parenteral administration abbot labratories 1966

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Booklet on the use of old style IV Infusion bottles, probably not useful except in the third world or if the world ends, still good history of medicine and medical techniques

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PARENTERA1 ADMINISTRATION

The following

are trademarks

of Abbott

Laboratories:

Abbocillin, Abboject, Abbo-Liter, Abbo-Vial, Bejectal, Butterfly-16, Butlerfly-19, Butlerfly-21, Butlerfly-23, Butlerfly-25, Cly-Q-Pak, Erythrocin, Hyazyme, lon-o-trate, Metaphen, Microdrip, Panheprin, Pentothal, Soluset, Twin-Site, Venopak, Venotube Color-Break, registered trademark, Kimble Glass Co. Fiberglas, registered trademark, E. I. du Pont de Nemours & Co. (Inc.) Gold-Band, registered trademark, Wheaton Glass Co. Teflon, registered trademark, Owens-Corning Fiberglas Corp. Zephiran, registered trademark, Winthrop Laboratories

ENTERING

THE

VEIN

.

4 4 9 9 11 12 14

Selecting and Preparing the Site for Injection Making the Venipuncture The Bevel The Needle Basic Venipuncture Other TechniquesABOUT THE INFUSION

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. 18

Selecting and Preparing the Equipment for Venoclysis Temperature of Solution at Time of Administration Assembling the Apparatus Rate of Infusion Mechanical Difficulties Adding Supplemental Medication Terminating the InfusionABBOTT EQUIPMENT FOR INFUSIONS

18 18 19 19 19 20 20

. 22

The Abbo-Liter The Venopak The Surgical Venopak The Venopak Microdrip The Secondary Venopak The Y-Type Venopak Soluset Venocath The Butterfly Infusion Set Venovalve 30 with "T" Connector "T" Connector Set Venotube 20, Venovalve 30, and Venotube 20 Sterile Pack The Venotube Twin-Site The Cly-Q-Pak for HypodermoclysisFROM THE SYRINGE

22 22 24 25 25 26 27 29 31 32 32 32 33 33

. 37

Transfer from the Ampoule and from the Multi-dose Vial. From the Ampoule From the Vial From the Two Compartment Vial. How to Prepare Solution Into the Vein Into the Muscle Into the Subcutaneous Tissues Into the Skin (Intradermal)REFERENCES

38 38 39 40 40 41 42 46 47

. 49

1

INTRODUCTION

2

Frequently in clinical practice drugs or solutions are administered by other than the oral or rectal route. Such administration is called parenteral (meaning apart from the intestine) and usually refers to injection of drugs. Parenteral injection is employed for a number of reasons, among which are the following: 1. The patient may be unconscious. 2. The patient may be nauseated or vomiting. 3. Some drugs cannot be absorbed from the gastrointestinal tract (for instance, some antibiotics have too large a molecular size). 4. Some drugs are partially or completely destroyed by the gastric and other digestive juices. 5. A drug's action may be needed instantly (as during anaphylaxis, an asthmatic attack, or other emergency). 6. A drug's action may be needed only in a prescribed area (for instance, a local anesthetic). 7. A physician may wish to prolong the action of a drug by injecting a repository form or a concentrated aqueous solution. 8. Severe disturbance of fluid and electrolyte balance may require intravenous infusion (or subcutaneous infusion when a suitable vein is not available). Parenteral injection encompasses several routes of administration such as injection into a joint, into the spinal canal, into an artery, into the brain, or (in an emergency) into the heart itself. In fact, injections may be made into almost any organ or area of the body. However, it is our aim here to describe only those injeCtions which are administered more routinely. These are: 1. intravenous (into the vein) 2. intradermal (into the skin) 3. subcutaneous (under the skin) 4. intramuscular (into a muscle) Abbott intravenous equipment will be described, and a number of drawings will serve to illustrate the points made, the techniques described, and the equipment used.

ENTERING

THE VEIN

ENTERING

THE VEIN

(venipuncture)

SELECTING AND PREPARING THE SITE FOR INJECTION.

