When conducting intravenous therapy through a peripheral venous catheter (PVC), complications are excluded if the following basic conditions are met: the method should not be used occasionally (become permanent and habitual in practice), the catheter should be provided with impeccable care. Well-chosen venous access is essential to successful intravenous therapy.

STEP 1. Selecting the puncture site

When selecting a catheterization site, consideration should be given to patient preference, ease of access to the puncture site, and suitability of the vessel for catheterization.

Peripheral venous cannulas are intended for use in peripheral veins only. Priorities for choosing a vein for puncture:

Well visualized veins with well developed collaterals.
Veins on the non-dominant side of the body (right-handed - left, left-handed - right).
Use distal veins first
Use veins that are soft and elastic to the touch
Veins on the side opposite to the surgical intervention.
Veins with the largest diameter.
The presence of a straight section of vein along the length corresponding to the length of the cannula.

The most suitable veins and zones for PVC installation are: back side brushes, inner surface forearms.

The following veins are considered unsuitable for cannulation:

Vienna lower limbs(low blood flow speed in the veins of the lower extremities leads to an increased risk of thrombosis).
Places where limbs bend (periarticular areas).
Previously catheterized veins (possible damage to the inner wall of the vessel).
Veins located close to arteries (possibility of arterial puncture).
Median ulnar vein (Vena mediana cubiti). Puncture of this vein according to the protocols is permissible in 2 cases - blood sampling for analysis, when providing emergency assistance and poor expression of the remaining veins.
Veins of the palmar surface of the hands (risk of vascular damage).
Veins in a limb that has undergone surgery or chemotherapy.
Veins of the injured limb.
Poorly visualized superficial veins.
Fragile and sclerotic veins.
Areas of lymphadenopathy.
Infected areas and areas of damaged skin.
Deep veins.

Table 1

Parameters and scope various types peripheral venous catheters

Color	Dimensions	PVC capacity	Scope of application
Orange	14G (2.0 x 45 mm)	270 ml/min.
Grey	16G (1.7 x 45 mm)	180 ml/min.	Rapid transfusion of large volumes of fluid or blood products.
White	17G (1.4 x 45 mm)	125 ml/min.	Transfusion of large volumes of fluid and blood products.
Green	18G (1.2 x 32-45 mm)		Patients undergoing routine transfusion of blood products (erythrocyte mass).
Pink	20G (1.0 x 32 mm)		Patients on long-term intravenous therapy (from 2-3 liters per day).
Blue	22G (0.8 x 25 mm)		Patients on long-term intravenous therapy, pediatrics, oncology.
Yellow	24G (0.7 x 19 mm)
Violet	26G (0.6 x 19 mm)		Oncology, pediatrics, thin sclerotic veins.

STEP 2. Selecting the type and size of catheter

When choosing a catheter, you must focus on the following criteria:

Vein diameter;
Required speed of solution introduction;
Potential residence time of the catheter in the vein;
Properties of the injected solution;
Under no circumstances should the cannula completely occlude the vein.

The main principle for choosing a catheter is to use the smallest size that provides the required insertion rate in the largest available peripheral vein.

All PVCs are divided into ported (with an additional injection port) and non-ported (without a port). Ported PVCs have an additional injection port for administering drugs without additional puncture. With its help, needle-free bolus (intermittent) administration of drugs without interruption is possible intravenous infusion.

Their structure always contains such basic elements as a catheter, a guide needle, a plug and a protective cap. A venesection is performed using a needle, and a catheter is inserted at the same time. The plug is used to close the catheter opening when infusion therapy is not performed (to avoid contamination), the protective cap protects the needle and catheter and is removed immediately before manipulation. For easy administration catheter (cannula) into a vein, the tip of the catheter has the shape of a cone.

In addition, catheters may be accompanied by an additional design element - “wings”. Not only do they securely secure the PVC to the skin, but they also reduce the risk of bacterial contamination by preventing direct contact between the back of the catheter plug and the skin.

STEP 3. Placement of a peripheral venous catheter

Wash your hands;
Collect standard set for vein catheterization, including several catheters of various diameters;
Check the integrity of the packaging and shelf life of the equipment;
Make sure that in front of you is the patient who is scheduled for venous catheterization;
Provide good lighting, help the patient find comfortable position;
Explain to the patient the essence of the upcoming procedure, create an atmosphere of trust, provide the opportunity to ask questions, determine the patient’s preferences regarding the location of the catheter;
Have a sharps disposal container available within easy reach;
Wash your hands thoroughly and dry them;
Apply a tourniquet 10-15 cm above the intended catheterization area;
Ask the patient to clench and unclench his fingers to improve the filling of the veins with blood;
Select a vein by palpation;
Remove the tourniquet;
Select the smallest catheter, taking into account: vein size, required insertion rate, intravenous therapy schedule, infusate viscosity;
Re-clean your hands using an antiseptic and put on gloves;
Apply a tourniquet 10-15 cm above the selected area;
Treat the catheterization site with a skin antiseptic for 30-60 seconds without touching untreated areas of the skin and let it dry on its own; DO NOT RE-PALPATE THE VEIN;
Secure the vein by pressing it with your finger below the intended catheter insertion site;
Take a catheter of the selected diameter using one of the grip options (longitudinal or transverse) and remove the protective cover. If there is an additional plug on the case, do not throw away the case, but hold it between the fingers of your free hand;
Make sure that the cut of the PVK needle is in the upper position;
Insert the catheter on the needle at an angle of 15 degrees to the skin, observing the appearance of blood in the indicator chamber;
If blood appears in the indicator chamber, further advancement of the needle must be stopped;
Fix the stylet needle, and slowly move the cannula completely from the needle into the vein (the stylet needle is not completely removed from the catheter yet);
Remove the tourniquet. DO NOT INSERT THE NEEDLE INTO THE CATHETER AFTER IT IS DISPLACED FROM THE NEEDLE INTO THE VEIN
Clamp the vein along its length to reduce bleeding and finally remove the needle from the catheter;
Dispose of the needle in a safe manner;
If, after removing the needle, it turns out that the vein is lost, it is necessary to completely remove the catheter from under the surface of the skin, then, under visual control, assemble the PVC (put the catheter on the needle), and then repeat the entire procedure for installing the PVC from the beginning;
Remove the plug from the protective sheath and close the catheter by inserting a heparin plug through the port or connecting the infusion set;
Secure the catheter to the limb;
Register the vein catheterization procedure according to the requirements of the medical institution;
Dispose of waste in accordance with safety regulations and sanitary and epidemiological regulations.

