In severe diseases of the child, the parenteral route is the main route of drug administration.
Medicinal substances, their dosage, intervals and route of administration ( subcutaneous, intramuscular intravenous) are prescribed by a doctor! All instruments and injection solutions must be sterile!
In order for the drug to be injected to the desired depth, it is necessary to correctly determine the injection site, the needle and the angle at which the needle is inserted (Fig. 21.1). The injection site should be chosen so as not to damage the periosteum, nerves and blood vessels.
Subcutaneous injections. Due to the fact that the subcutaneous fat layer is rich in blood vessels, subcutaneous injections are used for faster action of the drug. When administered subcutaneously, medicinal substances act faster than when administered through the mouth, since they are quickly absorbed into the loose subcutaneous tissue and do not have a harmful effect on it. Subcutaneous injections are performed with a needle of the smallest diameter, which is inserted to a depth of 15 mm; the volume of the administered medicinal substance should be no more than 2 ml.
Oxygen and oil solutions of medicinal substances (camphor oil solution), suspensions (long-acting forms of insulin) are injected subcutaneously. At the same time, a depot of the drug is formed in the subcutaneous tissue, from where it is gradually absorbed into the blood. The therapeutic effect with subcutaneous administration begins faster than with oral administration, but slower than with injection into the muscle (on average, after 10-30 minutes). It should be borne in mind that in shock, collaptoid states, the absorption of drugs from the subcutaneous tissue can slow down dramatically.
The most convenient sites for subcutaneous injection are:
The outer surface of the shoulder;
Subscapular space;
Anterior surface of the thigh;
Lateral surface of the abdominal wall;
The lower part of the armpit.
In these places, the skin is easily captured in the fold and there is no danger of damage. blood vessels, nerves and periosteum.
Performing a subcutaneous injection:
Wash your hands and put on gloves;
Treat the injection site sequentially with two cotton balls with alcohol: first a large area, then the injection site itself;
Place the third ball of alcohol under the 5th finger of the left hand;
Take the syringe in your right hand (with the 2nd finger right hand hold the cannula of the needle, with the 5th finger - the plunger of the syringe, with the 3rd-4th fingers hold the cylinder from below, and with the 1st finger - from above);
Grab the skin with your left hand in a triangular fold, base down;
Insert the needle at an angle of 45 ° into the base of the skin fold to a depth of 1-2 cm (2/3 of the length of the needle), hold the cannula of the needle with your index finger;
Transfer left hand on the piston and inject the drug (do not transfer the syringe from one hand to the other);
NB!If there is a small air bubble in the syringe, inject the medicine slowly, leaving a small amount of the medicine with the air bubble in the syringe.
Pull out the needle, holding it by the cannula;
Press the injection site with a cotton ball with alcohol;
Make a light massage of the injection site without removing the cotton wool from the skin;
Put a cap on a disposable needle, discard the syringe into a container for used syringes.
Intramuscular injections. Some drugs, when administered subcutaneously, cause pain and are poorly absorbed, which leads to the formation of an infiltrate. When using such drugs, and also when they want to get a faster effect, subcutaneous administration is replaced by intramuscular. Muscles contain a wider network of blood and lymphatic vessels, which creates the conditions for rapid and complete absorption of drugs. With intramuscular injection, a depot is created, from which the drug slowly enters the bloodstream. This maintains the required concentration of the drug in the body, which is especially important in relation to antibiotics. The intramuscular method of drug administration ensures the rapid entry of the substance into the general circulation (after 10-15 minutes). The magnitude of the pharmacological effect in this case is greater, and the duration is shorter than with oral administration. The volume of one intramuscular injection should not exceed 10 ml. If an oily solution or suspension is injected into the muscle, always make sure that the needle does not enter the vessel. To do this, the syringe plunger should be slightly pulled towards itself. If there is no blood in the syringe, the drug is injected.
Substances that can cause necrosis of surrounding tissues (norepinephrine, calcium chloride) or have a significant irritating effect are not injected under the skin and into the muscle.
