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1. Which drugs are not suitable for direct intravenous injection?
(1) high-concentration electrolyte
such as Potassium chloride, magnesium sulfate, etc. 10% potassium chloride injection 10ml contains 1g potassium chloride, the blood potassium concentration rises immediately after the bolus injection, which damages the myocardium and can cause sudden death of the patient. 10% or 25% magnesium sulfate injection should be diluted and injected intravenously, otherwise it may cause respiratory depression or even respiratory paralysis.
such as furosemide, sodium diuretic, etc. Intravenous bolus too fast can cause sudden tinnitus, deafness.
(3) neuromuscular junction blockers
aminoglycoside antibiotics such as Mikacin, gentamicin, streptomycin, ribomycin, tobramycin, netilmicin, etc., as well as polymyxin B, lincomycin, clindamycin, direct intravenous injection can Neuromuscular junction block occurs, causing respiratory depression.
(4) Non-aqueous solvent drugs
such as hydrocortisone injection, The solvent of chloramphenicol injection is ethanol solution, and intravenous injection is prohibited.
(5) aminophylline, phenytoin, lidocaine, vitamin K1, etc.
< span>Excessive intravenous bolus injection can cause death.
(6) Drugs with obvious local irritation
①Vancomycin, normethyl The local irritation of vancomycin is strong, which can cause local severe pain, phlebitis and tissue necrosis. Intravenous bolus injection can easily increase the adverse reaction rate of the drug, such as "red neck syndrome", thrombophlebitis, hypotension, etc.;
②Fluoroquinolones, erythromycin lactobionate, fosfomycin, imipenem/cilastatin, etc. Intravenous bolus injection is prone to phlebitis, so intravenous drip And control the dripping speed.
(7) Drugs for intramuscular injection
such as Prue Caine penicillin, benzathine penicillin, vitamin B1, vitamin B12 and other drugs marked for intramuscular injection are for intramuscular injection only, not for intravenous injection.
2. Which injections can only be injected intravenously and not intramuscularly?
Some injections can only be injected intravenously, not intramuscularly, mainly including the following situations.
①Great local irritation
Macrolide antibiotics and tetracycline antibiotics are more acidic , Intramuscular injection has strong local stimulation, excessive concentration can cause local severe pain, inflammation and necrosis, so intramuscular injection is not allowed, and it is advisable to use dilute concentration for slow intravenous drip. Norepinephrine, calcium gluconate (including various other calcium salts), potassium chloride (including various other potassium salts), vitamin C, sulfoethylamide, aminotoluic acid (including various other acid drugs), Sodium bicarbonate (including various other bases), norvancomycin, amphotericin B, fosfomycin, amoxicillin/clavulanate potassium, quinolone antibiotics, acyclovir and certain antibacterial drugs Tumor drugs, etc., if injected intramuscularly, can cause local strong irritating pain and even local tissue necrosis. Therefore, the above locally irritating drugs are not suitable for intramuscular injection.
②Poor local absorption
After intramuscular injection, the drug dissolves in tissue fluid, enters the capillary network, and reinfuses into the The veins either directly enter the small veins or enter the lymphatic fluid and then enter the large veins to enter the systemic circulation to function. Diazepam and other drugs are absorbed slowly, irregularly and incompletely by intramuscular injection. If intramuscular injection is used, the effective drug concentration cannot be achieved and the desired therapeutic effect cannot be achieved. Therefore, intramuscular injection is not suitable.
③Large volume of drugs
Some drugs, such as sodium foscarnet, metronidazole, etc., due to low solubility and other reasons, A large amount of solvent is required to dissolve, resulting in an excessively large volume of the drug solution in normal therapeutic doses, which is not suitable for intramuscular injection.
3. Which injections can only be injected intramuscularly but not intravenously?
Due to the difference between intramuscular injection and intravenous injection, some injections can only be injected intramuscularly and cannot be administered intravenously.
①Oil solution injections
Some drugs are insoluble or unstable in water or in order to delay the effect of drugs. Oil-solution injections are prepared by using non-aqueous solvents such as oil for injection. These injections are for intramuscular or local injection only and should not be used for intravenous administration. Such as vitamin A, vitamin D2, vitamin D3, progesterone injection are sterile oil solutions.
Hormonal drugs are commonly used in their acetate esters, which are mostly insoluble in water and are often made into mixtures. Suspension forms, such as methylprednisolone acetate suspension, are for intramuscular and intra-articular injection only, not for intravenous injection.
③Add local analgesic or bacteriostatic injectionsspan>
Some drugs can cause severe pain when injected, sometimes adding topical analgesics (such as procaine, lidocaine), generally limited to intramuscular or subcutaneous injection, such as Procaine penicillin injection, and some injections are prepared without adding local analgesics. Before use, add local analgesics in special solvents, such as penicillin potassium and 0.25% lidocaine as a solvent. These drugs cannot be given by intravenous injection.
④Injections that can cause serious adverse consequences
A sudden increase in blood concentration of aminoglycosides during intravenous bolus injection , can cause respiratory depression, only intramuscular injection and intravenous infusion.
⑤Injections that cannot be used for intravenous administration due to the characteristics of the dosage form or other reasons
including epinephrine injection, vitamin B1, vitamin B12, vitamin B2, vitamin K1, chondroitin sulfate injection, premixed insulin preparations, etc.
4. Which drugs can cause adverse consequences when extravascular leakage occurs during intravenous administration?
In case of inadvertent leakage during intravenous administration, some drugs may cause adverse consequences and should be paid attention to.
(1) Antitumor drugs
including cytotoxic, antimetabolite, For antineoplastic drugs such as alkaloids and antibiotics, the incidence of extravasation through peripheral intravenous administration is 0.5%-6%. Multiple injections can cause hardening of blood vessels, pain and thrombophlebitis, and local tissue necrosis can be caused by spillage of the drug solution. There are more and more types of chemotherapeutic drugs, and the application of chemotherapeutic drugs requires higher injection techniques to reduce or prevent drug extravasation.
(2) calcium salt preparations
including calcium gluconate, calcium chloride, Calcium folinate, etc., especially when administered too quickly, may cause redness, rash, pain, and even peeling and skin necrosis at the injection site. If leakage is found, the injection should be stopped immediately, and local injection of sodium chloride solution should be used.
(3) Peripheral alpha-receptor agonists
including norepinephrine and epinephrine, dopamine, etc. During intravenous infusion, skin whitening along the intravenous route, skin peeling, cyanosis, and redness at the injection site may occur. In case of liquid extravasation, 10 mg of phentolamine plus sodium chloride injection should be used for local sealing infiltration at the leakage site.
Source: Medical Nursing Channel
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