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 48 h 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. (C) 2007 Elsevier Ltd. All rights reserved.