To perform intramuscular injections, certain areas of the body are used that contain a significant layer muscle tissue in the absence of large vessels and nerve trunks. The length of the needle depends on the thickness of the subcutaneous fat, since the needle must pass through the subcutaneous fat and enter the thickness of the muscles. So, with an excess subcutaneous fat layer, the length of the needle is 60 mm, with a moderate one - 40 mm.
The most suitable places for intramuscular injections are the muscles of the buttocks (only the upper-outer part!), shoulder and thigh (anterior-outer surface).
NB!accidentally hitting the gluteal nerve with a needle can cause partial or complete paralysis of the limb. In addition, there is a bone (sacrum) and large vessels nearby.
When injecting in young children and malnourished patients, the skin and muscle should be folded over to ensure that the drug enters the muscle.
Intramuscular injection can also be performed in the deltoid muscle. The brachial artery, veins and nerves run along the shoulder, so this area is used only when other injection sites are not available, or when several intramuscular injections are performed daily.
Intramuscular injection into the lateral wide muscle of the thigh is carried out in the middle third of the anterior-outer surface.
Intramuscular administration of the drug is better for several reasons at once: the gastrointestinal tract is not injured, the medicine begins to act faster. It is not always possible to hire a professional worker, since the services are not cheap. Every parent should know how to give injections to children with their own hands correctly.
Rules and features of the procedure
Doing the right intramuscular injection is easy if you follow the recommendations. The procedure is carried out in several stages, each of which must be approached with seriousness.
What is needed for injection
Before giving intramuscular injections to children, it is necessary to purchase the drug. The doctor will tell you the dosage. We do not recommend taking a larger dosage drug and dividing the ampoule, since each medicine needs to be stored in its own way. A person without knowledge can harm his child, but you need to do everything right.
The second important component is cotton wool. It is correct to take a sterile one in a pharmacy. But it is more convenient to use cotton pads. Price in the store from 20 rubles.
The procedure is properly carried out under sterile conditions, so alcohol must be purchased. It can be replaced with vodka, but we do not recommend doing this. Vodka does not kill all bacteria, since the alcohol in it is diluted. You can buy ready-made liquid for injection at a pharmacy, it costs from 70 r.
Syringes with a thin and sharp needle. For children under 3 years old, you can take two cubic syringes; for older children, a needle from a small syringe may not be enough to make an intramuscular injection in the buttock correctly.
If the medicine is administered not intramuscularly, but subcutaneously to the child, then complications are possible: a lump, an abscess.
It is better to purchase an imported syringe with a rubberized piston. The medicine is introduced smoothly in this way and the medicine will be better absorbed, and it will be easier to do the procedure in the buttock.
Preparing for the injection correctly
Wash your hands thoroughly with antibacterial soap before injecting your buttocks. If not, wipe them with alcohol.
An intramuscular injection is given to the child in the buttock. To determine the place of insertion of the needle into the buttock, conditionally divide the muscle into 4 parts. An injection should be made in the upper right part of the buttock. If there are several injections, then the buttocks are changed.
The needle should be inserted into the buttock with a confident and quick movement, it depends on how painful it will be for the child.
The ampoule with the drug is wiped with alcohol and opened. If there is no fracture, then use a special knife. The tool is included in the package. The syringe is unpacked, the needle is put in its place.
Dry medication is diluted with a special composition for injection or painkillers (ledocaine). The better to dilute the powder, the specialist will tell you. You need to stir directly in the vial without opening. To do this, another needle is taken and liquid is collected, poured into a vial and everything is well shaken. It is drawn into a syringe and the needle is replaced.
To collect medicine from a vial with a tight rubber cap, use a different needle, since the tip can become blunt and when injected, it will experience pain.
The medicine is drawn into a syringe. It is turned upside down with a needle and lightly tapped on the walls. This procedure will help expel the air. Then pull on the plunger so that the medicine comes out a little from the needle.
You can start the procedure.
