Intravenous drip solutions

Intravenous drip infusion of solutions is used in medicine to introduce large volumes of medicinal fluids into the patient’s bloodstream. This method of administering drugs has many advantages: the drug enters the blood in unchanged form, dosage accuracy, the speed of reaching the therapeutic concentration, drug saturation of all tissues, especially organs with abundant blood supply (brain, kidneys, lungs, liver). In this way, drugs are administered that are not absorbed in the intestine or have a strong local irritant effect.

Indications and contraindications

Intravenous drip administration of drugs is indicated to restore the volume of circulating blood, relieve signs of intoxication, normalize electrolyte balance, restore acid-base balance in the blood, parenteral nutrition, and general anesthesia.

With the help of a special device for dripping liquids (systems), it is possible to ensure the flow of solutions into the bloodstream at a rate of 20 to 60 drops per minute.

Contraindications to the setting of droppers are lesions of the skin and subcutaneous tissue at the site of venipuncture, phlebitis of the vein intended for injection. If there are local contraindications for an intravenous injection, another vein is chosen.

System Selection

The market for medical supplies offers various kits for intravenous drip administration of medicinal solutions. When choosing a system, the size of the filter cells should be taken into account. There is a macro set, which is marked “PC”, and a micro set, marked “PR”.

The PC system is used to transfuse whole blood, blood substitutes or blood products. Blood cells and large molecules freely pass through the large filter cells. If the PR system is used to transfuse blood products, the filter quickly thromboses and the infusion stops.

For drip introduction of solutions of electrolytes, amino acids, glucose and other finely dispersed solutions, PR systems are used. The small size of the filter cells (diameter no more than 15 microns) prevents the ingress of harmful impurities from the solution into the circulatory system, but does not prevent the passage of medicinal components.

In addition to the size of the filter cells, the material from which the needles are made and their diameter are of great importance when choosing an infusion set. If prolonged or repeated intravenous drip administration of low molecular weight medicinal liquids during the day is required, preference should be given to polymer needles and catheters. For the introduction of solutions from glass containers closed with dense rubber stoppers, systems with metal needles must be chosen.

When choosing the diameter of the needle, remember that the larger the needle in diameter, the smaller the number it will be marked. So, for example, the thickest needle, which is used in resuscitation to relieve shock symptoms, is marked 14, and the “children’s” needle is marked 22.

Necessary equipment

For the procedure, you need to prepare everything you need. A diaper for covering the manipulation table, two trays (the first for sterile instruments and materials, the second for used ones), tweezers, scissors, gloves, cotton balls, and a set for intravenous drip should be sterile.

A tripod is needed to hang the dropper bottle. At home, you can use portable collapsible tripods or home-made devices (for example, a transparent polymer bottle with a device for hanging it).

In addition to the above, manipulation will require a pad or roller (under the elbow joint), a tourniquet for pinching the veins, an adhesive plaster, and medical alcohol (70 °) as a disinfectant solution.

Preparing for the procedure

In order for the manipulation to be safe, the personnel performing it must strictly follow the algorithm of actions when setting droppers.

Preparation for the procedure is carried out in the manipulation room, observing the rules of asepsis and infectious safety:

1. Check the tightness of the packaging of the dropper kit, its expiration date, the presence of caps on the needles. If the package is leaking or its expiration date has expired, this kit cannot be used, as its sterility has been violated.
2. Before unpacking the IV kit, staff should thoroughly wash their hands with warm soapy water, dry them, and put on sterile gloves. On the surface of the table for the preparation of injections, it is necessary to spread a sterile diaper. Treat the package with a dropper set with a sterile ball moistened with medical alcohol, then open it, and put the contents of the package on a sterile diaper.
3. The medicine bottle should be carefully examined. It should have a label with the name of the drug inside and the expiration date. The vial should be shaken to make sure that the appearance of the solution has not changed. If it is necessary to introduce additional medicines into the vial with the solution, you need to inspect the ampoules or vials with these medicines, make sure that their names correspond to the prescription list. They must be usable. The absence of names and / or expiration dates of medicines on ampoules is the basis for refusing to use them.
4. Remove the aluminum cap from the vial. To do this, it must be treated with a cotton ball dipped in alcohol, and then remove the cover with sterile tweezers or scissors. Treat the rubber stopper on the bottle with a ball moistened with alcohol.
5. Remove the cap from the air duct needle and insert the needle into the vial stopper until it stops. It is not necessary to additionally process the needle: if the conditions for opening the package with the dropper set are met, the needle is sterile. Do the same with the infusion tube needle. Check that the clamp (wheel) on the infusion tube is closed. The bottle is turned over and placed on a tripod.
6. Press the drip chamber twice to half fill it with the solution from the vial. To force air out of the infusion tube, open the clamp, remove the cap from the second tube needle and slowly fill the entire system with solution from the vial. After the air is completely expelled, the clamp on the tube is closed, and a cap is put on the needle. The drip system is considered ready for use.

The procedure for dripping the drug cannot be carried out without the knowledge of the patient himself or his relatives. Therefore, immediately before it is carried out, they need to take consent to the manipulation.

