I. Which drugs should not be directly intravenous injection?
(1) High concentration electrolyte
Such as potassium chloride, magnesium sulfate and the like. 10% potassium chloride injection 10ml contains 1g of potassium chloride. After the injection, the blood potassium concentration rises immediately, which damages the myocardium and can cause sudden death. 10% or 25% magnesium sulfate injection should be diluted after intravenous injection, otherwise it may cause respiratory depression and even cause respiratory paralysis.
Such as furosemide, sodium diureate, etc., intravenous injection speed can cause sudden tinnitus, deafness.
(3) Neuromuscular junction blockers
Aminoglycoside antibiotics such as amikacin, gentamicin, streptomycin, ribomycin, tobramycin, netilmicin, etc., and polymyxin B, lincomycin, clindamycin Direct venous bolus can cause neuromuscular junction blockage and cause respiratory depression.
(4) Non-aqueous solvent drugs
For example, the solvent of hydrocortisone injection and chloramphenicol injection is ethanol solution, and intravenous bolus injection is prohibited.
(5) Aminophylline, phenytoin, lidocaine, vitamin K1, etc.
Excessive venous push can cause death.
(6) Locally stimulating drugs
① Local stimulation of vancomycin and norvancomycin can cause local pain, phlebitis and tissue necrosis. Intravenous injection can easily increase the adverse reaction rate of drugs, such as “red neck syndrome”, thrombophlebitis, Hypotension, etc.;
② Fluoroquinolone, erythromycin lactobionate, fosfomycin, imipenem / cilastatin, etc., intravenous bolus is prone to phlebitis, so intravenous drip and control of drip rate.
(7) Drugs for intramuscular injection
For example, procaine penicillin, benzathine penicillin, vitamin B1, vitamin B12, etc. are labeled as intramuscular injections, only for intramuscular injection, not intravenous bolus.
II. Which injections can only be injected intravenously but not intramuscularly?
Some injections can only be injected intravenously, not intramuscularly, mainly including the following.
① Local irritant
Macrolide antibiotics and tetracycline antibiotics have strong acidity, and intramuscular injection has strong local irritation. Excessive concentration can cause local pain, inflammation and necrosis, so it should not be injected intramuscularly. Note. Norepinephrine, calcium gluconate (including various other calcium salts), potassium chloride (including various other potassium salts), vitamin C, phenolsulfonamide, aminotoluic acid (including various other acid drugs), Sodium bicarbonate (including various other alkali drugs), norvancomycin, amphotericin B, fosfomycin, amoxicillin/clavulanate potassium, quinolone antibiotics, acyclovir and some antibiotics Oncological drugs, etc., if intramuscular injection can cause local intense irritation pain, and even local tissue necrosis. Therefore, the above-mentioned locally irritating drugs are not suitable for intramuscular injection.
② Local absorption difference
After the intramuscular injection of the drug, it dissolves in the tissue fluid, enters the capillary network, and then flows into the vein or directly into the venule or into the lymph and then into the large vein to enter the systemic circulation. Drugs such as diazepam, intramuscular injection absorption is slow and irregular, incomplete, if the intramuscular injection can not achieve effective drug concentration, can not achieve the desired therapeutic effect, so it is not suitable for intramuscular injection.
③ Drugs are large
Some drugs, such as sodium foscarnet, metronidazole, etc., require a large amount of solvent to dissolve due to low solubility, etc., resulting in a volume of the drug solution of normal therapeutic dose is too large, and is not suitable for intramuscular injection.
III. Which injections can only be injected intramuscularly but not intravenously?
Because of the difference between intramuscular injection and intravenous injection, some injections can only be injected intramuscularly and cannot be administered intravenously.
① Oil solution injection
Some drugs are made into oil-injected injections by using non-aqueous solvents such as injectable oils because they are insoluble or unstable in water or for delaying the effects of the drugs. These injections are for intramuscular injection 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.
② Suspension injection
Hormone drugs are commonly used in their acetates, which are mostly insoluble in water. They are often formulated as suspensions, such as methylprednisolone acetate suspension. They are only for intramuscular and intra-articular injections and cannot be injected intravenously.
③ Injection of local analgesics or antibacterials
Some drugs can cause severe pain when injected, sometimes add local analgesics (such as procaine, lidocaine), usually limited to intramuscular or subcutaneous injection, such as procaine penicillin injection, and some injections No local painkillers are added during preparation. Local analgesics such as penicillin potassium are used as a solvent in 0.25% lidocaine before use. These drugs cannot be administered intravenously.
④ Injections that can cause serious adverse consequences
When the aminoglycoside is injected intravenously, the blood concentration suddenly rises, which can cause respiratory depression, and only intramuscular injection and intravenous drip.
⑤ Injectables that cannot be used for intravenous administration due to the characteristics of the dosage form or other reasons
Including adrenaline injection, vitamin B1, vitamin B12, vitamin B2, vitamin K1, chondroitin sulfate injection, premixed insulin preparation, and the like.
IV. Which drugs can cause extravascular leakage when administered intravenously?
If leakage occurs inadvertently during intravenous administration, some drugs may cause adverse consequences and should be taken care of.
(1) Antineoplastic agents
Including cytotoxic, antimetabolites, alkaloids, antibiotics and other anti-tumor drugs, the incidence of peripheral venous administration of extravasation is 0.5%-6%. Multiple injections can cause hardening of the blood vessels, pain and thrombophlebitis, such as drug spillage can lead to local tissue necrosis. There are more and more types of chemotherapeutic drugs, and the application of chemotherapeutic drugs requires higher injection technique to reduce or prevent drug extravasation.
(2) Calcium salt preparation
Including calcium gluconate, calcium chloride, calcium leucovorin, etc., especially when the drug delivery rate is too fast, redness, rash, pain, and even peeling and skin necrosis appear at the injection site. It was found that the leakage should be stopped immediately, and local injection with sodium chloride solution, partial fixation of hydrocortisone, lidocaine, and hyaluronic acid, while raising the affected limb and hot compress.
(3) Peripheral α-receptor agonist
Including norepinephrine and epinephrine, dopamine and the like. When intravenously infused, the skin becomes white along the vein path, and local skin loss, blemishes, redness, etc. are injected. In case of extravasation of the drug solution, 10 mg of phentolamine plus sodium chloride injection should be used as a partial closed infiltration injection at the leak.
(4) Hypertonic drugs
Including 20% mannitol injection, 5% sodium bicarbonate injection, 50% glucose injection, 10% sodium chloride injection, etc., extravasation can cause tissue edema and skin necrosis.
Such as vasopressin, etc., can cause peripheral blood vessels to contract to cause thrombosis and gangrene.