Injection Safety Practice among Health Workers in Static Immunisation Centres in an Urban Community of Nigeria

Background: Immunisation injection accounts for less than one-tenth of the global total injections, and it is believed to be safer than therapeutic injections. However, reports have it that about one-third of immunisation injections are unsafe in many countries of the world including Africa. Objectives: This study was conducted to determine the practice of sage immunisation injection among health workers in static immunisation centres in a urban community in Nigeria with a view to assessing the safety of immunisation injection services in the area. Study design/methods: Pre-tested semi-structured questionnaires were administered to 102 consenting staff and observation checklist was completed for each of the 13 fixed immunisation centres in the study area. Results: Most of the subjects 82(80.4%) had poor knowledge of safe immunisation injection and about the same number were not aware of any policy on injection safety. Injection abscess was the main health hazard of unsafe injection reported by majority 71(69.9) of the subjects while as few as 10(9.8%) mentioned needle prick as a health hazard. The common infections associated with unsafe injection listed by the subjects were abscess, HIV and Hepatitis in that order of frequency. Also, most of them 69(67.5%) felt that open burning is the ideal method of disposal of injection waste, while the actual method of disposal practised in most health facilities were mainly open burning (48%) and open dumping into an insecure pit (24%). Up to 83% of the subjects preferred the use of standard disposable syringes and needles for vaccination, but most of them (75(73.5%) confirmed that they use both sterilisable and disposable syringes and needles for vaccination in their health centres. BCG vaccine was exclusively administered using sterilised needles and syringes, while tetanus toxoid was given using disposable syringes and needles in virtually all the centres. Re-use of syringe for vaccine withdrawal and re-capping of used needles before discard were common practices observed while accidental needle stick injury was reported by about half (49%) of the subjects. Conclusion: Staff re-training, adequate supplies of injection equipment and provision of appropriate facilities for disposal of injection waste would go a long way to enhance safe immunisation injection practice in the area. Key words: immunisation, injection practice, injection safety.     

低分子肝素皮下注射时间与皮下出血关系的研究

目的比较3种皮下注射低分子肝素持续注射时间与注射部位皮下出血的关系。方法选择接受低分子肝素治疗的人工全髋关节置换术后患者30例，分为3组后分别接受3种不同注射时间。然后观察皮下出血倒次及出血面积的大小。结果皮下注射低分子肝素持续30s以上及注射持续10s，但是停留10s后拔针都比注射10s明显减少瘀斑的数目和面积。结论皮下注射低分子肝素持续30s以上及注射持续10s是停留10s后拔针可应用于临床实践中。     

Injection safety and Indian Academy of Pediatrics

A major proportion of injections administered in India are unsafe. Unsafety is due to (1) steps that are associated with increased risk of spread of blood borne viruses and (2) errors related to technique of injection and faulty habits. Recommendations of Indian Academy of Pediatrics revolve round the following points: Equipment related, safe injection practices, best injection techniques, rational injection practices, prevention of needle stick injuries and reducing disease transmission recommendation for HIV-PEP (postexposure prophylaxis), HBV-PEP, disposal of syringes and sharps. The points have been discussed elaborately.     

Injections--how safe

Injection, is a skin-piercing event performed by a syringe and needle with the purpose of introducing a curative substance or vaccine in a patient. According to WHO, safe injection is one which does not harm to the recepient, does not expose the health worker to any risk and does not result in waste that is dangerous for the community. To achieve this injection should be prepared on a clean workspace, provider should clean his hands appropriately, sterility of the syringe and needle to be maintained, skin of the recipient should be cleaned and above all sharps waste should be managed appropriately. Common danger of unsafe injection is infection. Most medication used in primary care can be administered orally. So firstly the behaviour of healthcare providers and patients must be changed so as to decrease overuse of injections, secondly provision of sufficient quantities of appropriate injection equipment and infection control supplies should be made available and thirdly a sharp waste management system should be set up.     