Standard set for peripheral vein catheterization:

Sterile tray
Garbage tray
Syringe with heparinized solution 10 ml (1:100)
Sterile cotton balls and wipes
Adhesive bandage and/or adhesive bandage
Skin antiseptic
Peripheral IV catheters in several sizes
Adapter and/or connecting tube or obturator
Sterile gloves
Scissors
Langeta
Medium bandage
3% hydrogen peroxide solution

STEP 4. Removal of the venous catheter

Wash your hands
Stop infusion or remove protective bandage (if present)
Treat your hands with antiseptic and wear gloves
From the periphery to the center, remove the fixing bandage without using scissors
Slowly and carefully remove the catheter from the vein
Apply gentle pressure to the catheterization site with a sterile gauze pad for 2-3 minutes
Treat the catheterization site with a skin antiseptic, apply a sterile pressure bandage and secure it with a bandage. Recommend not to remove the bandage or wet the catheterization site for 24 hours
Check the integrity of the catheter cannula. If there is a blood clot or the catheter is suspected of being infected, cut off the tip of the cannula with sterile scissors, place it in a sterile tube and direct it to bacteriological laboratory for research (as prescribed by a doctor)
Document the time, date, and reason for catheter removal.
Dispose of waste in accordance with safety and sanitary regulations

Venous catheter removal kit

Sterile gloves
Sterile gauze balls
Band-Aid
Scissors
Skin antiseptic
Garbage tray
Sterile tube, scissors and tray (used if the catheter is clotted or if infection of the catheter is suspected)

STEP 5. Subsequent venipunctures

If there is a need to perform several placements of PVK, change them due to the end of the recommended period of PVK being in the vein or the occurrence of complications, there are recommendations regarding the choice of venipuncture site:

It is recommended to change the catheterization site every 48-72 hours.
Each subsequent venipuncture is performed on the opposite arm or proximal (higher along the vein) of the previous venipuncture.

STEP 6. Daily catheter care

Each catheter connection is a gateway for infection. Avoid repeatedly touching the equipment with your hands. Strictly observe asepsis, work only with sterile gloves.
Change sterile plugs frequently and never use plugs whose interior surfaces may be infected.
Immediately after administering antibiotics, concentrated glucose solutions, or blood products, rinse the catheter with a small amount of saline.
Monitor the condition of the fixing bandage and change it if necessary or every three days.
Regularly inspect the puncture site for early detection of complications. In case of swelling, redness, local fever, catheter obstruction, leakage, as well as painful sensations When administering drugs, notify the doctor and remove the catheter.
When changing an adhesive bandage, do not use scissors. There is a danger for the catheter to be cut off, causing the catheter to enter the bloodstream.
To prevent thrombophlebitis in the vein above the puncture site thin layer apply thrombolytic ointments (for example, Traumeel, Heparin, Troxevasin).
The catheter should be flushed before and after each infusion session with a heparinized solution (5 ml of isotonic sodium chloride solution + 2500 units of heparin) through the port.

Possible complications:

Despite the fact that catheterization of peripheral veins is significantly less dangerous procedure Compared to central venous catheterization, it carries the potential for complications, as does any procedure that compromises the integrity of the skin. Most complications can be avoided thanks to the nurse's good manipulation technique, strict adherence to the rules of asepsis and antisepsis, and proper care of the catheter.

Table 2

Possible complications and their prevention

Possible complications
Air embolism	It is necessary to completely remove air from all plugs, additional elements and “droppers” before connecting to the PVVC, and also stop infusions before the bottle or bag with the drug solution is empty; use devices for intravenous administration of appropriate length so that the end can be lowered below the installation site, thus preventing air from entering the infusion system. Important role reliable sealing of the entire system plays a role. The risk of air embolism during peripheral cannulation is limited by positive peripheral venous pressure(3-5 mm water column). Negative pressure in the peripheral veins can form when choosing a site for installing a PVC above the level of the heart.
Hematoma associated with catheter removal	Apply pressure to the venipuncture site after removing the catheter 3-4 min. or raise the limb.
Hematoma associated with PVC insertion	It is necessary to ensure adequate filling of the vein and carefully plan the venipuncture procedure, not to puncture poorly contoured vessels.
Thromboembolism	Venipuncture of the lower extremities should be avoided, and the minimum possible diameter of the PVVC should be used to ensure continuous blood washing of the tip of the catheter located in the vessel.
Phlebitis	Should be used aseptic technique installation of PVVC, choose the smallest possible size to achieve the volumes required for intravenous therapy; securely fix the catheter to prevent its movement in the vein; ensure adequate dissolution medicines and their introduction at an appropriate rate; replace the PVVC every 48-72 hours or sooner (depending on conditions) and alternate sides of the body for the catheter insertion site.

