Intravenous and
Intra-arterial Injections
Dr. Russu Cristian
Dr. Russu Eliza
Intravenous injection
Diagnostic - anatomical and functional exploration of an organ:
kidney: urography, renal scintigraphy
lung: pulmonary scintigraphy
phlebography
liver: hepatic scintigraphy
For therapeutic purposes: hypertonic solutions, solutions in
large quantities (infusions, transfusion of blood derivatives
administration).
Very good way for the management of shocked patient
Not used for administration of suspensions or oil solutions
Advantages:
The active substance gets quickly into circulation
Full absorption
Integral action
Injection of hypertonic solutions (which have necrotizing effect
on other tissues)
Used for anatomic and functional exploration
Routes of administration
Superficial veins: located at the fold
of the elbow, forearm, dorsal aspect of
the hand or foot (in theory any vein)
Deep veins: femoral, jugular,
subclavian vein
Syringes with needles 4-5 cm long,
thicker, with short and sharp bizou.
The air in the syringe is mandatory to
be evacuated.
Superficial veins of the upper limb
Superficial veins IV injection technique
Highlighting the vein: application of the tourniquet and muscle
contraction, maintaining latch member position
Disinfection of the area
With fingers I, II of the left (nondominant) hand, disinfected in
advance, immobilize the vein
Install the syringe needle (with the bizou upward)
Enter in an acute angle to the plane of the region (25), then
advance the needle parallel to the skin and puncture the vein
(the sensation of break through into emptiness").
Advance the needle into the vein up to the bizou
When we create vacuum the blood enters into the syringe
After injection, gently massage the spot (this avoid formation
of a hematoma)
Areas of choice:
superficial veins from the fold of the elbow
any other superficial vein
I.v. injection times
Jugular vein puncture technique
External jugular vein
Most commonly used for infusions in
children, pre- and postoperatively in
shocked patients
The body will be rotated so that the vein
will be visible at the posterior border of
sternocleidomastoid muscle
Aspiration is applied continuously
during the insertion of the needle (pay
attention to the risk of gas introduction)
Subclavian vein puncture technique
o
It is used a long needle - 8cm
Puncture site: delto-pectoral groove where it can
be identified the first chondro-costal joint
The patient lies in supine position with the
head rotated towards the opposite side
The needle penetrates obliquely (slightly
upward and medial) following the subclavian
groove at an angle of 45.
Aspiration is applied continuously during the
insertion of the needle.
Femoral vein puncture technique
The groin area is shaved and disinfected
Identify the femoral artery (pulses to
palpation)
1 cm medial to the femoral artery, insert
the needle and penetrate obliquely upward
at an angle of 60-70, easily aspiring and
loading the vein on the needle
After injection, a moderate local pressure
is to be maintained for 2-3 minutes
Incidents and accidents
Difficulties at puncture (obese patients, thin veins, children,
vein sclerosis, collapse) approach of a deep vein or
preparation of a vein
Parvenous injection: site pain, burning at the injection site,
swelling
Can go up to tissue necrosis is necessary, in this case,
another vein puncture and injection of lidocaine 1%
Pain on injection: by irritating the endovenous layer
venous spasm slow injection
Embolism (gas, fat) death
Thrombophlebitis (repeated injections in the same vein)
Incorrect puncturing:
arteries (femoral, subclavian)
pleura subcutaneous emphysema
fluidopneumothorax
Intra-arterial injection
Purpose of exploration: administration of radiopaque
substance (Odiston), radioactive substance (Xe, I)
Therapeutic purposes:
Injection of vasodilators substances in arterial
disease
Antibiotics in the distal infections of the lower limb
Injected only by doctors
Elective location - accessible arteries: femoral,
carotid artery, abdominal aorta
Arteriography
Using special syringes with special needles and
devices, contrast substance is injected with constant
flow (the Seldinger technique).
Femoral artery puncture technique
Hair removal, disinfection of the area
Disinfection of the left index and medius
Tracking the femoral artery pulsation, in the
groin area, between the two fingers
Enter, with the needle installed to the syringe,
between those two fingers and penetrate the
skin perpendicular, then oriented gently upper
oblique - light colored blood will enter the
syringe.
After injection the needle is removed and local
compression is applied for 10-15 min
Radial artery puncture
Before carrying out the radial artery puncture, Allen test must be
performed.
Allen test:
it is used to assess the arterial blood flow at the hand level;
first the radial and ulnar arterial pulse is palpated by deep
compression of the anterior aspect of the forearm;
the patient is asked to make a fist, then both arteries are
compressed firmly between the two thumbs;
next, the patient will be asked to open the fist and will notice that the
palm is pale (the compression on arteries is maintained the whole
time );
the ulnar artery will be decompressed (the compression is
maintained on the radial artery); If ulnar artery is patent, the normal
hand coloration will be observed in 3-5 seconds;
then the radial artery will be decompressed (the compression is
maintained on the ulnar artery); If radial artery is patent, the palm will
become red in seconds cause of the bloodflow;
by this procedure, the maintenance of paleness after the
decompression of one of the arteries indicates an occlusion at that
level.
Radial artery puncture technique
a rolled towel is placed under the patient's wrist to support
it
the artery is localized and palpate the pulse
the puncture site is disinfected and is expected to dry the
place
the artery is palpate with the index and middle finger of
one hand while the other hand is holding the syringe
for radial artery puncture, the needle is oriented at an
angle of 30-45
the skin and the arterial wall is punctured by a single
motion which will automatically fill the syringe with blood
after the puncture, compress firmly to stop bleeding (for at
least 5 min). The time of compression shall be extended in
patients on anticoagulant therapy or with bleeding
disorders (10-15 min).
an adhesive bandage will be attached after the bleeding
stops
Aortography:
percutaneous injection of
abdominal aorta using Dos Santos technique
o The patient is placed in right lateral decubitus
o Aortic puncture is made at half the distance
between VII rib and the iliac crest, in general
anesthesia
o Use a long needle of 12 cm, 1mm in
diameter, with short bizou mounted at a 20 ml
syringe, the injection being made at an angle
of 30-45 from the sagittal plane.