静脉输液的拔针按压法

静脉输液是护士基础护理操作的重要内容,而拔针、按压是护理工作中最基本,最简单的一项技术操作,经常由于方法的不当等因素给患者带来疼痛,皮下淤血,针眼出血,红肿甚至感染等,而引发护患纠纷,影响了患者的情绪,加重了其心理负担,继而直接关系到治疗效果。针对这一常见情况,我科护理人员,经过不断的学习,实践中又采取了另一种拔针、按压方法—创可贴按压法[1],取得了满意的效果。     

The effect of air-lock technique on pain at the site of intramuscular injection

Objectives:

To investigate the effects of air-lock technique (ALT) on pain of intramuscular (IM) injection delivered to the ventrogluteal and dorsogluteal site (DS).

Methods:

A randomized controlled trial design was used to assess the pain intensity associated with IM injections administered using 2 different methods and injection sites. Recruitment of patients was carried out between April and August 2013 at the Department of Brain Surgery, Cekirge State Hospital, Bursa, Turkey. The sample comprised 60 patients who developed no complications at the IM site, and had no illness that could affect their perception of pain. The patients were randomly divided into 2 groups of 30 patients. Patients in the first group received injections in the ventrogluteal site (VS), while the DS was used for injections in the second group. Patients in each group received 2 injections, one using ALT and one not using the technique. After each injection, the pain felt by patients during the injection was immediately assessed using a visual analog scale.

Results:

The mean pain score after injections to the DS by the ALT was 3.30 ± 2.70, while the mean pain score after injections to the VS using the same technique was 2.53 ± 2.52.

Conclusion:

Although the difference between groups was not significant, the results of the study supported the idea that injections delivered to the VS by ALT are less painful than those delivered to the DS.Drugs are delivered via many routes, such as orally, topically, and parenterally.1 One of the techniques for parenteral drug delivery is intramuscular (IM) injection, and one of the sites for this is the large muscle masses.2 Intramuscular injection is a technique, which causes the patient pain and discomfort.3-5 According to the results of one study,6 40% of patients receiving IM drug injections rate it as a very painful process. In the administration of IM injections, the choice of a reliable injection site and injection technique are important factors in the reduction of pain arising from IM injection. In the literature, it has been stated that one site used for IM injection, the dorsogluteal site (DS), is rich in blood vessels, is close to the sciatic nerve, and has a thicker layer of subcutaneous tissue than other sites, making it the most risky site, while the ventrogluteal site (VS) can be safely used instead.1,7-10 The dorsogluteal area, which is frequently preferred by health professionals has been reported to be the most risky area for IM injection.10 If the injection site is not chosen correctly, very serious complications may result.7,8 It is accepted that the VS is safer for injections and causes less pain, because there are no large blood vessels and nerves in the area, and it is distant from bony tissue. This area has the added advantages that the subcutaneous layer here is thin, the necessary position for the patient is easy, and the probability of the medication being delivered to the subcutaneous tissue is low.11-13 Although the literature identifies the VS as the safest site for IM injections, studies have shown that most health professionals do not use this site and are unwilling to change; in addition, although they are aware of the complications that can arise from the use of the DS, they do not give up in using this site.11,12 A study in Turkey14 showed that 60% of nurses always used the DS for IM injections. At the same time, it is believed that the air-lock technique (ALT) used in the administration of IM injections reduces tissue trauma, and reduces pain at the time of injection by preventing the medication from reaching the subcutaneous tissue.9 In a study carried out by Mac Gabhann15 it was stated that the ALT was found to be effective in reducing discomfort due to IM techniques. Najafidolatabad et al16 reported that the ALT was effective in reducing the pain felt after IM injection. It was observed that there are very few studies examining the effectiveness of reduction of IM-induced pain in the dorsogluteal and ventrogluteal injection regions, and the ALT applied there. Besides, it was found that the results of existing studies were not up to date. In this study, we aim to investigate the effects of ALT on the pain of IM injections delivered to the ventrogluteal and DS. This research was conducted for the purpose of providing additional data to practitioners at the level of clinical evidence, and contribute to the literature in light of the current data.     