STEP 7. Central catheter care

Puncture catheterization of the central vessels is a medical procedure. The subclavian vein, jugular and femoral vein, both left and right. The central venous catheter can function and remain uninfected for many weeks. This is achieved through strict adherence to the rules of catheter care, including adherence to aseptic rules during its installation, precautions when performing infusions and injections.

If the catheter is left in the PV for a long time, the following complications may occur:

Vein thrombosis;

Catheter thrombosis;

Thrombo- and air embolism;

Infectious complications (5 - 40%), such as suppuration, sepsis, etc.

That is why central venous catheterization requires careful adherence to the rules of care and monitoring of the catheter:

1. Before all manipulations, you should wash your hands with soap, dry them and treat them with 70% alcohol, and put on sterile rubber gloves.

2. The skin around the catheter is inspected daily and treated with 70% alcohol and 2% iodine solution or 1% brilliant green solution.

3. The dressing is changed daily and as it gets dirty.

4. Before starting infusion therapy, ask the patient to take a breath and hold his breath. Remove the rubber stopper, attach a syringe with 0.5 ml of saline solution to the catheter, pull the plunger towards you and make sure that blood flows freely into the syringe. Connect an intravenous infusion system to the catheter, allow the patient to breathe, and adjust the frequency of drops. Pour the blood from the syringe into the tray.

5. After completion of infusion therapy, it is necessary to place a heparin lock as follows:

Ask the patient to inhale and hold his breath;

Plug the catheter with a rubber stopper and allow the patient to breathe;

Through a stopper pre-treated with alcohol, inject 5 ml of solution with an intradermal needle: 2500 units (0.5 ml) of heparin + 4.5 ml of saline;

Secure the plug to the catheter with adhesive tape.

6. Be sure to rinse the catheter with the same solution as when installing a heparin lock in the following cases:

After injecting the drug through a catheter;

When blood appears in the catheter.

7. It is prohibited to bend the catheter, place clamps on the catheter that are not intended for the design, or allow air to enter the catheter.

8. If problems associated with the catheter are detected: pain, swelling of the arm, the bandage gets wet with blood, exudate or infusion medium, fever, catheter breaks, immediately inform your doctor.

9. The catheter is removed by the attending physician or anesthesiology service staff, followed by a note in the medical history.

10. It is prohibited to leave the hospital premises with a catheter! In case of referral to another medical institution the patient must be accompanied by a health worker; In the discharge summary, a note is made about the presence of a subclavian catheter in the patient.

V.L. GOLOVCHENKO, L.M. ROMANOVA

A catheter is placed in a vein in cases where uninterrupted access to the patient’s bloodstream is necessary, namely:

if necessary, stabilize and maintain the water-salt balance of the blood;
for intravenous administration of drugs;
for parenteral nutrition;
for transfusion of blood or its components;
to immerse the patient in anesthesia;
to detoxify the body;
to undergo a course of chemotherapy.

In such cases, setting intravenous catheter can be performed immediately after approval of the treatment plan, if the patient has no contraindications to this procedure.

Placement of a catheter into a vein

Before inserting a catheter into a vein, the doctor examines the future puncture site for damage, inflammation, and infection. The skin area is then disinfected and the catheter is inserted in one of three ways:

On the needle. Venous puncture is performed with the sharp end of a needle on which a catheter is placed. The needle is used to insert a subclavian catheter and catheterize the jugular vein.
Through a large bore needle. The vein is punctured using a needle, through which a flexible and soft catheter is passed.
Catheterization using the Seldinger method. This method involves puncturing a vein with a needle, through which a special conductor is passed, and a catheter is inserted through it. In this way, a catheter is placed in the central vein.

Features of placing a catheter in the central vein

Placement of a central jugular or subclavian catheter into a vein is performed in outpatient or inpatient conditions. Before placing a catheter in the central vein, local anesthesia or anesthesia. The procedure is performed under sterile conditions, under X-ray or ultrasonic control. A catheter is inserted into a vein through a needle or guidewire; the other end of the catheter is brought out and secured to the skin. When installing the U-PORT catheterization system from YURiYA-PHARM, the entire structure is placed under the skin, and injections are made into a special subcutaneous reservoir.

Peripheral catheter and its placement in a vein

Placement of a peripheral intravenous catheter begins with the selection of an appropriate catheter and selection of a vein, treatment with hand antiseptics and the site of future puncture. Then a tourniquet is applied above the puncture site, the vein is fixed and catheterization is carried out using the “through a needle” method. Then the tourniquet is removed and the needle is carefully removed. The catheter is carefully fixed to the skin. All waste after the procedure is disposed of according to the established procedure. Immediately after installation, the peripheral catheter can be used for infusions and blood sampling for analysis.

Completed:

midwife of the OBS department - 4

Gorbatenko Marina.

Belgorod 2011.

Technique for catheterization of peripheral veins and catheter placement

Peripheral venous catheter care

Complications and their prevention during catheterization of peripheral veins

Principles for choosing venous access and catheter size

Selection of catheterization area

Contraindications to peripheral venous catheterization

Indications for catheterization of peripheral veins

Relevance of the problem of catheterization of peripheral veins

Catheterization of peripheral veins is a method of establishing access to the bloodstream on long period time through peripheral veins by installing a peripheral intravenous catheter.

