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

Drug use problems with self-injected low-molecular-weight heparins in primary care

PURPOSE

Outpatient subcutaneous therapies are becoming increasingly common. A literature search failed to find produced any studies on application problems pertaining to the self-injection of low-molecular-weight heparins (LMWH) in a heterogeneous outpatient population under daily-life conditions. We therefore designed a study with the aim of recording drug use problems, patient satisfaction, compliance, problems arising from the injection site (abdomen vs. thigh), and residual drug volumes in pre-filled syringes used in self-injection therapy.

METHODS

Patients were recruited in community pharmacies by 95 trained Master's students in pharmacy. Data were collected during recruitment and by means of structured questionnaire-based telephone interviews that were carried out at the beginning and the end of the LMWH treatment.

RESULTS

The median age of the 213 patients enrolled in the study was 54 years [interquartile range (IQR) 39-70 years]; of these, 15.5% had their injections administered by a third person. The rate of self-reported non-compliance was 17.1%. At least one relevant problem was recorded in 85.0% of the cases. At the end of the treatment, 38.9% of the patients stated self-administration of the injections required some effort. The preferred injection site was the thigh (68.5%). An overall mean residual drug volume ≥ 10.0% was detected for 3.9% of the patients. If residual drug was present, a median of 11.2% (IQR 8.6-17.6%) of the total drug volume had not been injected. Patients injecting into the thigh showed a higher risk of leaving residual medication (odds ratio 2.16, 95% confidence interval 1.04-4.51).

CONCLUSIONS

Most patients had drug use problems, whereas no clear factors were associated with non-compliance, the injection site (apart from residual drug), and discomfort or effort required (apart from prior injection use).

Administração de medicamentos por via subcutânea: convenção ou controvérsia para a enfermagem?

A administração correta e segura de medicamentos, independentemente da forma, é de responsabilidade da equipe de enfermagem. A essa equipe são necessários conhecimentos e habilidades específicos, bem como atualização contínua dos processos que envolvem tais cuidados. Este artigo tem como objetivo tecer considerações com base em conhecimentos sobre o tema, adequando-os à prática comum dos enfermeiros. Para isso, apresentamos uma revisão da literatura que aborda os principais métodos de aplicação de fármacos por via subcutânea. Em seguida, discutimos alguns aspectos para o aprimoramento dos profissionais, a fim de que a administração de medicamentos seja satisfatória e segura no processo de cuidar.