Administering subcutaneous heparin

The Effect of Administration Protocol of Subcutaneous Enoxaparin Injection on Formation of Ecchymosis

Subcutaneous heparin administration is routinely used for many patients in orthopaedic clinics. Nurses frequently encounter ecchymosis formation with heparin administration. Previous research indicates that the administration protocol may have effect on ecchymosis formation. The study was performed to determine and compare the effect of three different approaches of subcutaneous enoxaparin injection on ecchymosis formation in patients who underwent joint replacement surgery. Three protocols were compared: (1) injecting enoxaparin in 10 seconds, (2) injecting enoxaparin in 30 seconds, and (3) injecting enoxaparin in 30 seconds and waiting for an additional 10 seconds before withdrawing the needle. Ecchymosis formation was assessed in both size and frequency. Descriptive statistics, Kruskal-Wallis analysis, Mann-Whitney U test, and Spearman rank correlation test were used to assess the data. The ecchymosis frequency was higher in the 10-second administration. Ecchymosis size was smaller when the enoxaparin was administered in 30 seconds and the needle was kept in the tissue for 10 seconds after injection. The enoxaparin should be administered in a longer duration (30 seconds). Keeping the needle in the tissue for 10 seconds may further decrease the size but not the incidence of ecchymosis.

Assessment of four different methods in subcutaneous heparin applications with regard to causing bruise and pain

Subcutaneous administration of the anticoagulant heparin sodium is a frequently performed nursing intervention. Subcutaneous heparin injection often causes problems such as bruise, pain, induration, and hematoma at the injection site. Bruising that result from heparin injections may lead to anxiety, disruption of body image, the rejection of the treatment in patients, and the reduction of the reliance of patient to nurse. The purpose of this study was to determine and compare the effects of four different injection technique pain and on bruising associated with subcutaneous heparin. The research involved ninety-five patients. Each subject received four injections by the same investigator using four different techniques. Site bruising was measured at forty-eight and seventy-two after each injection. The bruising size was measured using milimetric transparent palyethylene wrap and the verbal pain scale. There was significant difference in the incidence or size of bruises and pain perception the subject among techniques. Results of the study show that use of air lock technique without aspiration and two-minute cold application to the area of injection with methods reduce bruise and pain.

Effect of injection duration on bruising associated with subcutaneous heparin: A quasi-experimental within-subject design

AIM

The purpose of this study was to determine and compare the effects of three different injection durations on bruising associated with subcutaneous heparin.

BACKGROUND

Subcutaneous administration of the anticoagulant heparin sodium is a frequently performed nursing intervention. Heparin preparations are widely used for the post surgical prophylaxis, deep vein thrombosis and pulmonary emboli. Subcutaneous heparin injection often causes problems such as bruise, pain, induration, and hematoma at the injection site. Bruising that result from heparin injections may lead to anxiety, disruption of body image, the rejection of the treatment in patients, and the reduction of the reliance of patient to nurse.

METHOD

The study used a quasi-experimental design. The population for the research was formed by the patients who were hospitalized at Chest Disease and Surgery Hospital and ordered to receive subcutaneous low-molecular weight heparin (LMWH). The research involved 36 chronic obstructive pulmonary disease (COPD) patients. Each subject received three injections by the same investigator using three different techniques. Site bruising was measured at 48h after each injection. The bruising size was measured using a plastic ruler. Descriptive statistics, Wilcoxon signed-rank and McNemar chi(2) tests were used to evaluate of the data. The level of significance was determined at P<0.05.

RESULT

The 30s duration injection technique and waiting 10s before withdrawing the needle after 10s injection duration resulted in significantly smaller and less bruises than 10s duration injection technique.

CONCLUSION

The 30s duration or waiting 10s before withdrawing the needle after 10s injection duration techniques should be used for subcutaneous heparin injections in clinical practice.

[Evaluation of the technique of subcutaneous administration of heparin in the development of hematomas]

This study identified and evaluated the presence and extent of hematomas, pain and other complications after the administration of low-dose subcutaneous heparin. It compared applications using the conventional technique and applications with modified techniques in 60 patients hospitalized in an University Hospital in the interior of São Paulo State-Brazil. Each patient received four heparin injections, that is, two injections of each of the techniques mentioned. The site was observed after 24 hours. Results showed that hematomas were observed after the application of 83.7% of the injections. The thigh was the site with the highest incidence of hematomas, followed by the arm and the abdomen. There were no significant differences in the formation of hematomas caused by the two techniques. It was concluded that the techniques used for heparin application were probably not related to the formation of hematomas.