

In order to avoid such a complication, the doctor subsequently prescribed in the morning of this day subcutaneous injections of heparin in intact places of the abdomen at a safe distance from the previous injection to a depth of 0.5 cm with the preliminary injection of 0.1-0.2 ml of a 2% solution into the tissue lidocaine hydrochloride, detaching the syringe and inserting a mandrel from a metal that easily conducts heat into the needle over its entire length, followed by heating the protruding part of the mandrel above an open flame until a whitish ring appears on the skin around the injection needle Veta. In particular, on the morning of the indicated day, the nurse pierced the skin with a needle in an intact part of the abdomen at a distance of 5 cm from the site of the previous injection, complicated by bloody tissue infiltrate. The needle was inserted to a depth of 0.4 cm, injected 0.1 ml of a solution of 2% lidocaine hydrochloride into the subcutaneous fat, disconnected the syringe, inserted a sterile copper wire mandren into the needle along its entire length, part of which remained 2 cm protruding from needles out. Then she led the open flame of a gas lighter to the protruding part of the mandrel and began to heat the mandrin, observing the change in skin color around the needle. After 2 minutes 15 seconds, a whitish ring about 1 mm wide appeared around the needle. After that, she immediately stopped heating the mandrin and took it out of the needle. I attached a second syringe with heparin to the needle and introduced 2500 UNITS of heparin into the tissue. After 6 hours, the injection site looked like a hyperemia spot about 1.5 mm in size. After this, a subcutaneous injection of 2500 U of heparin was carried out every 6 hours for 7 days. Regular punctures of the skin were carried out in a similar way at a distance of 4-5 cm from the previous puncture in the clockwise direction around the navel while monitoring the absence of infiltrates in the selected place when examining the patient before the next injection.

A study of injection areas after cessation of heparin injection confirmed the absence of post-injection blood infiltrates in them. Each puncture site was originally a trace of a puncture wound in the form of a hyperemia spot with a diameter of about 1-1.5 mm, which was then scarred by primary intention after 3-4 days.

The patient was discharged without bloody imbibition of subcutaneous fat around the navel.

Claims (1)

A method for subcutaneous injection of heparin, including treating a selected skin area with alcohol, collecting this skin area with the left hand in a triangular fold with the base down, holding the injection needle with the second finger of the right hand, the piston with the fifth finger of the right hand, and the other fingers of the right hand of the cylinder, quickly inserting the needle into the base triangle at an angle of 45 ° between the first and second fingers of the left hand, the slow introduction of the solution and the rapid removal of the needle, after which rubbing the injection site with alcohol and pressing it for a short time a cotton swab moistened with alcohol, characterized in that the needle is inserted into the intact area of the body at a safe distance from the previous injection to a depth of 0.5 cm, 0.1-0.2 ml of a solution of 2% lidocaine hydrochloride is injected, and then disconnected the syringe is inserted into the needle over its entire length of the mandrel from a material that easily conducts heat and protrudes from the needle to the outside, heat the protruding part of the mandrel with an open flame until a whitish ring appears on the skin around the needle, after which the mandrin is removed from the needle and attached to the needle Swarm syringe with heparin and inject it.