A peripheral intravenous (venous) catheter (PVC) is a device inserted into a peripheral vein and providing access to the bloodstream.

Vein catheterization has long become routine medical procedure. In one year, over 500 million peripheral venous catheters are installed worldwide. With the advent of high-quality intravenous catheters on the domestic market in Ukraine, the method of conducting infusion therapy using a cannula installed in a peripheral vessel is gaining more and more recognition every year medical workers and patients. The number of central venous catheterizations began to decrease in favor of an increase in peripheral ones. As modern practice shows, most types of intravenous therapy, previously carried out through central catheters, are more appropriate and safe to carry out through peripheral intravenous catheters. Wide Application infusion cannulas are explained by the advantages they have over the conventional method of infusion therapy using a metal needle - the catheter will not come out of the vessel and will not pierce it through, causing the development of infiltration or hematoma.

Delivering intravenous therapy through a peripheral venous catheter has a number of advantages for both healthcare providers and patients. The method assumes reliable and accessible venous access, promotes rapid effective administration of an accurate dose of drugs, and saves time medical personnel, spent on venipuncture with frequent intravenous injections, which also minimizes the psychological burden on the patient, provides motor activity and patient comfort. In addition, this simple manipulation is associated with a minimum number of severe life-threatening complications, provided that basic conditions are met: the method must become permanent and habitual in practice and, as with any invasive medical procedure, impeccable care must be provided.

Comparative characteristics of peripheral venous catheters

Depending on the material from which the catheter is made, metal can be distinguished (the part of the cannula remaining in the vein is made of metal alloys) and plastic catheters.

Metal catheters consist of a needle connected to a connector. After puncture, the needle remains in the vein, performing the function of a catheter. Connectors can be transparent plastic or metal and have wings, for example, VENOFIX® (Fig. 1), BUTTERFLY®.

Rice. 1. Modern metal catheters VENOFIX9 (butterfly needles). The catheter is a needle made of chromium-nickel alloy with a microsiliconized cut, integrated between plastic fastened wings. On the other hand, a transparent flexible tube 30 cm long is connected to the needle through the wings, at the end of which there is a Luer lock type connection with a hydrophobic plug. There are catheters various sizes with different needle lengths

This is the most best option intravenous catheters with a steel needle for long-term use(approximately 24 hours). Of all the metal intravenous catheters, they are the most commonly used. Among these catheters, the following modifications are distinguished:

catheters with reduced cut length and needle length (to reduce mechanical irritation);

with a flexible tube between the needle and the connector (also in order to reduce mechanical irritation - forced manipulations of the connector are not transmitted to the sharp tip of the needle);

with wings made of soft plastic, between which the needle is integrated, which ensures safe puncture even in difficult-to-reach veins.

IN modern practice steel catheters are used extremely rarely, since they are not suitable for long-term stay in the vein due to high frequency complications associated with their use. The rigidity of the needle causes mechanical irritation (with further development of phlebitis or thrombosis), trauma and necrosis of sections of the vein wall, followed by extravasal administration of the drug, the formation of infiltration and hematoma. The infusion media introduced through these catheters are poured into the vein not along the blood flow, but at an angle to it, which creates conditions for chemical irritation of the intima of the vessel. A sharp needle creates an abrasive effect on the inner surface of the vessel. To reduce the incidence of these complications when working with steel catheters, their reliable fixation is required, and achieving this condition limits the patient’s motor activity and creates additional discomfort for him.

However, there are advantages to using steel catheters. When they are installed, the risk of infectious complications is reduced, since the steel prevents the penetration of microorganisms through the catheter. In addition, due to their rigidity, manipulation of the puncture of difficult-to-visualize and thin veins is facilitated. In pediatrics and neonatology they are the catheters of choice.

Plastic catheters consist of an interconnected plastic cannula and a transparent connector, pushed onto a guide steel needle. The transition from a steel needle to a plastic tube in modern catheters is smooth or with a slight conical design, so that at the time of venipuncture the needle moves without resistance (Fig. 2).

Fig.2. Transition between catheter and guide needle

Unlike catheters with metal intravenous elements, plastic ones follow the route of the vein, which reduces the risk of vein trauma, infiltration and thrombotic complications, and increases the time the catheter remains in the vessel. Thanks to the flexibility of the plastic, patients can allow greater physical activity, which contributes to their comfort.

Currently offered various models plastic intravenous catheters. They may have an additional injection port (ported, Fig. 3) or not (non-ported, Fig. 1), they can be equipped with fixation wings or models without them can be produced.

peripheral venous catheter installation

Fig.3. Plastic intravenous catheter with injection port and protective clip on the guide needle

To protect against needle sticks and the risk of infection, cannulas with a self-activating protective clip mounted on the needle have been developed. To reduce the risk of contamination, catheters are produced with removable injection elements. For better control behind the catheter, which is located in the vein, X-ray contrast strips are integrated into the transparent cannula tube. The sharpening of the piercing cut of the guide needle also facilitates the puncture - it can be lanceolate or angular. Leading PVC manufacturers are developing a special position of the injection port above the fixation wings of the connector, which reduces the risk of cannula displacement when performing additional injections. In addition, some catheters have special holes in them to ventilate areas of the skin located under the fixing wings.

Thus, the following types of cannulas should be distinguished:

1. A cannula without an additional port for bolus injections is a catheter mounted on a stylet needle. After entering the vein, the cannula is moved from the stylet into the vein.

