Paranephric injection method

FIELD: medicine; surgery, nephrology; neurology; clinical pharmacology.

SUBSTANCE: method can be used at injection introductions of medicinal aids into deep layers of soft tissues of lumbar area. Ultrasonic detector is applied to selected area. Area to be found in depth of tissues is detected by means of device on the screen. Different areas of skin are subject to periodical pressing by finger and appearance of wave-shaped reversible changes in skin is observed on screen under point of pressing. Part of skin is marked for injection introduction from which part the deformation wave reaches selected area more precise. Distance from skin to the area is measured and needle is introduced for the depth. 1-1,5 ml of solution is pressed out of syringe. Correctness of introduction is estimated from ultrasonic visualization of localization point which appears in tissues of medicinal infiltrate. Procedure is repeated till correct introduction is performed and that the required medicinal solutions are introduced.

EFFECT: improved precision; prevention of complications.

1 ex

 

The invention relates to medicine, in particular to surgery, Nephrology, neurology and clinical pharmacology, and can be used for injectable administration of medications in the deeper layers of the soft tissues of the lumbar region.

The known method Volkova used to blockade the 2nd lumbar sympathetic node, where a patient is put on the table with his back to the doctor, making the blockade, produce anesthesia of the skin 3-4 cm away from the spinous process of the 2nd lumbar vertebra, using a needle, 11-12 cm in length with put on her gum in the form of a disk (lock-timer), placing it perpendicular to the skin, and then pierce the tissue to a depth of 3-4 cm to the rear surface of the transverse process, then the rubber disk on the needle set at 3.5 to 4.5 cm from the surface of the skin, the needle promote parallel to the sagittal plane, above and below the transverse process to the depth marked on the needle with the rubber disk, and in the process of moving the needle to produce a control aspiration syringe, following the absence of the blood, predposylki introduction of novocaine down until it touches the rubber stamp with the skin, then enter 10-15 ml of 1% solution of novocaine, proper introduction which the patient feels the appearance of a pleasant feeling of warmth in the leg (Lobzin SV Puncture and blockade in neurolo the AI. SPb.: Hippocrates - 1999. - S).

The disadvantage of this method is high risk, low accuracy and the narrow scope injecting a solution of a medicinal product. The fact that "blind" piercing the skin of all patients in the same place, namely in the lumbar region at a distance of 3-4 cm from the spinous process of the 2nd lumbar vertebra through the use of needles, 11-12 cm in length causes a wound mechanical damage of parenchymatous organs (kidney, adrenal) pelvis, ureters, aorta or intestines of individuals with anomalies of the kidneys, adrenal glands, or abnormal location of the spinous process of the 2nd lumbar vertebra. In addition, the introduction of the injection needle to a depth of 3.5 to 4.5 cm from the skin surface into the soft tissues of the lumbar region contributes to puncture the parietal peritoneum and the penetrating end of the needle into the abdominal cavity in patients suffering from cachexia or have deformities or deformation defects in the lumbar region. In addition, the method cannot be used in people with significant defects of the spinous process of the 2nd lumbar vertebra, as well as in individuals deprived of the spinous process, or are in the cast, excluding the possibility of determining the location of the spinous process, as well as in children of early age and persons in the besso is a wearable condition, because of the impossibility of assessing the correctness of the drug.

The purpose of the invention is to increase safety, precision injection and expansion of scope.

The essence of the proposed method Nistratov, including anesthesia chosen area of skin, the tissue piercing long injection needle, the control aspiration syringe, following the absence of the blood, predposylki introduction of novocaine, medication and evaluating the appropriateness of the introduction, is that originally put the ultrasonic sensor to the lumbar region, find with it on the screen of the device to the desired site in the depth of the lumbar region, produce periodic pressure with your fingers on different parts of the skin, followed by ultrasound for the appearance of wave-like changes in the structure of the tissue under pressure and thereby determining the possible path and the desired depth of the movement injection needle, choosing the area of skin from which the deformation wave most closely reaches the selected area, and evaluating the appropriateness of introducing is carried dispensed from the syringe 1-1,5 ml of procaine and ultrasonic visualization of locations appearing in the tissues of drug infiltration, after which the syringe is disconnected, connect the second syringe with the required l the drug product and enter it.

In the proposed method by applying ultrasound sensor to the study area of the body is able to visualize the deeper layers, including desired location, regardless of the morphological and anatomical structure of the body, particularly the spine. Due to ultrasound tissue structure with periodic pressure with your fingers on different parts of the skin are able to observe the appearance of a wavy deformation of the tissue, localization which allows to judge the likely path of movement of the injection needle puncture these areas of the skin. Due to the generated reversibly deforming changes in the structure of tissues is possible to accurately choose an area of skin from which the deformation wave most closely reaches the chosen site in the depth of the body regardless of the age of the patient and pathological processes. However, ultrasound is able to accurately determine the distance to this area from the surface of the skin. Subsequent dispensed from the syringe 1-1,5 ml of a solution with simultaneous visualization of the process of formation of drug infiltration allows to evaluate the correctness of the solution. The use of additional syringe allows you to safely and accurately enter additional drug.

Example 1. The patient P. in the age of 1 year with cystic dysplasia of the kidneys, after the actions of the chronic hematogenous osteomyelitis in the absence of the spinous process of the 2nd lumbar vertebra in the conditions of the Nephrology Department was appointed injection analgesic and antispasmodic funds in perirenal tissue of the median region of the kidney. When the blockade by way Volkova after insertion of the needle to a depth of 2.5 cm physician-nephrologist suspected injection injury of the pelvis and refused further application of the method. Applying ultrasonic sensor to the lumbar region revealed on the screen of the device to the desired site in the depth of the lumbar region. Producing periodic pressure with your fingers on different parts of the skin and followed by ultrasound for the appearance of wave-like changes in the structure of the tissue under pressure and thus defining possible way and the depth of the movement of the injection needle, and stopped on a particular area of skin from which the deformation wave is most accurately achieved favorites of the median area of the kidney, and the distance is equal to 2 cm from the skin surface. After making this puncture in the same place and entering the needle to a depth of 2 cm, is dispensed from a syringe 1 ml of novocaine or ultrasonic visualization of the localization appeared infiltrate in perirenal tissue confirmed the correct insertion of the needle. After this introduced an additional 3 ml of novocaine, disconnect the syringe connected to the needle of the syringe with baralgin and brought to 0.5 ml

The way perirenal injections, including Anette is their chosen area of skin, the tissue piercing long injection needle with predposylki the introduction of novocaine, the control in the absence of the appearance of blood in the syringe during aspiration and evaluating the appropriateness of the introduction, characterized in that initially elected to land apply ultrasonic sensor, find with it on the screen of the device the required section in the depth of the tissue, and then produce periodic pressure with your fingers on different parts of the skin, watching on the screen for the appearance of wavy reversible changes in the structure of the tissue under pressure, say for injecting the skin area from which the deformation wave most closely reaches the chosen field, measure the distance to it from the surface of the skin, injected the needle on the depth, extruded from a syringe 1-1,5 ml of the solution, evaluate the correctness of the introduction of ultrasound imaging locations appearing in the tissues of drug infiltration, repeating the procedure until the correct entry, then enter the required medicines.



 

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