Effects of Vapocoolant Spray Prior to SC LMWH Injection: An Experimental Study

Abstract

The aim of this study was to evaluate the effects of vapocoolant spray administration prior to subcutaneous (SC) low molecular weight heparin injection on local ecchymosis, hematoma, and pain. This randomized controlled study was carried out on 64 patients (n = 128 injections) in an orthopedics and traumatology clinic. After randomization, vapocoolant spray and then heparin injection was applied on one arm. The second necessary dose of heparin was applied to his or her other arm as a placebo by a water spray. Then, the pain of the patients was assessed. After 2 days, ecchymosis and hematoma were evaluated. Significant lower pain scores were determined in applications in which the vapocoolant spray was used. There was no statically significant difference between the mean diameter values of ecchymosis in both arm groups. There was no hematoma on the injection site after injections. However, this method did not create any significant reductive effect on ecchymosis. Nurses are advised to take advantage of vapocoolant spray effects prior to SC heparin injection.

Effect of Cold Application on Pain and Bruising in Patients With Subcutaneous Injection of Low-Molecular-Weight Heparin: A Meta-Analysis

“…16 – 18 Cold application can also contract peripheral blood vessels and reduce the flow of blood to the tissue, thereby reducing the occurrence of bruises and hematomas. 18 , 19 …”

Effect of Cold Application on Bruising and Pain Following Heparin Subcutaneous Injection: A Systematic Review and Meta‐Analysis

“…The cold had been similarly applied for 3 to 5 min before or after heparin injections in all the studies. Only one study (Amaniyan, Varaei, Vaismoradi, Haghani, & Sieloff, 2016) had applied the cold for 20 min, and vapocoolant spray had been administrated for 10 s before injection in the study by Unal et al (2019).…”

“…Sequence generation. All the included studies except one (Ross & Soltes, 1995) had described the method of random sequence generation using computergenerated randomization software (Şendir, Büyükyilmaz, Çelik, & Taşköprü, 2015), block randomization (El-Deen & Youssef, 2018;Unal et al, 2019), pulling cards (Amaniyan et al, 2016), drawing balls (Farnia et al, 2017), random numbers (Rahmani Anaraki et al, 2014), and lottery method (Sharma et al 2015;Shijila & Tresa, 2016). Blinding of Outcome Assessors.…”

“…Only one study (Amaniyan et al, 2016) had analyzed all the randomized participants, leading us to believe that the intention-totreat (ITT) approach had been applied. Likewise, four studies (El-Deen & Youssef, 2018;Farnia et al, 2017;Şendir et al, 2015;Unal et al, 2019) had a description of the number of drop-outs, but they had not used the ITT approach. In fact, the omission of some participants in the analysis stage and the failure to calculate the missing data led us to conclude that analysis was based on "as treated" and not based on ITT; therefore, they were assigned to high risk-of-bias groups (e.g., in the study of El-Deen & Youssef [2018], 128 patients agreed to participate in the study, but only 105 patients were involved in data analysis [18% drop-outs]).…”

“…Adverse events. Only one trial (Unal et al, 2019) reported adverse events in 4 out of 64 patients (6.25%) in the intervention group, such as temporary skin rashes due to applying vapocoolant spray.…”