Carrying out the manipulation

The patient for an intravenous drip procedure should lie down comfortably: he will have to lie with a motionless arm for a certain period of time. To install a dropper, you need to puncture the vein. It is preferable to puncture the veins on the “non-working” arm. It is better to choose dark venous vessels to make it easier to control the process.

The dropper is best placed in the median vein of the elbow or medial saphenous vein. They are also easier to place catheters. Less commonly, veins on the back of the hand are used for drip injection of solutions. In order for the medical staff to have the opportunity to puncture the vein a second time (if the first time was unsuccessful), it is better to do the puncture closer to the hand. The second time, it is impossible to inject into the previous puncture site: this is dangerous by rupture of the venous wall.

After selecting a vein for venipuncture and before puncturing the venous wall above the injection site, a tourniquet is applied to the arm. Tighten the tourniquet so that the pulsation of the veins on the arm below it stops. After applying the tourniquet, a pad is placed under the patient’s elbow to achieve maximum extension of the joint. The patient must “work with his fist” to create an artificial venous congestion.

Before venipuncture, the medical staff should put on sterile gloves and treat the skin around the puncture site three times: with the first sterile ball, a large field of skin around, with the second – a small field, and with the third – directly at the venipuncture site. This triple treatment of the skin provides sufficient disinfection of the skin at the site of the dropper.

After disinfection of the skin, the cap is removed from the free needle of the infusion tube, the needle is turned with the cut up, the vein is fixed with the thumb of the left hand in order to immobilize it as much as possible. At an angle of 30-45 °, a puncture of the skin and venous wall is made. From the cannula of the needle, when properly manipulated, blood should appear.

A sterile ball is placed under the needle cannula, the tourniquet is removed, the clamp on the infusion tube of the system is opened, a few drops of the solution are drained, the system is connected to the needle cannula. The ball with drops of blood is removed. To fix the needle in the vein, it is attached to the skin with a band-aid.

The drug solution vial and drip chamber should be higher than the lower cannula of the system. Violation of this rule can lead to air entering the bloodstream. The required rate of drug delivery is regulated by means of a clamp on the infusion tube of the dropper. The rate of drug delivery is determined by the clock with a second hand. As the drug solution is dripped, the patient’s well-being and the place where the dropper is installed must be constantly monitored.

If during the procedure the patient needs to inject additional medication intravenously, this is done by puncturing the infusion tube, having previously treated it with a disinfectant solution.

End of procedure

After the end of the procedure, close the clamp on the infusion tube, remove the adhesive plaster, cover the venipuncture site with a sterile cotton ball and pull the needle out of the vein and skin. After that, the patient should bend the arm at the elbow, holding the cotton ball at the site of the skin puncture. In this position, the hand must be held for at least 3-5 minutes to prevent the formation of a hematoma at the site of the vein puncture.

In order to maintain infectious safety, it is necessary to disconnect the dropper system from the medicine bottle, cut it with scissors and place it in a container with a disinfectant solution (needles – separately, cut tube – separately). After that, the medical staff can take off their gloves, wash and dry their hands.

In the register of manipulations and procedures, as well as in the appointment sheet, a note should be made about the manipulation performed.

Possible complications

When setting an intravenous drip, complications are possible. These include:

• vein spasm during venipuncture;
• painful swelling and hematoma at the site of skin puncture;
• extravasation;
• phlebitis;
• sepsis;
• air and fat embolism;
• damage to tendons, nerves and arteries;
• pyrogenic and allergic reactions;
• dizziness, heart rhythm disturbances, collapse.

If spasm of the vein occurs during venipuncture, its opposite wall may be damaged. As a result, blood and the drug enter the paravasal space. The outpouring of blood is fraught with swelling and the formation of a hematoma at the puncture site, and some types of medications, such as calcium chloride or aminophylline, have a local irritating effect on the perivascular tissues.

Extravasation is the ingress of a large amount of the drug into the perivascular space, which is due to a violation of the manipulation technique. The most dangerous consequence of extravasation is tissue necrosis.

Phlebitis (inflammation of the venous walls) develops from irritation of the vascular walls with medicinal solutions. May result in thrombosis of the damaged vein. Sepsis is a consequence of violations of the rules of asepsis and antisepsis during manipulation.

Fat embolism develops as a result of erroneous injection of fat emulsions into a vein, and air embolism – as a result of air bubbles entering the bloodstream in violation of the algorithm for preparing and setting up a dropper.

If the median vein of the elbow is punctured too deep, the tendon of the biceps brachii or the brachial artery may be damaged.

Pyrogenic reactions (a sharp increase in body temperature, chills) may occur when expired medications are used for infusion or when patients are hypersensitive to certain medications. Too rapid administration of drugs can cause the patient to experience dizziness, heart rhythm failures or collapse.

Allergic reactions to intravenous drip of therapeutic solutions develop when they are intolerant to patients and can manifest as skin allergies, rashes, itching, Quincke’s edema and anaphylactic shock.

With local complications, patients require local treatment (absorbable compresses, iodine nets). In case of severe general complications, it is necessary to stop the procedure and provide emergency care to patients, for example, in case of anaphylactic shock or collapse.

Intravenous drip injection of solutions is often used in medicine, but insufficient qualifications of the medical personnel who perform the manipulation and violation of the instructions for its implementation can lead to the development of complications dangerous to the health and life of the patient.

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