Community Health Research Center, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran.
J Nurs Scholarsh. 2020 Nov;52(6):634-642. doi: 10.1111/jnu.12598. Epub 2020 Sep 4.
We performed this review systematically to assess the effect of cold application at the heparin subcutaneous injection site on incidence and size of bruising, hematoma, and pain intensity.
A systematic review and meta-analysis were utilized as the study design.
To retrieve the relevant randomized controlled trials (RCTs) published up to July 2019, the databases of PubMed, Scopus, Web of Science, ScienceDirect, Cochrane Library, Google Scholar, TRIP, and Elmnet.ir were searched.
Those RCTs were selected in which the participants had received any type of heparin via subcutaneous injections at least once a day, as were those comparing the effect of cold application (i.e., moist or dry ice packs or vapocoolant spray) on injection sites with no interventions or placebos. The types of outcomes measured included pain intensity, bruising, and hematoma at injection sites. Furthermore, odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were employed to measure the pooled data.
A total of nine studies recruiting 896 patients with a mean age range of 37 to 62 years were ultimately included in this study. The findings revealed that eight studies had used low-molecular-weight heparin, but unfractionated heparin had been administered in one study. The quality of the studies was also assessed in seven domains. Overall, risk of bias in the included articles was low to moderate. Pooling data of six studies showed that the patients had experienced less pain intensity once cold had been applied at the heparin injection sites (MD = -1.67; 95% CI -3.03 to -0.31; p = .02; I = 92%). Bruising had been correspondingly reported in eight and six studies in terms of size and incidence, respectively. In particular, the results had demonstrated no statistically significant difference between either group in terms of bruising size or incidence at 48 to 72 hr following heparin injection. Furthermore, hematoma incidence had been reported in two studies, and one trial had reported hematoma size only. The results had suggested that the patients had smaller hematomas (MD = -0.87; 95% CI -1.63 to -0.11; p = .03) and a lower incidence of hematomas (OR = 0.35; 95% CI 0.16 to 0.76; p = .008) in the cold application group 48 hr after injection.
The results of this systematic review and meta-analysis showed that patients could experience less pain and fewer hematomas once the cold had been applied for 3 to 5 min at the injection sites before or after subcutaneous heparin administration. During this period, clinicians should also consider the patient's comfort; if some patients feel discomfort at the cold application site, the minimum possible time should be considered.
This study's results could be used as evidence for all hospitalized and outpatients who need to receive any form of heparin and may suffer from local complications of this medicine.
我们进行了这项系统评价，以评估肝素皮下注射部位冷敷对瘀斑、血肿和疼痛强度发生率和大小的影响。
系统评价和荟萃分析被用作研究设计。
为了检索截至 2019 年 7 月发表的相关随机对照试验（RCT），我们检索了 PubMed、Scopus、Web of Science、ScienceDirect、Cochrane Library、Google Scholar、TRIP 和 Elmnet.ir 数据库。
选择了那些参与者至少每天接受过一次任何类型肝素皮下注射的 RCT，以及那些比较冷敷（即湿或干冰袋或 vapocoolant 喷雾）对注射部位与无干预或安慰剂的效果的 RCT。测量的结果类型包括注射部位的疼痛强度、瘀斑和血肿。此外，使用优势比（OR）和均数差值（MD）及其 95%置信区间（CI）来衡量汇总数据。
共有 9 项研究纳入了 896 名年龄在 37 至 62 岁之间的患者，最终纳入了本研究。研究结果表明，8 项研究使用了低分子肝素，但有一项研究使用了未分级肝素。也评估了 7 个领域的研究质量。总体而言，纳入文章的偏倚风险为低到中度。对 6 项研究的数据进行汇总显示，在肝素注射部位应用冷敷后，患者的疼痛强度降低（MD=-1.67；95%CI-3.03 至-0.31；p=0.02；I=92%）。瘀斑的大小和发生率分别在 8 项和 6 项研究中进行了报告。特别是，在肝素注射后 48 至 72 小时，两组之间在瘀斑大小或发生率方面没有统计学意义上的差异。此外，在 2 项研究中报告了血肿发生率，而只有 1 项试验报告了血肿大小。结果表明，在注射后 48 小时，冷敷组的患者血肿较小（MD=-0.87；95%CI-1.63 至-0.11；p=0.03），血肿发生率较低（OR=0.35；95%CI 0.16 至 0.76；p=0.008）。
这项系统评价和荟萃分析的结果表明，在皮下注射肝素之前或之后，将冷敷应用于注射部位 3 至 5 分钟，患者可以减轻疼痛和减少血肿。在此期间，临床医生还应考虑患者的舒适度；如果一些患者在冷敷部位感到不适，应考虑尽可能短的时间。
本研究的结果可作为所有需要接受任何形式肝素治疗并可能出现该药局部并发症的住院和门诊患者的证据。