We put an intramuscular injection in the buttock
In the buttock, an intramuscular injection to a child can be done by the following actions:
An intramuscular injection was delivered to the child. And how they talk about the procedure in the program of E. Malysheva, let's look at the video:
Every day, repeat the procedure in different buttocks, otherwise the child will have bumps from the accumulation of medicine. If the bumps hurt, lubricate the place with traxevasin and draw an iodine mesh.
Forewarned is forearmed
- Before the procedure, you need to play with the baby. You can buy a doctor's kit with plastic syringes and show on toys how the injection will be done. The kid should not be afraid and strain the muscle, otherwise the needle will break. If this happens, call an ambulance immediately.
- The child needs to perform all the manipulations confidently, children should not see the fears of adults. Otherwise, the baby will start to get even more nervous.
- If an intramuscular injection calls out fear in a child, calm him down and distract him.
- Do not deceive the baby, saying that the procedure is completely painless. On the contrary, say that it will hurt, but he is strong and brave, how proud you are of him.
- Throw away the needle, having previously closed the cap. The syringe can be washed in hot water and give to the child. Let the baby also treat his dolls or bears. So, psychologically, the procedures will be easier.
- After the injection, praise the baby and give him something, such as candy or a toy. This will be a great motivation to be patient next time.
Follow the rules and it will be easy for children to deliver intramuscular injections with their own hands. A little practice and the procedure will not cause fear.
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In the life of every mother, it can happen that a properly made intramuscular injection can save the life of a child, alleviate suffering, and turn out to be a decisive procedure. Therefore, it is very important to know how togive an injection to a child.
Living in a foreign country, the inability to pay for the services of a medical worker, the work schedule is a small list of reasons that encourage each mother to learn how to independently and correctly give intramuscular injections to a child. In this case, it is important to follow the instructions exactly.
intramuscular injection in ass - this is a strong pain and emotional stress for every baby. Therefore, if the disease is at a mild stage and it is possible to replace the procedure, talk to your doctor about alternative treatment.
The drug, administered intramuscularly, affects the body 3 times faster than a tablet or syrup, works more efficiently and does not damage the gastrointestinal tract.
In the case when you need emergency help and time goes by for minutes - do not hesitate and think. It is necessary to act on the lesion, treat the cause and consequences, put an injection in the ass.
What is needed for an injection?
To make an intramuscular injection to a child, you need to buy in a pharmacy:
- medical alcohol or a specially antiseptic for intramuscular injections;
- sterile cotton;
- a syringe with a needle of the appropriate size;
- medicine in the right dosage (it is necessary to check that the expiration date and contents are appropriate).
The needle is selected depending on the age of the patient. For infants up to a year, you need to use syringes with a dosage of 1 ml, for children 1-5 years old, you can purchase 2 ml. And for patients aged 6 to 9 years, it is recommended to purchase needles 0.5x25 or 0.6x30.
How to prepare for the procedure?
Buttock injection for a child- this is a micro-intervention in the work of the child's body, which is carried out in order to improve the general condition of the small patient. In order not to infect the baby during manipulation, it is important:
- wash your hands clean;
- treat them with a special disinfectant solution or alcohol;
- carefully treat the puncture site before the introduction of the drug and after manipulation.
It is important to remember that young children are very suspicious and shy. Therefore, in order not to frighten the patient, it is better to do all the manipulations not in front of the child.
Before giving an injection to a child, moral preparation is important for the mother. You need to understand that by inflicting pain on the baby for just a few moments, the quality and effectiveness of treatment improves. Therefore, so that the child is less hysterical, crying and afraid, calm appearance mother (the person giving the injection) is the most important. Decisiveness, understanding and firmness of action is half the success. The second part of it depends solely on the execution technique.
Another important preparatory moment before manipulation is the choice of a syringe. For children under 3 years old, experts recommend using 2-cc syringes with a small and sharp needle. In such syringes, the needle is very thin, and therefore less painful. If the baby needs to inject more than 2 cubes of the drug at once, then doctors recommend purchasing separately sterile thin needles.