Certain preliminary

preparations

should be made, and precautions

observed, to insure as fossa (median

safe and painless an entry as possible. Although most superficial veins are suitable for venipuncture, veins in the antecubital basilic and median cephalic) are most frequently for all occasions. Other suitable alternatives with advantage. lies in the antecubital tionships). Other available network011

chosen because they sometimes

are usually large and easily accessible. However, this site is not the best are available, Also, one should keep in mind that the median nerve fossa and that, in some patients, the brachial artery rela-

may lie superficially (see figure 9, page 11, for possible anatomical

veins include the cephalic and basilic veins in the fossa, the metacarpal and the dorsal venous

arm above the antecubital antebrachial movement,

the back of the hand. The accessory cephalic and median veins of the forearm are favored by many clinicians for long in the antecubital fossa precludes arm in a forearm especially flexion at the elbow, venipuncture

infusions. Whereas venipuncture

vein and securing of the needle and tubing allow the patient some movement without the risk of puncturing surface. The legs present the great saphenous and femoral veins in the thigh, and the great saphenous at the ankle. On the foot are the venous plexus of the dorsum, the dorsal venous arch, the medial marginal vein, and the lateral marginal vein. Ordinarily at least one or two of these veins will be suitable for injection. Also, with careful attention ment of the tourniquet, be utilized. To avoid the difficulties described later on page 10 (figure 8), the operator generally is urged to "use as small a needle as possible, and to insert it into the largest convenient 4 vein just distal to a venous junction, securing it by some means which does not occlude the vein distal to the point of insertion. Thus, he should try to enter large veins at the to the application of heat and placeeven veins that are small and poorly filled may the posterior wall of the vein. Here, again, one should be aware that aberrant arteries sometimes lie near the

. Anterior

Posterior

V. basilica

V. basilica

V. mediana

antibrachii Vv. metacarpeae dorsales

V. ext. sup. femoralis,

V. saphena

magna

V. saphena V. saphena

parva magna

V. saphena

magna

Rete venosum

dorsale pedis

V. marginalis

medialis

Figure 1. The superficial veins used in blood transfusion or intravenous (From Proceedings Staff meetings. Mayo Clinic, 12:122-125, 1937.)

injection.

proximal

end of a limb, and avoid the small veins at the distal end."1 the operator should ascerdegrees of varicosity of infused do not exist at or above the proof flow in such areas can there. untoward When this reactions delay solution

When using veins of the lower extremities, tain that marked posed point of injection. result il~ a collection accumulated the intravenous The partial stagnation or injected the general

fluid reaches

circulation,

may occur. Also, when an immediate the onset. However, if varicosities

effect is desired (as is usual when cannot be avoided, the point of into increase care should

route is chosen) varicose veins may considerably and the veins massaged has been determined, centrally utmost

jection should be elevated

the blood flow. When the site for injection measure, let the extremity

be given to the proper distention

of the vein. As a simple preliminary

in which the vein is located hang dependent compression above the site, as The tourniquet can A blood presconstriction used for tube held by a

for a time. This action alone may serve to make the veins more apparent. If the veins stand with a tourniquet, sure cuff is probably and of providing hemostat this purpose. If a vein in the antecubital sufficiently 6 to obstruct venous fossa is chosen, tighten return without stopping and will maintain the tourniquet arterial flow. arterial flow. At out well, manual will be sufficient to fill them.

vary from a twisted bandage

to complicated

mechanisms.

the most efficient means of applying

a quick smooth release. A soft rubber

or tied in a slip knot

(figure 2) is most frequently

This will fill the veins to capacity the same time, the patient

should continually

open and close his hand,

Figure 3. Shaded portions represent congestion from correct and incorrect application of heat. (From Proceedings Staff Meetings, Mayo Clinic, 12:122-126, 1937.)

finally keeping it closed until the needle is in the vein. When the veins are small or deep, constriction alone may not produce adequate dilatation. In this event, lightly slapping the veins at the wrist may cause additional dilatation of the vein. Application of heat to the and may be extremity is a valuable aid prior to applying the tourniquet administered,

necessary should the other means mentioned be unsuccessful. Properly this heat can mean the difference between a routine inby a venous cut-down. For example, jection and an involved administration

As illustrated in figures 3 and 4, heat must be applied not only to the area around, but also distal to, the site of venipuncture. if a vein of the upper extremity is to be used, the hand, wrist, forearm and arm (to a point above the elbow) should be enveloped in a warm,

Figure 4. Method of applying moist heat to dilate poorly filled veins. The arm is wrapped with a Turkish towel wrung out of hot water, over which is placed a'rubber sheet enclosed in turn by a dry Turkish towel. This is left in place 10 to 20 minutes.

7

Figure 5. Sma

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