2 weeks, 1 day ago

 

The factors that cause pain from drugs and needles are actually less than the patient's condition itself. Sometimes it is the patient's forbearance that leads to adverse effects. If you have to give some needles or medicines that will hurt, you can start to talk about them (this article does not include oral administration, according to the requirements of the title, from the perspective of injection administration). 


 which drug injections cause pain

1. 
 pain caused by hyperosmolar pressure or chemical phlebitis 
: high concentration electrolyte such as potassium in peripheral vein, some vasoactive drugs in peripheral vein, or some antibiotics such as levofloxacin and bifidomide are easy to cause pain, which may lead to chemical phlebitis. In addition, it can also cause pain when hanging some nutrient solution with high osmotic pressure. These are all caused by the drug itself. 


 solution: 
 in the face of these pain prone drugs, oral administration may be a good way to relieve pain. Taking potassium chloride as an example, oral potassium chloride injection can not only supplement rapidly and efficiently, but also reduce the cost-effectiveness brought by various punctures. For those patients with mild potassium deficiency and good gastrointestinal and renal functions, it is more convenient and cost-effective. However, whether it can be replaced by oral medicine has a special difference, which depends on the doctor's judgment. 

2. 
 intravenous pain can also be caused by mediating anesthetics. However, the peripheral veins are dominated by multi-channel pain receptors, which mediate the response to pain caused by the injection of certain anesthetics 
 [1] 



 solution: 
 the most effective clinical method has been to inject propofol into the great vein 
 [2] 
 so as to reduce the incidence of pain caused by propofol injection in the back of the hand from 30-40% to 3% or less in the forearm fossa. 

Of course, in some cases, even after induction of general anesthesia, there is still an 84% probability of upper limb convulsion. For example, muscle relaxants will show pain after injection of rocuronium. Some studies have shown that 
 [3] 
 if pretreatment with 30 mg lidocaine, rocuronium related injection pain has moderate relief. In general, if one drug is used in conjunction with another, the product is used outside the license, and the anesthesiologist bears some of the responsibility of the manufacturer. Secondly, the more drugs given to patients, the greater the chance of adverse reactions. 

Therefore, it is the best choice to choose the great vein as the injection vein, or to carry out deep vein puncture instead of peripheral vein indwelling. 

The above are just a few of the ideas I have thought of temporarily, including but not limited to the above. I will continue to make up for them when I have time. 


 why does it cause pain


 although some of the pain is due to strong irritation or high osmotic pressure of the drug itself, injection pain will inevitably occur if there is a wrong route of administration. 


The commonly used injections are intravenous, intramuscular and subcutaneous injection, and others include intra-articular, subconjunctival and epidural injections. At present, people's understanding of them can be roughly divided into two categories: intravenous and intramuscular. For different drugs, due to different objectives and the influence of drug properties, the instructions specify different injection methods. If the drug is given wrongly, it can be divided into two categories: intravenous injection and intramuscular injection Drugs, will inevitably cause different degrees of harm to the human body, for example, due to the subcutaneous sensory organs are more, stimulating drugs generally avoid subcutaneous injection. 

For example, promethazine is usually injected intramuscularly, and the preferred muscle is gluteus maximus. However, if promethazine is injected intravenously or subcutaneously, there will be pain and even more serious complications, such as phlebitis, subcutaneous hematoma, bruise and even more serious skin tissue necrosis. 

In addition, the muscle injection of gluteus maximus should not be too deep. If it is too deep, it is easy to hit the sciatic nerve, and in serious cases, it can cause paralysis. 

In addition, the size of the needle also affects the degree of pain caused by injection. In order to make needles to relieve pain, people are increasingly interested in making smaller needles that should relieve pain. For example, insulin needles are getting thinner now, and the pain of insulin injection is very small 
 [4] 
. 

Although finer needles are constantly being studied, smaller needles are not suitable for all applications. The length of the needle mainly depends on a person's body shape (a child needs a shorter needle than an adult) and the insertion position of the needle. For example, subcutaneous injection needs to enter the adipose tissue under the skin. Because these needles are relatively shallow, the needles required are small and short, and intramuscular injection directly enters the muscle, because the muscle is deeper than the subcutaneous layer of the skin, so the needles used for intramuscular injection must be thicker and longer. In addition, it is also related to the drugs presented. For example, a large number of rapid delivery and preparations with large particles need larger needles; as the needle size approaches the skin, the needle head should be larger Because of the surface topography and the size of mechanical deformation, it is more difficult to insert the micro needle into the skin, and in some cases, a special insertion device may be needed. 

In general, there is no way to choose a thinner needle to avoid pain. 


 how to avoid these pains as much as possible

In addition to the above-mentioned choice of alternative drugs, there are several effects


 puncture technique 
: Although the nurses are very gentle and lovely, each time they are punctured, they immediately become disgusting. For the nurse sister, the process of puncture must be fast and accurate, so that the puncture is usually completed before we have time to feel the pain, and the pain of patients is the least. Or when facing a child patient, the best way to do this is to build trust and divert attention during the puncture. This can greatly reduce the pain and crying of children. 

In addition, if the technique is skilled, the large angle puncture also has the indispensable credit to alleviate the pain. Because the small angle puncture usually increases the resistance, the friction to the vascular wall will increase, while the large angle puncture reduces the resistance and friction. 


 needle extraction technology 
: there is a needle pulling out naturally when there is a puncture, and the pain of pulling out the needle should not be underestimated. This side requires the nurses to pull out the needle correctly. First of all, do not press the puncture site when pulling out the needle, which can reduce the friction and even damage of the needle to the vein. In addition, the faster the speed of pulling out the needle, the less pain it will suffer, and the smaller the pulling stimulation around the vascular wall. 

Coincidentally, how to press after puncture is also a technique. If pressing is not appropriate, it is easy to form subcutaneous hematoma, causing pain and bruise. Pressing requires us to press along the direction of venipuncture with the strength of the thumb. In fact, the needle eye we see is not necessarily the eye of the bleeding blood vessel. Sometimes there is a certain distance between them, which requires us to expand the pressing area. At the same time, the strength of the thumb is just enough for us to stop bleeding


 selection of treatment site: 
 in addition, puncture in the area with less nerves can also reduce the pain. Generally, the area with rich nerves has strong sensitivity. Or more high-tech is the use of venography for puncture, its puncture success rate can be greatly improved. 


 of course, the pain is not only related to drugs and needles, but also to a lot of times. Be sure to say, don't be arrogant. 


It is believed that many people have had the experience of being sick and being hospitalized with saline. When the thick and hard needle goes into your blood vessel, you will inevitably feel pain. I still remember a friend's experience of hanging water once. The nurse's sister told him that the drug had strong intravenous stimulation, and it might hurt if it was hung in. At the beginning, she didn't believe it. She thought that she was young and strong. In order to seek speed, she resolutely accelerated the speed of the hanging needle after the nurse's little sister left. His wife always asked him whether it hurt so fast, but he always expressed calm. 

However, after a while, along the direction of the vein, the area obviously began to swell and ache, and even felt a little red. He immediately slowed down the speed and called the nurse's younger sister. People knew that he was disobedient and hung too fast, and told him that he had caused phlebitis. Fortunately, he had Fabao immediately applied medicine to him, and then slowed down the speed of hanging salt water, which made him feel better. 


 
 
 injections have become commonplace for our medical staff. However, how to avoid these pain is the direction we need to explore, but more importantly, patients can cooperate.

Comment

No Comment Yet.