胰岛素泵与多次皮下注射强化治疗Ⅱ型糖尿病的疗效对比分析

目的对比持续胰岛素泵强化皮下输注（CSII）和胰岛素多点皮下注射（MDI）在Ⅱ型糖尿病患者强化治疗中的效果。方法 100例Ⅱ型糖尿病患者随机分为CSII和MDI两组,每组各50例,CSII组使用持续胰岛素皮下输注赖脯胰岛素（Lispro Injection）强化治疗;MDI组使用赖脯胰岛素联合精蛋白锌重组人胰岛素中效型（Humulin NPH）多点皮下注射强化治疗,对比分析两组血糖改善情况。结果 CSII组比MDI组控制血糖更理想,血糖波动更小,达标更快,低血糖发生率更低,单位体重胰岛素用量更少,差异均有统计学意义（P〈0.05）。结论 CSII能更好、更快、更安全地完成Ⅱ型糖尿病的强化治疗,可在临床治疗中推广应用。     

尺胫针疗法对甲醛致痛模型小鼠血清5-HT含量的影响

目的研究尺胫针疗法的镇痛机理,为临床应用提供实验依据。方法将小鼠分为模型组、腕踝针组及尺胫针组,于小鼠第二、三跖趾关节之间皮下注射5％甲醛溶液致痛造模,观察各组不同时间点小鼠血清5-HT含量变化。结果血清5-HT含量在造模后4h即明显升高;于一、二次治疗后,尺胫针组和腕踝针组均低于模型组（P〈0．01;P〈0．05）,而尺胫针组较腕踝针组更低（P〈0．05）。结论尺胫针与腕踝针疗均可降低足底注射甲醛溶液致痛小鼠模型血清5-HT含量,尺胫针组降低作用优于腕踝针组。     

酪酪肽对荷人肝癌裸鼠皮下移植瘤的影响

目的 研究酪酪肽(PYY)对荷人肝癌裸鼠皮下移植瘤生长的影响并初步探讨其作用机制.方法 用含1×107/ml的HepG2人肝癌细胞悬液0.2 ml打人裸鼠皮下,待其长出的肿瘤直径约1cm时将瘤块取出,在无菌PBS液中剪成大小1 min×1 mm×1mm的小块,用组织插块法制作裸鼠皮下肝癌模型.选取成瘤的32只裸鼠平均分为4组:PYY大、小剂量组,阳性对照组给与腹腔注射氟尿苷,阴性对照组给与皮下注射生理盐水.实验过程中观察裸鼠的一般情况.结果 PYY大、小剂量组在肿瘤体积、血清AFP、瘤重及瘤组织cAMP中均低于阴性对照组(P＜0.05).结论 PYY可以抑制裸鼠肝癌皮下移植瘤的生长,其机制可能与抑制肝癌细胞内cAMP的含量有关.     

益阳市基层医疗机构门诊处方行为的综合评价

目的：分析益阳市基层医疗机构门诊处方行为及影响因素,并对其行为进行综合评价,为提高合理用药水平提供科学依据。方法：采用多阶段随机抽样的方法,随机抽取益阳市21家基层医疗机构,每家机构每月随机抽取15张处方,一年共3 780张,逐一登记处方信息,分析评价处方行为。结果：每张处方平均用药种数和注射剂处方百分率超过国际标准。未成年患者多重用药、抗生素、激素和注射剂处方使用率较高,女性患者基本药物使用率较高,夏、秋季抗生素、激素使用率较高,乡镇卫生院多重用药、抗生素、注射剂和基本药物使用率较高,皮肤和皮下组织疾病多重用药处方使用率较高,呼吸系统疾病抗生素、激素和静脉注射处方使用率较高。大部分基层医疗机构合理用药水平为中上等。结论：益阳市基层医疗机构处方合理用药水平整体较好,但仍面临每张处方平均用药品种数和注射剂处方百分率超过国际标准的双重挑战,基层医师应严格规范处方用药行为。     

