Content area
Full Text
Current practice for administration of subcutaneous low-molecular weight heparin in the abdomen causes major side effects, such as bruising and pain. Findings of this study suggest the deltoid is a more appropriate injection site than the abdomen to reduce bruising.
Low-molecular weight heparin (LMWH) (e.g., enoxaparin [Lovenox®]) is used widely to reduce patients' risk of harmful clot formation. It has several potential advantages: reliable anticoagulant effect, lower incidence of heparin-induced thrombocytopenia, and a simple subcutaneous administration that permit short-term and long-term treatment (Palese, Aidone, Dante, & Pea, 2013). However, more than 90% of subcutaneous injections of LMWH by nurses lead to pain and bruising (Akbari Sari, Janani, Mohammady, & Nedjat, 2014).
Subcutaneous injection usually is selected when slow, continuous medication absorption is desired. The medication is injected into fat and connective tissue underlying the dermis, where there is less blood flow and as a result slower medication absorption. The umbilical region of the abdomen, and lateral arms and thighs are considered appropriate sites for subcutaneous injection (Akbari Sari et al., 2014). Research has found the occurrence and size of bruising, as well as pain of subcutaneous injection, can be influenced by multiple actions. These include appropriate selection of injection site and needle size, injection duration, aspiration of the syringe before injection, application of local dry heat, and massage after the injection (Amaniyan, Varaei, Vaismoradi, Haghani, & Sieloff, 2016; Avsar & Kasikci, 2013; Balci Akpinar, 2013; Pourghaznein, Azimi, & Jafarabadi, 2014; Sendir, Büyükyilmaz, Çelik, & Tasköprü, 2015).
Because patient safety and quality of care are primary nursing concerns, nurses are accountable for taking steps to prevent and limit such side effects through appropriate medication administration.
Significance of Research
The thicker subcutaneous tissue (>25 mm) and larger surface area of the abdominal wall are believed to reduce the risk of extravasation of enoxaparin (Avsar & Kasikci, 2013). However, abdominal wall hematomas and fetal rectus sheath hematoma have been reported in multiple studies related to subcutaneous injection (Hatjipetrou, Anyfantakis, & Kastanakis, 2015; Miguel-Gomez, Fonda-Pascual, Carrillo-Gijon, & Munoz-Zato, 2016; Salemis et al., 2014).
Although healthcare professionals and drug manufacturers consider the abdomen the best location for enoxaparin injection, clinical observations show patients typically experience bruising in this area (Avsar & Kasikci, 2013; Hatjipetrou et al., 2015; Miguel-Gomez et...