Older patients need to take syringes with longer needles, since if the drug gets under the skin, a lump, an abscess may form.
Important! If the medicine is supposed to be taken by violating the integrity of the rubber stopper, then before giving an injection in the ass, you need to replace the needle with a new one. 
How to take medicine?
Before giving an injection to a child, you need to know:
- time of drug administration;
- chemical properties of the substance;
- with what to dilute the medicine. When an injection is dispensed in a pharmacy as a powder, you need to check with a specialist what kind of component you need to dilute it with. It should be understood that the mixing of drugs is carried out directly in the vial with the powder. To do this, without opening the ampoule, you need to inject a diluent (ledocaine or a special solution) through a needle, shake well and re-fill the syringe with ready-made medicine for intramuscular injection.
- Methods for removing air from a syringe. The absence of air when the drug is injected into the thigh is an important point, which is strictly forbidden to be ignored. To remove excess air from the syringe, experts recommend turning it upside down with the needle and tapping the walls a little. Thus, the bubbles will begin to move towards the needle. Then you need to slightly press on the piston, releasing the rest of the air. When the medicine appears at the end of the needle, the air is released.
How to mentally prepare a child?
For young children, injections are the biggest punishment, accompanied by pain and fear. And medical vaccination in this case is no exception. Do not deceive the child with stories that everything will happen unnoticed. It is better to say that it will be a little painful, but all the experiences of the mother will be there, will support. Giving an injection during a child's tantrum is highly undesirable.
You can buy a play set for the doctor in advance and show the baby how to give injections to toys, treat them with pills and other methods. So the baby will see that injections are not a very pleasant treatment, but they should be tolerated for a speedy recovery. After all, what toys get sick for a long time?
As an additional motivation for the child, if there are free funds in the family budget, the baby can buy a toy, sweets, a small souvenir. Collecting positive emotions, very soon the child will stop crying, hysteria and will independently allow injections.
How is an injection done?
To make an injection in the buttock with minimal trauma to the patient, you need to follow a certain sequence:
- Clear the work surface. Remove pants (tights), underwear.
- Fix the lower limbs. Even if the baby voluntarily lay down on the couch, then when the skin is pierced, the leg can move reflexively.
- Within a minute, you can do a light massage of the buttocks. This manipulation will distract the baby and relax the muscles.
- Conditionally divide the buttock into 4 sectors (square) and select the upper extreme (on the outside) quarter of the buttock for injection.
- Disinfect the puncture site. Before you give an injection, you need to plentifully, and carefully wipe this place with a cotton swab dipped in alcohol.
- Accurately, quickly and with a "firm" hand insert the needle with the syringe into the designated place.
- Gradually withdraw the medicine from the syringe.
- Pull out the syringe with the needle and wipe the area with cotton soaked in alcohol.
If suddenly during the procedure the needle breaks, you need to immediately call an ambulance!
If a young mother has never given injections before, and now she has to treat the child at home, experts recommend that you familiarize yourself with how to do it.injections to children in the buttocks on video.Thus, in most parents, the fear of performing manipulation and the awareness of the need for the procedure become understandable. 
How else to prepare the baby for vaccination?
It's no secret that vaccinations should be done only in the clinic. In this case, panic, children's crying and tears on the part of children simply cannot be avoided. In order to set the child up for the procedure as positively as possible, it is important to explain the essence of the manipulation and the reason.
Often, to get rid of tension in the immunology rooms, there are toys, bright pictures. They serve as an excellent distraction to put the baby in the right position and instill as painlessly as possible.
After a successful injection, be sure to praise the child, tell how proud you are, admire his courage.
In conclusion, it should be noted that only the right approach and competent execution of manipulation can guarantee success. Do not intimidate, deceive the child, inspire fear of medical personnel. The absence of fear, confidence in the support of loved ones will be real helpers for effective treatment.