2. A cannula with an additional port expands the possibilities of its use, facilitates maintenance, and therefore prolongs the period of its installation.

There are two modifications of this cannula. The first modification is the most common configuration. Convenience during placement and fixation, the presence of an upper port for short-term insertions and heparinization of the cannula during infusion breaks have earned the love of doctors.

Great variety brands from different manufacturers The only difference is the quality of the product. But despite the apparent simplicity of the design, not everyone manages to combine the triad of qualities:

1) needle sharpness and optimal sharpening angle;

2) atraumatic transition from needle to cannula;

3) low resistance to insertion of the catheter through the tissue.

Manufacturers of such cannulas include B. Braun and VOS Ohmeda (part of the BD concern).

In the process of peripheral vein cannulation, sometimes the first attempt may fail for one reason or another. Invisible to the eye“scratches” on the cannula, as a rule, do not allow it to be reused or reduce the period of use to one day.

HMD has released a new material for the traditional cannula, which potentially allows it to be used if the first cannulation attempt fails without reducing placement time, and makes the cannula more resistant to sticking when kinked. This cannula is registered under the brand name "Cathy".

Target: A peripheral venous catheter is inserted into a peripheral vein and provides access to the bloodstream, allows for long-term infusion therapy, and reduces the frequency psychological trauma(especially in children) associated with numerous punctures of peripheral veins.

When choosing a catheter, you should consider following rules :

ü The catheter should cause the least discomfort to the patient;

ü Ensure optimal infusion rate (drug administration);

ü The length of the catheter must correspond to the length of the straight section of the vein being used;

ü The diameter of the catheter must correspond to the diameter of the selected vein (catheters of smaller diameter give ...
the possibility of better blood flow around the catheter and dilution of the drug with blood; large-diameter catheters can close the lumen of the vein or damage the inner lining of the vein).

ü Orange– for rapid blood transfusion;

ü Grey— for transfusion of blood and its components;

ü Green– for blood transfusion or administration of sick volumes of fluid;

ü Pink– for the administration of large volumes of liquid, rapid administration contrast agents at diagnostic procedures;

ü Blue– for long-term intravenous drug therapy in children and adults (small veins);

ü Yellow– for newborns, chemotherapy.

The duration of operation of one catheter is 3 days. When operating the boat, strictly follow the rules of asepsis and antiseptics. The connection points of the catheter with the system for intravenous drips and the plug must be thoroughly cleaned of blood residues and covered with a sterile napkin. Monitor the condition of the vein and skin in the puncture area. To avoid thrombosis of the catheter with a blood clot, fill it with heparin solution. To avoid migration of the catheter, constantly monitor the reliability of its fixation.

Indications: 1. administration of medications to patients who cannot take them orally; if the drug must be administered in an effective concentration and accurately, especially if the drug can change its properties when taken orally;

2. Cases when emergency administration of a drug or solution may be required;

3. Frequent intravenous administration of drugs;

4. Blood collection for clinical trials carried out at time intervals (for example, determining glucose tolerance, drug levels in plasma and blood;

5. Transfusion of blood products;

6. Parenteral nutrition (except for the administration of nutritional mixtures containing lipids);

7. Rehydration of the body (restoration of water and electrolyte balance).

Contraindications: The catheter should not be inserted into: 1. Veins that are hard to the touch and sclerotic (their inner lining may be damaged); 2. Veins of the flexor surfaces of the joints ( high risk mechanical damage); 3. Veins located close to arteries or their projections (there is a risk of puncture of the artery); 4. Veins of the lower extremities; 5. Previously catheterized veins (damage to the inner wall of the vessel is possible); 6. Small visible but not palpable veins; 7. Veins of the surface of the arms, median ulnar veins (usually they are used to draw blood for testing); 8. Veins in a limb that has undergone surgery or chemotherapy.

Workplace equipment: sterile gloves, clean gloves, mask, safety glasses, waterproof apron, bottle of intravenous drug, bottle of 0.9% sodium chloride solution, heparin, file for opening ampoules, scissors, sterile tweezers, sterile dressing material in the package ( cotton balls, gauze wipes), adhesive plaster, two sterile disposable syringes with a volume of 0.5 ml, a bottle of disinfectant solutions for treating ampoules and vials, a bottle of antiseptic for treating the patient’s skin and the hands of medical staff, containers with a disinfectant solution for disinfecting waste material, containers for waste material, splint, tool table, containers with disinfectant solution for surface treatment, clean rags, hemostatic clamp.

