Pourghaznein Tayebe, Azimi Amir Vahedian, Jafarabadi Mohammad Asghari
Department of Medical-Surgical, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.
J Clin Nurs. 2014 Apr;23(7-8):1105-13. doi: 10.1111/jocn.12291. Epub 2013 Jul 12.
To determine and compare the effects of four methods of subcutaneous heparin injection on pain and bruising in abdomen and thighs.
Subcutaneous heparin injection is a common nursing clinical intervention. Nurses frequently inject heparin subcutaneously and this action often results in some complications such as bruising, haematoma, pain and induration in the injection site. There are also some other factors inducing complications associated with heparin injection, including the injection site and the injection duration.
A quasi-experimental within-subject design.
This study was conducted on 90 patients with COPD hospitalised in two ICU wards at two teaching hospitals in urban areas of Iran. They were administered heparin subcutaneously, 4000 units every 12 hours. Each patient received four injections in their abdomen and thighs, using four different methods. The number and size of bruising at the injection site were measured through a flexible millimetre ruler, 48 hours after each injection. The severity of pain was measured through pain visual analogue scale immediately after each injection. Collected data were analysed by descriptive and analytical statistics using spss 11.5 software.
In the method 15 seconds injection duration and waiting for 5 seconds before withdrawing the needle, the number of bruising was significantly lower and size of bruising was significantly smaller, but no significant difference was found in the severity of pain. However, in other methods, the severity of pain in thighs was significantly higher than in abdomen, but no statistically significant difference was reported between the size and number of bruising in abdomen and thighs.
The method 15 seconds injection duration and waiting for 5 seconds before withdrawing the needle is recommended to be used for subcutaneous heparin injection by clinical nurses. As to the results, the severity of pain in abdomen was lower than in thighs.
This study proposed a suitable method for subcutaneous heparin injection in order to reduce pain and bruising.
确定并比较四种皮下注射肝素的方法对腹部和大腿疼痛及瘀伤的影响。
皮下注射肝素是一种常见的护理临床干预措施。护士经常进行皮下肝素注射，而这一操作常常会导致一些并发症，如注射部位出现瘀伤、血肿、疼痛和硬结。还有一些其他因素会引发与肝素注射相关的并发症，包括注射部位和注射持续时间。
一项准实验性的自身对照设计。
本研究对伊朗城市地区两家教学医院两个重症监护病房收治的90例慢性阻塞性肺疾病（COPD）患者进行。他们每12小时皮下注射4000单位肝素。每位患者在腹部和大腿使用四种不同方法各接受四次注射。每次注射后48小时，通过柔性毫米尺测量注射部位瘀伤的数量和大小。每次注射后立即通过疼痛视觉模拟量表测量疼痛的严重程度。使用SPSS 11.5软件对收集的数据进行描述性和分析性统计分析。
在注射持续时间为15秒且拔针前等待5秒的方法中，瘀伤数量显著减少，瘀伤大小显著变小，但疼痛严重程度未发现显著差异。然而，在其他方法中，大腿的疼痛严重程度显著高于腹部，但腹部和大腿瘀伤的大小和数量之间未报告有统计学显著差异。
建议临床护士采用注射持续时间为15秒且拔针前等待5秒的方法进行皮下肝素注射。至于结果，腹部的疼痛严重程度低于大腿。
本研究提出了一种合适的皮下肝素注射方法，以减轻疼痛和瘀伤。
