Effects of injection duration of subcutaneous heparin on site-pain intensity and bruising

Abstract

The prophylactic use of heparin can help in treatment and prevention of deep venous thrombosis (DVT). Site-pain associated with subcutaneous heparin injections can be distressing, and up to 90% of patients develop a bruise or hematoma. There is a need to explore which subcutaneous injection technique should be used to minimize these two adverse outcomes. The study aim was to identify the duration of subcutaneous heparin injection technique associated with the least pain and bruising through comparing perceived injection site pain intensity, and visible size of bruising among subcutaneous heparin injection techniques of 2, 10, and 30 seconds duration, at 48 and 60 hours after injection. This quasi-experimental study was done at the cardiac intensive care units at Eldemerdash University hospital on 60 patients receiving subcutaneous injections of 5000 units of calheparin twice a day. The tools used included demographic and clinical data sheet, Bruising Category Scale, and Visual Analogue Scale for pain. The results have shown that the 2-second injection duration had the highest mean score of pain, and the lowest was with the 30-second injection duration, 7.71.2 and 1.20.9, respectively, p<0.001. Also, bruise area was statistically significantly lower with the 30-second injection duration at 48 hours. At 60 hours, both the 10 and 30-second methods had lower area of bruising, compared, p<0.001. At 60 hours, most of the patients had no bruises in the 10 and 30-second groups, 75.0% and 71.7%, respectively, compared to only 30.0% of the 2-second injection group, p<0.001. Pain scores were higher among females, and they had larger bruise areas, compared to males. In conclusion, the 30-second duration injection significantly reduced site pain and bruising, which supports the researchers’ hypotheses. Thus, it is recommended that subcutaneous heparin injections be administered slowly over a minimum of 30 seconds. Future research could examine the possibility of a sliding scale that considers injection duration per volume of injectate.