№	Stages	Rationale
Preparatory stage
1.	Inform the patient about the upcoming procedure, explain the purpose and progress of the procedure. Obtain verbal consent. Carry out vein catheterization in the treatment room or in the ward.	Ensuring the patient's right to information, his participation in the manipulation.
2.	Check the patient's allergy history.	Prevention of allergic reactions.
3.	Remove objects from your hands (rings, watches, bracelets). Carry out hygienic antiseptics. Wear personal protective clothing.
4.	Prepare the manipulation table for operation: ü Using a clean rag moistened with a disinfectant solution, treat the surfaces of the table, first the top, and then the bottom and sides; 2 times with an interval of 15 minutes. ü We place containers for disinfection of post-consumer waste on the bottom shelf. No. 147. ü Remove gloves and disinfect them.
5.	Check the sterilization date of the bix and tweezers. Note the date of the autopsy and sign the nurse. Open the bix, make sure that the material is sterile using the sterility indicator, use sterile tweezers to remove the sterile material from the bix and place it on the top shelf of the manipulation table, in individual packaging - note the opening date.	Control of terms of use.
6.	Place the necessary equipment on the top shelf of the instrument table, check the expiration dates of medications and the integrity of the packaging.	Checking the correctness of the taken medicinal substance. Control of terms of use.
7.	Put on the label of the bottle with the solution the date the bottle was opened and a signature. Take two balls, moisten them with an antiseptic, treat the metal cap and the upper third of the bottle with one ball, remove the middle part of the metal stopper with tweezers or scissors, treat the accessible part of the rubber stopper with another ball of antiseptic; leave the ball. Also process other vials.	Compliance with infection safety.
8.	Take a package with a syringe, assemble it, check the patency of the needle and draw 5 ml of a 0.9% sodium chloride solution and place it inside the opened package.	For further implementation manipulation.
9.	Take a package with a syringe, assemble it, check for patency of the needle, draw heparin at the rate of 1 ml of heparin per 100 ml of 0.9% sodium chloride solution, insert it into a bottle with saline solution, draw 2-3 ml of the resulting solution into the syringe and place it inside the opened package.	For further manipulation; prevention of catheter thrombosis.
10.	Invite the patient to take a comfortable position, inform about the rules of conduct during manipulation.
11.	Select the site of the intended vein catheterization.	To carry out manipulation.
12.	Apply a tourniquet 10-12 cm above the elbow (on a napkin or clothing in the middle third of the shoulder).
13.	Check for a pulse radial artery below the place where the tourniquet is applied.	Prevention of artery compression.
14.	Make massaging movements with the edge of the palm towards the elbow bend, asking the patient to clench and unclench his fist. Palpate the vein with a clenched fist, remove the tourniquet (make sure that the tourniquet can be easily removed after venipuncture).	Strengthening venous stagnation, facilitating vein puncturing.
Main stage
1.	Wear safety glasses, a mask, carry out hygienic hand antiseptics and put on sterile gloves.
2.	Apply a tourniquet 10-15 cm above the punctured vein.	Creation of artificial venous stasis (vein swelling).
3.	Take two pregnancy balls and moisten them with antiseptic. Treat the injection site with movements from bottom to top or from the periphery to the center, with one ball - wide, the other - narrow, leave for 1-2 minutes. For drying.	Disinfection of the injection field.
4.	Place a sterile napkin on the injection field below the puncture site.	Ensuring infection safety in accordance with instructions.
5.	Open the catheter packaging and remove it by bending the wings of the catheter, grasp the catheter with three fingers of your right hand, and remove the protective cap.	Ensuring infection safety.
6.	With your left hand, fix the vein, press it thumb below the intended puncture site.	Ensure that the manipulation is carried out clearly.
7.	Insert the catheter on the needle into the vein at an angle of 25-30 0 to the skin, observing the appearance of blood in the indicator chamber of the catheter.	Warning potential problems exit of the needle from the vein.
8.	When blood appears in the indicator chamber, reduce the angle of the stylet needle to the skin to 10-15 and advance the needle and catheter a few millimeters along the vein.	Prevention of complications.
9.	Right hand Fix the stiletto needle motionlessly to the indicator chamber (or to the stop for thumb). With your left hand, slowly move the catheter cannula into the vein along the stylet needle until the catheter pavilion comes into contact with the skin. (the stylet needle is not completely removed from the catheter yet).	Ensure that the manipulation is carried out clearly.
10.	Remove the tourniquet. Press the vein with your free hand a few centimeters above the intended location of the end of the catheter. Remove the stiletto needle completely.	To prevent blood from leaking from the catheter.
11.	Connect a syringe with a 0.9% sodium chloride solution to the catheter and inject 4-5 ml of solution (the absence of infiltration confirms the correct installation of the catheter).	Confirmation of correct catheter placement.
12.	Press the vein, disconnect the syringe, attach the syringe with heparin solution, inject the solution into the catheter until it is filled (1-2 ml).	Prevention of catheter thrombosis.
13.	Press the vein, disconnect the syringe and secure the catheter with a sterile plug.	Prevention of complications.
14.	Clean the outer part of the catheter and the skin from traces of blood.	Ensuring infection safety.
15.	Secure the catheter using a special self-adhesive bandage or adhesive tape.	Ensuring infection safety.
16.	Wrap the catheter plug with sterile gauze pad, secure it with adhesive tape.	Prevention of complications.
17.	Apply a protective bandage.	Prevention of complications.
Final stage
1.	Disinfect used medical material and instruments contaminated with blood in accordance with the disinfection instructions. (order No. 165 of the Ministry of Health of the Republic of Belarus)	Prevention of nosocomial infections.
2.	Treat work surfaces with disinfectant solutions.	Ensuring infection safety.
3.	Remove the waterproof apron, protective screen, gloves, and disinfect them.	Prevention of nosocomial infections.
4.	Wash your hands under running water with pH neutral liquid soap, dry with a disposable napkin and apply cream.	In order to eliminate potential problems.
5.	Inspect the catheterization site regularly. We apply thrombolytic ointments daily above the catheterization site to reduce thrombosis and the risk of phlebitis.	Prevention of complications.

Possible complications:

General: septicemia, embolism (catheter embolism), air embolism, anaphylactic shock.

Local: phlebitis (inflammation of a vein), thrombophlebitis (inflammation of a vein with the formation of a blood clot), tissue infiltration and necrosis, hematoma, catheter blockage, venous spasm, damage to a nearby nerve.