Before staging the injection, it is necessary to conduct a psychological preparation of the child, if age permits, that is, older than 4 years, if the child is young, then explain to the mother the course and purpose of the manipulation, and establish friendly contact with the child.
When making an injection, it is necessary to hold the child firmly, fixing the arms and legs. For this purpose, an assistant is used.
In older children, injections are made in the upper outer square of the buttocks (as in adults). In children under 3 years of age, injections are carried out in the anterolateral region of the thigh.
When performing an injection, one should take into account the proximity to the surface of the body of blood vessels, nerve plexuses and bone tissue.
In children with an insufficiently pronounced subcutaneous fat layer (in underweight, premature and suffering from malnutrition), a musculocutaneous fold should be formed, the needle should be inserted into the tissues at an angle of 30 °. In other children, the angle of insertion remains 90°.
Nursing examination of children with respiratory disease.
When examining a child, you should pay attention to:
On the color of the skin. Can be diathesis general or local. In young children, foamy discharge at the corners of the mouth (penetration of inflammatory exudate from the respiratory tract) is sometimes noted.
Nose - possibly difficult breathing, participation in the act of breathing of the wings of the nose, the nature of the discharge (mucous, mucopurulent, mucoserous, sanious).
Oral cavity - it is necessary to pay attention to the condition of the pharynx and tonsils. With the help of the mother, who fixes the child, the health worker quickly draws a spatula to the root of the tongue and, with strong downward pressure, forces the child to open his mouth wide. Determines the degree of hyperemia of the pharynx, the condition of the tonsils, the presence of plaque on them, examines the palatine arches and the back wall of the pharynx.
Type of breathing in children under 2 years of age, the abdominal type of breathing, then chest-abdominal, and then from the age of 8, the boys remain abdominal, and the girls chest.
Breathing frequency - counting the frequency of breathing in one minute, depending on the type of breathing.
Shortness of breath - with obstruction of the upper respiratory tract, there is difficulty in inhaling (inspiratory dyspnea), and with bronchial asthma, obstructive bronchitis, difficulty in exhaling (expiratory dyspnea) is observed.
Mixed shortness of breath is characteristic of pneumonia.
Cough - paroxysmal, with reprisals (with whooping cough), dry, debilitating (with tracheitis), wet, deep (with bronchitis and pneumonia), barking (with laryngitis), painful, short (with pleurisy).
Usually children are given injections in a hospital, and this procedure in a child is associated with a doctor in a white coat, but not with parents. However, in life, a situation may arise in which the syringe will have to be picked up by mom or dad.
For example, a baby needs urgent help with a drug that is best absorbed in injections, or a course of injections is prescribed for a baby, and there is no way to go to the doctor every day.
In such a case, at least one family member should be able to give injections, and quickly and as painlessly as possible, because we are talking about a small child.
What will be needed to give an intramuscular injection to a child?
medicinal product
To make an injection at home, you will first need the necessary medicine. Do not forget to read the instructions for the drug before the procedure and make sure that the expiration date allows it to be used.
Carefully inspect the medicine container (jar, ampoule) and check it for damage. If the integrity of the container is broken, the drug should not be used.
Syringe
No injection is complete without a syringe. For young patients, it is recommended to choose the best modern syringes - three-component. The design of such an instrument consists of a cylinder, a piston and a rubber seal on it, which ensures smooth administration of the drug and reduces the pain of the procedure for the crumbs.
It is very important to choose a syringe of the right volume. As a rule, special syringes for babies with a volume of 1 ml are used to perform injections for babies up to a year old. Older children can be injected with standard syringes with a volume of 2 ml or more, depending on the administered dose of the drug.
Syringe needles
Care should also be taken to purchase needles suitable for injection. Before you go to the pharmacy for syringes, find out which agent you need to inject - water-based or oil-based.
The type of injection depends on which needle the pharmacist in the pharmacy chooses for you. Be sure to tell the specialist that you need a needle for intramuscular injection medicines.
It's great if you buy a few extra needles, in addition to those that come with syringes. They are useful, for example, if you need to prepare a solution of a powdered drug for injection.
