Clinical Evaluation of Three Techniques for Administering Low-Dose Heparin

Vanbree, Nancee S.; Hollerbach, Ann D.; Brooks, Gladney

doi:10.1097/00006199-198401000-00004

Cited by 28 publications

(27 citation statements)

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“…McNemar's test of proporbons did not yield a significant difference in the incidence of haematoma formabon when ice was or was not apphed to the mjecbon site pnor to, and following, subcutaneous hepann mjecbon It is of mterest, however, that the results were approachmg significance m favour of the non-use of ice This contradicts the suggesbon made by Genton (1974), Lundm (1978), andCaprmi et al (1977), who advocate the use of ice as a means of mmimizmg haematoma formabon at the mjecbon site Size Evaluabons of haematoma size, usmg repeated measures of ANOVA, yielded no significant differences when ice was or was not applied to the injection sites for the whole population, or for subgroups divided accordmg to age and gender It was noted that males had smaller bruises them femeiles, regardless of age (10 3, SD10 8 cm vs 14 2, SD 13 5 cm) In addibon, males had smaller hniises when ice was applied (8 8, SD 10 7 cm) while females had larger bruises (16 3, SD 15 1 cm) (P=0 03) OveraU, larger bruises were noted with the apphcabon of ice (14 6, SD 14 5 cm vs 12 2, SD 13 1 cm), which may be explamed by a predommantly female sample Wooldndge & Jackson (1988) noted a difference m incidence and size of bnusmg m femedes 60 years or older In our study this aspect was not evaluated, smce only one female subject was over 60 years of age Although the relabonship between the apphcabon of ice and haematoma mcidence and size was shown to be msigmficant m our study, researchers (Wooldndge & Jackson 1988, VanBree et al 1984 identified that vanabons m admmistrabon technique may contnbute to bnusmg Smce only one technique was used m the present study.…”

Section: S Ross Andd Soltescontrasting

confidence: 55%

Heparin and haematoma: does ice make a difference?

Ross

Soltes

1995

Journal of Advanced Nursing

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Subcutaneous heparin injections are frequently prescribed for the prevention of deep vein thrombosis. One of the most commonly encountered adverse physiological responses to this intervention is the formation of a haematoma at the injection site. This creates a challenge for the nurse attempting to minimize haematoma formation and/or patient discomfort during the treatment regime. The purpose of this study was to determine if the application of ice to subcutaneous heparin injection sites decreases the incidence and size of haematoma formation and/or minimizes patient discomfort. The study used a quasi-experimental design with the subjects as their own control. A convenience sample of 70 subjects was each given two injections of subcutaneous heparin, 12 hours apart. Ice was applied pre- and post-injection to one of the sites. Immediately following each injection, the subjects were asked to rate the level of perceived discomfort at the time of the injection using a visual analogue scale. Forty-eight hours post-injection, the nurse inspected the injection sites for the presence of haematoma. Results showed that when ice was applied there was no significant difference in the incidence or size of haematoma; however, the subject's perception of pain was significantly less.

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Section: S Ross Andd Soltescontrasting

confidence: 55%

Heparin and haematoma: does ice make a difference?

Ross

Soltes

1995

Journal of Advanced Nursing

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“…Bruising usually takes place at 48 h (incidence peak) and tends towards resolution at 72 h after the use of LMWH [29] , revealing that the assessment timeframe was appropriate in all studies. In only one research [20] , the outcomes were analyzed during 10 days or until the end of the treatment.…”

Section: Discussionmentioning

confidence: 99%

“…In that study, with an LMWH treatment time of ten days, the group that received LMWH through a prefilled syringe, with or without aspiration, showed lower levels of bruising (p<0.048). In addition, the literature appoints that the advantage of using prefilled syringes is their lesser manipulation [29] . Incidence levels of bruising and hematomas were higher in women over 60 years of age (p<0.05) and obese individuals (p<0.01) [20] .…”

Section: Discussionmentioning

confidence: 99%

Subcutaneous administration technique of low-molecular-weight heparins: An integrative review

Campos¹,

Silva

Beck

et al. 2013

Clinical Nursing Studies

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Anti-coagulant drugs for subcutaneous injection, like low-molecular-weight heparins (LMWH), are increasingly used to prevent and treat thromboembolic events, with local adverse reactions. The aim in this integrative review was to identify and analyze knowledge production about the most appropriate SC injection technique of LMWH to reduce hematomas, bruising and local pain. The following inclusion criteria were used: papers published in English, Spanish and Portuguese; between the first week of August 2001 and the last week of August 2012. Papers in which LMWH was compared with unfractionated heparin in the assessment of the outcomes and papers without statistical data analysis were excluded. The searches were undertaken in the electronic databases PubMed/MedLine, CINAHL, Scopus, Web of Science and LILACS/IBECS. The quality of the articles was assessed with the critical appraisal tool JBI MAStARI. The incidence of bruising ranged between 20%, when the application time of the injection was 30s, and 88.9% when it took 10s. In 50% of the studies, the authors concluded that LMWH injections taking 30s caused lower levels of bruising, with statistically significant differences, as well as a reduction in pain intensity in the injection site by up to 50%. The group that received LMWH through a prefilled syringe, with or without aspiration, showed lower levels of bruising. The formation of a skinfold, the 90º angle and the abdomen as the application site have been well documented in the literature. These findings are important for clinical nursing practice, as they found the elaboration of evidence-based care protocols and contribute to the improvement of patient care quality.

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“…The patients rated the intensity of the injection site pain by placing a mark at a point along the line of the VAS. Vanbree et al, 19 Wooldridge and Jackson, 20 and de Campos et al 13 stated that bruising peaked at 48 to 60 hours and that healing began 72 hours after injections. Therefore, in this study, bruising at the injection site was assessed at 48, 60, and 72 hours after each injection.…”

Section: Measurement Of Pain Intensity and Bruisingmentioning

confidence: 99%