Medicines can be administered into the body in various ways, depending on the indications: medicines are administered enterally (orally) in the form of tablets, powders, solutions, mixtures, capsules; rectally (into the rectum) - in the form of suppositories, enemas; parenterally (bypassing the gastrointestinal tract) - in the form of injections or applying drugs to the skin and mucous membranes.

In this article we'll talk about the parenteral method of administering drugs under the skin and into the muscle using a syringe, as well as into a vein using an intravenous catheter.

General rules for performing injections

Injection is the introduction of a drug by pumping it under pressure into a particular environment or tissue of the body, violating the integrity of the skin. This is one of the most dangerous ways to use medications. As a result of an incorrectly performed injection, nerves, bones, tissues, blood vessels or the body becomes infected with microflora.

The following types of injections are distinguished: intradermal, subcutaneous, intramuscular, intravenous, intraarterial, intraarticular, intraosseous, intracardiac, subdural, subarachnoid (spinal injections), intrapleural, intraperitoneal.

To perform injections, sterile instruments are required - a syringe and a needle, intravenous catheters of various sizes, infusion (drip) systems, as well as alcohol beads, injection solutions, tourniquets, etc. When using each element, it is important to adhere to certain rules.

Rice. 1. Syringes of various volumes (from 1 to 50 ml) used in veterinary medicine

Syringes. Before starting work, you need to check the integrity of the syringe packaging, then sterilely open it from the piston side, take the syringe by the piston and, without removing it from the packaging, insert it into the needle.

Needles. First of all, check the integrity of the packaging. Then it is opened sterilely from the cannula side, and the needle is carefully removed from the cap.

Infusion systems. Manipulations are performed in the following order:

open the package in the direction of the arrow;
close the roller clamp;
remove the protective cap from the needle for the bottle and insert the needle completely into the bottle with the infusion solution;
hang the bottle with the solution and squeeze the needle container until it is ½ full;
open the roller clamp and release air from the system;
connected to a needle or intravenous catheter;
open the roller clamp and adjust the flow rate.

Set of medicine in a syringe from an ampoule
First of all, you need to familiarize yourself with the information placed on the ampoule: the name of the drug, its concentration, expiration date.
Make sure that the medicinal product is suitable for use: there is no sediment, the color does not differ from the standard one.
Tap the narrow part of the ampoule so that all the medication ends up in the wide part.
Before sawing off the neck of the ampoule, you need to treat it with a cotton ball with a disinfectant solution. Cover the ampoule with a napkin to protect yourself from splinters. With a confident movement, break off the neck of the ampoule.
Insert a needle into it and dial required quantity medicinal product. Wide opening ampoules should not be inverted (Fig. 2). It is necessary to ensure that when taking the medicine, the needle is always in the solution: in this case, air will not get into the syringe.
Make sure there is no air in the syringe. If there are air bubbles on the walls, you should slightly pull back the syringe plunger, “turn” the syringe several times in a horizontal plane and squeeze out the air.

Rice. 2. Ampoules with a wide “neck” should not be inverted to avoid leakage of the drug

A set of medicines in a syringe from a bottle closed with an aluminum cap
Just as in the case of an ampoule, first of all you need to read the name of the drug, the concentration, and the expiration date on the bottle; make sure that the color does not differ from the standard one.
Bottles with solutions are checked for integrity of packaging and contamination.
Then, using non-sterile tweezers (scissors, etc.), bend back the part of the bottle cap covering the rubber stopper.
Wipe the rubber stopper with a cotton/gauze ball moistened antiseptic.
Insert the needle at an angle of 90° into the bottle and draw it from the bottle into a syringe. required quantity medicinal product.
Each time the contents are taken from the vial, separate sterile needles and syringes are used.
Opened multi-dose vials are stored in the refrigerator for no more than 6 hours, unless otherwise indicated in the instructions.

Rice. 3. A set of the drug from a bottle with a rubber stopper, rolled up with an aluminum cap

Injection technique

When performing injections, it is very important to follow certain rules.

Subcutaneous injections. In this method, the medicinal substance is injected directly into the subcutaneous tissue, preferably in an area that is well supplied with blood. Subcutaneous injections are less painful than intramuscular injections. The inguinal fold and withers are the most suitable places for subcutaneous injections. Before injection, the skin is folded to determine the thickness subcutaneous tissue. Grasping the skin with the thumb and forefinger, an injection is made into the resulting triangle. To correctly administer the medicine, it is necessary to accurately calculate the length of the fold and the thickness of the subcutaneous tissue. The needle is inserted at an angle from 45° to 90° to the skin surface.

Intramuscular injections. In this way those are introduced medicinal substances, which at subcutaneous injection give severe irritation(eg, magnesium sulfate) or are slowly absorbed. The medicine is injected into the posterior femoral muscle group or into the shoulder muscles.

Intravenous injections. They are carried out both with a syringe and a needle, and through the preliminary installation of an intravenous catheter. In veterinary medicine, due to the mobility of patients, it is optimal to use catheters. When choosing a catheterization site, it is necessary to take into account the ease of access to the puncture site and the suitability of the vessel for catheterization. There are practically no complications if the basic rules are followed. The catheter must be provided with impeccable care.

Rules for vein catheterization

Indications for venous catheterization. A peripheral intravenous catheter is an instrument inserted into a peripheral vein to provide access to the bloodstream.