As a rule, the solvent is introduced into the powder container by piercing the rubber cap with a syringe needle. In no case should you make an injection with the same needle! It is no longer sterile and not sharp enough.
Asepsis and hygiene products
In addition to the drug and basic tools, for the injection, the baby will also need hygiene and aseptic means:
- sterile wipes;
- alcohol (preferably medical);
- cotton wool
How to mentally prepare the baby for an injection?
If an injection is to be given to an infant, preliminary conversations are not required. Rather, you will need to spend some time with the baby and feel sorry for him after this unpleasant procedure. But older patients still have to be persuaded to take the injection.
Doctors unanimously repeat that it is impossible to give injections to a child on the sly, without warning. This method can work only once, and after it no other will work. The kid will get fear of this procedure, and you will get the distrust of your child.
confidential conversation
The best way to prepare your baby for an injection is to talk to him. Warn that it will really be a little painful and unpleasant. Discuss why this procedure is necessary and what benefits it provides.
Let the little patient know that injecting the medicine with a syringe will help him recover much faster.
Do not skip this step even if you need an emergency injection in the buttock (for example, at a very high temperature). Even one “introductory” sentence: “Son, be patient, please, I will inject the medicine now, and you will feel better soon,” will help the child more easily accept the need for this unpleasant procedure.
Playing or watching a cartoon
If the condition of the baby allows for a more thoughtful preparation for the procedure, watch together a cartoon about a hippo who was afraid of vaccinations, discuss what you saw.
You can carry out both procedures at the same time, at the expense of "three". You can also distract the child with a cartoon - in such stressful situation like the need for an injection, it is permissible. Ask for help from other family members: let the baby be interested for a few minutes while you carry out all the necessary manipulations.
It is important not only to prepare the child for the injection, but also to be mentally prepared. Children feel all the emotions of their parents, besides, the nervousness and insecurity of the “home nurse” can make the procedure much more painful than we would like.
We put an injection in the child's buttocks: step by step instructions
So, when everything is more or less ready: the mother is calm, the patient is calm, the father is ready to fix the baby for the time of the injection in order to avoid traumatic situations, you can proceed to the procedure.
We collect the drug in a syringe
Even before inviting the child into the room, it is worth preparing a syringe with medicine:
- With clean hands (wash them with soap and wipe with a sterile cloth), open the ampoule with the drug, having previously treated its tip with an alcoholized cotton swab.
- Dial the medicine from the ampoule by lowering the syringe needle into it all the way. If the product is powdery and requires dilution, prepare the solution according to the instructions, then draw it into the syringe and change the needle.
- Position the syringe with the needle up and, tapping the barrel with your fingernail, collect any air bubbles at the top.
- Then lightly press the plunger and remove excess air from the syringe.
We put the baby an injection in the buttock
And now comes the most important part:
- Lay the child on his stomach or on his side so that the gluteal muscles are relaxed.
- Choose an injection site: upper outer quarter of the buttocks.
- Knead the muscle in the right place and wipe it with an alcoholized piece of cotton.
- Gather the skin at the injection site into a fold.
- With a precise movement, insert the needle into the muscle three-quarters of its length at a right angle.
- Slowly, slowly inject the medicine by pressing the plunger.
- Press the injection site with a cotton swab dipped in alcohol and quickly remove the needle. Massage the muscle for faster absorption of the drug.
That's all! Now praise your little brave man, he really deserves it. And breathe out. Be sure to throw away the syringe and needle, as well as the ampoule and all used cotton wool, so that the child cannot accidentally or intentionally get them. Never reuse syringes and needles!
Remember: if the baby will have more than one injection, but a long course is prescribed, it is better to inject into the other buttock every two days in order to avoid the appearance of bumps and seals in the muscle.
Giving injections to young children is not easy, but extremely important. If you had to take on the role of a nurse, don't worry. Knowledge of the theory and the ability to control yourself will help you do everything correctly, quickly and almost painlessly.