胰岛素泵强化治疗效果观察

目的:对胰岛素泵的治疗效果进行评价。方法:通过比较胰岛素泵持续皮下注射与诺和灵30R多次皮下注射,观察两者治疗效果的不同。结果:胰岛素泵持续皮下注射组血糖达标时间少于诺和灵30R多次皮下注射组,且低血糖发生率低于对照组。结论:胰岛素泵作为一种先进的糖尿病治疗措施,有其优越性,值得临床广泛使用。     

抗原穴位注射增强机体免疫功能的神经免疫调节作用

目的 探讨神经免疫调节在抗原穴位注射增强机体免疫功能的作用。方法 采用免疫组化、免疫荧光标记和RT－PCR定量分析技术,观察了不同途径免疫的大鼠中枢神经的下丘脑外侧区（LH）和杏仁核区（AA0中IL－1β、IL－6的表达与脾脏单个核细胞的IL－1β、IL－2γ变化的关系。结果 抗原穴位注射组小鼠LH和AA脑区IL－10β、IL－6的表达明显高于皮下注射组。但阳性细胞表达的高峰时间相似。免疫荧光标记结果显示细胞因子阳性细胞为神经元。穴位免疫组脾脏单个核细胞IL－2和IFN－γ的表达明显高于皮下免疫组,IL－1β的表达无差异。结论 结果提示抗原经不同注射途径（皮下、穴位）免疫动物,动物中枢神经系统的神经免疫调节功能活动的作用时程是相似的,仅表现为神经免疫调节的作用强度不同;LH和AA脑区IL－1β、IL-6介导的神经免疫调节功能与机体的免疫功能状态呈正相关;神经元神经免疫调质／递质的来源。抗原经穴位注射增强机体免疫功能的作用机制可能为穴位免疫可更有效的动员中枢神经系统的免疫相关脑区的神经免疫调节功能,参与对免疫系统的功能调节。     

套管针经脐缘穿刺行卵巢癌腹腔化疗41例

目的　简化腹腔穿刺方法 ,提高卵巢癌腹腔化疗的效果 .方法　将静脉套管针距脐缘 0 .5 cm处刺入腹腔 ,拔出针芯 ,接通输液管并灌注化疗药 .结果　经 2 71次穿次 ,所有穿刺均 1次成功 ,未发生任何并发症 ;其临床缓解率为87.8% ,明显高于常规腹腔化疗方法 (P<0 .0 5 ) .结论　在卵巢癌腹腔化疗中 ,采用静脉套管针近脐缘单次穿刺的方法 ,简便 ,安全 ,注液速度快 ,药液弥散广 ,并可反复实施     

静脉留置针在儿科应用中存在的不安全因素及护理对策

目的:观察静脉留置针在儿科应用中存在的不安全因素,分析原因提出对策以提高其安全性。方法:前瞻性调查600例患儿应用静脉留置针的情况,分析留置过程中存在的不安全因素。结果:发现其不安全因素主要有用留置针穿刺留取血标本时易形成血栓、输液滴注不畅、留置时间短或意外脱落、输液外渗不易察觉、拔针不当、针眼机械摩擦后形成疤痕、封管液肝素剂量难把握等。结论:加强留置针留置期间风险管理,做好患儿家属的健康宣教可提高患儿在静脉留置针使用中的安全性。     

无损伤钝头丰乳穿刺针减少隆乳术出血的临床观察

目的探讨“无损伤钝头丰乳穿刺针”减少聚丙烯酰胺凝胶填充剂隆乳术术中及术后出血等并发症 ,提高隆乳术的成功率。方法 10 0 0例隆乳术者随机分为观察组和对照组各 5 0 0例 ,观察组采用笔者发明的“无损伤钝头丰乳穿刺针”为手术器械 ,对照组采用传统锐针为手术器械。结果观察组术中出血率为 0 .6 0 % (3/ 5 0 0例 ) ,术后出血率为 1.0 0 % (5 / 5 0 0例 ) ;对照组术中出血率为 3.0 0 % (15 / 5 0 0例 ) ,术后出血率为 3.4 0 % (17/ 5 0 0例 ) ,两组比较有显著性差异 (P 相似文献   