Rice. 4. Intravenous catheters

Indications for use of an intravenous pump:

emergency conditions in which quick access to the bloodstream is necessary (for example, if you need to administer drugs urgently and at high speed);
prescribed parenteral nutrition;
overhydration or hydration of the body;
transfusion of blood products ( whole blood, red blood cell mass);
the need for rapid and accurate administration of the drug in an effective concentration (especially when the drug can change its properties when taken orally).

Well-chosen venous access largely ensures the success of intravenous therapy.

Criteria for choosing a vein and catheter. With intravenous injections, the advantage remains with the peripheral veins. The veins should be soft and elastic, without compactions or knots. It is better to administer drugs into large veins, on straight section corresponding to the length of the catheter.

When choosing a catheter (Fig. 4), you must focus on the following criteria:

vein diameter (the diameter of the catheter should be less than the diameter of the vein);
required rate of solution injection (than larger size catheter, the higher the rate of solution administration);
potential time the catheter remains in the vein (no more than 5 days).

When catheterizing veins, preference should be given to modern Teflon and polyurethane catheters. Their use significantly reduces the frequency of complications and with high-quality care, their service life is much longer.
The most common reason for failures and complications during peripheral venous catheterization is the lack of practical skills among personnel, violation of the technique for placing a venous catheter and caring for it. This is largely due to the lack of veterinary medicine generally accepted standards for peripheral venous catheterization and catheter care rules.

A standard kit for peripheral vein catheterization (Fig. 5) includes a sterile tray, sterile wipes moistened with a disinfectant solution, adhesive tape, peripheral intravenous catheters of several sizes, a tourniquet, sterile gloves, scissors, gauze or self-fixing elastic bandage.

Rice. 5. Standard set for peripheral vein catheterization

Peripheral catheter placement. They start by ensuring good lighting of the manipulation area. Then hands are thoroughly washed and dried. A standard set for vein catheterization is assembled, and the set should contain several catheters of different diameters.
Apply a tourniquet 10-15 cm above the intended catheterization area. A vein is selected by palpation.
Selecting a catheter optimal size, taking into account the size of the vein, the required rate of administration, the schedule of intravenous therapy.
Put on gloves.
The catheterization site is treated with a skin antiseptic for 30-60 seconds and allowed to dry.
Having fixed the vein (it is pressed with a finger below the intended insertion site of the catheter), take a catheter of the selected diameter and remove the protective cover from it. If there is an additional plug on the cover, the cover is not thrown away, but held between the fingers of your free hand.
The catheter is inserted on a needle at an angle of 15° to the skin, observing the indicator chamber. When blood appears in it, reduce the angle of the stiletto needle and insert the needle into the vein a few millimeters (Fig. 6). Having fixed the stiletto needle, slowly move the cannula completely from the needle into the vein (the stiletto needle is not yet completely removed from the catheter). Remove the tourniquet.
Do not insert the needle all the way into the catheter after it has been dislodged from the needle into the vein! This will lead to injury to the walls of the vessel.
The vein is clamped to reduce bleeding, and the needle is finally removed from the catheter.
The needle is disposed of taking into account safety rules.
Remove the plug from the protective cover and close the catheter or connect the infusion system.
The catheter is fixed to the limb with an adhesive tape (Fig. 7).

Rice. 6. Installation of an intravenous catheter in a cat. The assistant compresses the vein above the catheter installation with his thumb. The catheter tube is in the vein, the stylet needle is half withdrawn.

Rice. 7. The installed catheter is fixed on the paw with an adhesive tape.

Catheter care rules
Each catheter connection is a gateway for infection. Repeated touching of the instruments with your hands should be avoided. It is recommended to change sterile plugs more often and never use plugs whose inner surface could be infected.

Immediately after the administration of antibiotics, concentrated glucose solutions, and blood products, the catheter is washed with a small amount of saline.

To prevent thrombosis and prolong the life of the catheter in the vein, it is recommended to flush the catheter saline solution additionally - during the day, between infusions.

Complications after venous catheterization are divided into mechanical (5-9%), thrombotic (5-26%), and infectious (2-26%).

It is necessary to monitor the condition of the fixing bandage and change it if necessary, as well as regularly inspect the puncture site in order to identify complications as early as possible. If swelling (Fig. 7), redness, local increase in temperature, obstruction of the catheter, leakage, as well as pain in the animal to which the drug is administered, the catheter should be removed and a new one installed.

Rice. 7. Swelling of a limb in an animal due to improper fixation of the catheter (the paw is very tightly tied with a plaster)

When changing an adhesive bandage, do not use scissors, because the catheter can be cut off, causing it to enter the bloodstream. It is recommended to change the catheterization site every 48-72 hours. To remove a venous catheter, you need a tray, a ball moistened with a disinfectant solution, a bandage, and scissors.

Conclusion

Despite the fact that catheterization of peripheral veins is a much less dangerous procedure than catheterization of central veins, if the rules are not followed, it can cause a complex of complications, like any procedure that violates the integrity of the skin. Most complications can be avoided with good manipulation techniques by personnel, strict adherence rules of asepsis and antiseptics and proper care behind the catheter.

Literature

Handbook for nurse treatment room. - St. Petersburg: “Printing house “Beresta”, 2007.
Mitin V.N. First aid small pets. - M.: KolosS, 2005.
Handbook for nurses resuscitation department // Ed. A.Ya. Grinenko. - St. Petersburg: Health Committee of the Leningrad Region, Association of Nurses, 2007.

S. V. Panfilova, veterinary clinic "Biocontrol"
at the Russian Oncological scientific center them. N.N. Blokhina (Moscow)