承泣穴的解剖学研究

[目的]探讨承泣穴的解剖结构、针刺深度和方向。[方法]通过解剖观测48例成人尸体眼眶。[结果]承泣穴直刺进针,针尖穿经的结构为皮肤、皮下组织、眼轮匝肌、眶脂体、下斜肌、下直肌。[结论]承泣穴直刺进针达12.00mm时针尖应稍斜向后上方,同时深度不超过25.0mm。     

妇科手术切口不同缝合方法效果观察

目的：比较妇科手术切口不同缝合方法的临床效果,提出操作简单、疗效好的缝合方法。方法将300名患者分成对照组和观察组对象对比研究。结果研究发现腹部切口在皮肤及皮下组织层彻底止血的情况下,可不缝合皮下组织及皮肤,仅用一次性皮肤吻合器,每间隔1．0cm订合皮肤1针,切口表面覆盖敷料,腹带加压固定24h,术前30min及术后2天静脉应用抗生素,预防感染,定期更换敷料,并予以对症支持治疗,皮下组织均可自然愈合。结论不缝合皮下组织及皮肤可缩短手术时间,减少术后线结反应,且切口愈合美观,深受广大患者接受。     

口服依托咪酯对大鼠伤害性刺激的抑制作用

目的:研究口服依托咪酯是否具有镇痛作用. 方法:口服给药,观察依托咪酯对福尔马林和蜜蜂毒诱发的持续自发缩足反射的影响以及对蜜蜂毒诱发的热和机械性痛敏的影响. 结果:口服不同剂量依托咪酯(5,20,30,40和50 mg/kg),在剂量为5 mg/kg时,依托咪酯只对福尔马林诱发的自发缩足反射的第二相有抑制作用,增加剂量后,依托咪酯对福尔马林诱发的自发缩足反射的第一和第二相都有明显的抑制作用,最大抑制率为(51.48±9.18)%;不同剂量的依托咪酯对蜜蜂毒诱发的自发缩足反射行为产生剂量依赖性抑制作用,其最大抑制率为(51.59 ±3.92)%,但口服5 mg/kg和20 mg/kg的依托咪酯,对于蜜蜂毒注射后热刺激潜伏期缩短和机械刺激阈值降低并没有影响. 结论:口服依托咪酯可明显抑制福尔马林和蜜蜂毒诱发的自发缩足反射行为,表现出镇痛效果,但对于蜜蜂毒诱致的热和机械性痛敏没有抑制作用.     

NGF、ASIC3与实验性大鼠Ⅲ型前列腺炎骨盆疼痛的相关性研究

目的 探讨神经生长因子（NGF）、三型酸敏感离子通道（ASIC3）在实验性大鼠Ⅲ型前列腺炎的前列腺组织中表达的意义。方法 选取性成熟雄性SD大鼠30只，分为对照组（0.9% NaCl于盆腔区域皮下、双侧肩胛皮下多点注射）、Ⅲ型前列腺炎模型组〔实验性自发免疫性前列腺炎（EAP）组，完全弗氏佐剂与前列腺组织混悬液于盆腔区域皮下、双侧肩胛皮下多点注射〕，每组15只。建立EAP模型过程中，于建模第0、5、10、20、30、40天予Von-Frey测痛纤维进行骨盆区域痛觉测试。建模成功后取大鼠的前列腺组织，进行HE染色观察病理学改变；通过免疫组化和Western blot方法检测NGF及ASIC3的蛋白表达。结果 Von-Frey测痛结果显示:EAP组大鼠骨盆疼痛表现较对照组明显。HE染色结果显示:EAP组大鼠前列腺间质内淋巴细胞和中性粒细胞浸润，腺体周围充血；对照组未见明显炎症细胞浸润。免疫组化染色和Western blot结果显示:EAP组大鼠的前列腺组织中，NGF及ASIC3蛋白表达（主要表达于细胞核与细胞浆中）较对照组增加(P<0.01)。结论 EAP大鼠前列腺组织中NGF及ASIC3表达增加，NGF及ASIC3可能是导致Ⅲ型前列腺炎骨盆区域疼痛的重要介质，有望作为干预及治疗Ⅲ型前列腺炎的靶向指标。