The Effect of Extended Injection of Subcutaneous Heparin on Pain Intensity and Bruising Incidence
Keywords:
Extended injection time; Heparin; Pain intensity; BruisingAbstract
Background: Reducing patients’ pain is one of the main goals of providing clinical services, which requires nursing skill. As a simple technique, increasing the duration of subcutaneous heparin injection may affect the intensity of pain and bruising.
Objective: The aim of this study was to assess the effect of increasing the heparin injection time on pain intensity and bruising associated with subcutaneous injection.
Methods: The present quasi-experimental study consisted of 86 patients, admitted to our hospital, who were treated with subcutaneous heparin injection. A McGill pain intensity questionnaire was used to measure pain severity in a purposive sampling. All of the subjects received subcutaneous heparin twice for 10 seconds. They also were injected twice with heparin infusion, although it was for 30 seconds this time. The interval between the two injections was 24 h, and the intensity of the pain was measured after each injection. The Pearson correlation coefficient was measured, and analysis of variance (ANOVA) and the t-test were used to analyze the data.
Results: Eighty patients received heparin. The body mass indexes were reported as 52 (60%) and 34 (40%) for subjects within the age range of 18.5-24.9 and 25-29.9, respectively. Regarding the mean of pain intensity, there was a significant difference between the 10 and 30 s injections (p ˂ 0.05). Additionally, there was a significant difference in bruising rates between the two methods 48 and 72 h after injection (p ˂ 0.05). The ANOVA test showed a significant association between gender and bruising (p = 0.001).
Conclusion: According to the results, by elevating the duration of heparin injection, the severity of pain was reduced, and, therefore, the patients felt more comfortable.
Trial Registration: The trial was registered at the Thai Clinical Trials Registry (TCTR) with the TCTR identification of TCTR20160221001.
Funding: This research was supported by the research cluster grant (88186-25/01/89) from Mashhad University of Medical Sciences, Mashhad, Iran. The authors received no financial support for the authorship and/or publication of this article.
References
Lee HS. Physical Diagnosis 101: A Lesson From the First Year of Medical School. ASA. 2004; 68(11): 37.
doi: 10.1016/j.sna.2003.10.008.
Lynch M. Pain as the fifth vital sign. J Gen Intern Med. 2001; 24(2): 85-94. doi: 10.1111/j.1525- 1497.2006.00415. PMCID: 1924634.
Yuen T, Irwin M. The'fifth vital sign'. HKMJ. 2005; 11(3): 145-6. PMID: 15951577.
Dorothy'Dale'M M, Torma L, Byock I, Norris K. Speaking the language of pain. AJN. 2001; 101(2): 44-50.
PMID: 11227229.
Parfitt K, Martindale W. The complete drug reference. Pharmaceutical Press, London. 1999; 31: 51.
Fowler-Kerry S, Lander JR. Management of injection pain in children. Pain. 1987; 30(2): 169-75. doi:
1016/0304-3959(87)91072-4. PMID: 3670868.
Venketasubramanian N, Chua HC. Subcutaneous low molecular weight heparin in place of heparin infusion
during warfarin dose optimisation in cerebral ischaemia. Clin Neurol Neurosurg. 1998; 100(3): 193-5. doi:
1016/S0303-8467(98)00039-0. PMID: 9822840.
Ross S, Soltes D. Heparin and haematoma: does ice make a difference? J Adv Nurs. 1995; 21(3): 434-9.
doi: 10.1111/j.1365-2648.1995.tb02724. PMID: 7745195.
Kuzu N, Ucar H. The effect of cold on the occurrence of bruising, haematoma and pain at the injection site
in subcutaneous low molecular weight heparin. Int J Nurs Stud. 2001; 38(1): 51-9. doi: 10.1016/S0020- 7489(00)00061-4. PMID: 11137723.
Bergqvist D. Enoxaparin: A pharmacoeconomic review of its use in the prevention and treatment of venous
thromboembolism and in acute coronary syndromes. Pharmacoeconomics. 2002; 20(4): 225-43. doi:
2165/00019053-200220040-00002. PMID: 11950380.
Warner GT, Perry CM. Enoxaparin: in the prevention of venous thromboembolism in medical patients. Am
J Cardiovasc Drugs. 2001; 1(6): 477-81; discussion 83-4. PMID: 14728009.
CM J. Mechanism of heparin action. Baillieres Clin Haematol. 1990; 3(3): 483-504. PMID: 22566220.
Machovich R. Mechanism of action of heparin through thrombin on blood coagulation. Biochim Biophys
Acta. 1975; 412(1): 13-7. doi: 10.1016/0005-2795(75)90334-7. PMID: 1191673.
Hirsh J, Anand SS, Halperin JL, Fuster V. Mechanism of action and pharmacology of unfractionated
heparin. Arterioscler Thromb Vasc Biol. 2001; 21(7): 1094-6. doi: 10.1161/hq0701.093686. PMID:
Hull RD, Pineo GF, Stein PD, Mah AF, MacIsaac SM, Dahl OE, et al. Timing of initial administration of
low-molecular-weight heparin prophylaxis against deep vein thrombosis in patients following elective hip
arthroplasty: a systematic review. Archives of Internal Medicine. 2001; 161(16): 1952-60. doi:
1001/archinte.161.16.1952. PMID: 11525697.
Palese A, Aidone E, Dante A, Pea F. Occurrence and extent of Bruising according to duration of
administration of subcutaneous Low-Molecular-Weight Heparin: a quasi-experimental case-crossover
study. J Cardiovasc Nurs. 2013; 28(5): 473-82. doi: 10.1097/JCN.0b013e3182578b87. PMID: 22760174.
Santamaria A, Romani J, Souto J, Lopez A, Mateo J, Fontcuberta J. Skin necrosis at the injection site
induced by low-molecular-weight heparin: case report and review. Dermatology. 1998; 196(2): 264-5. doi:
1159/000017889. PMID: 9568422.
Chan H. Effects of injection duration on site‐pain intensity and bruising associated with subcutaneous
heparin. J Adv Nurs. 2001; 35(6): 882-92. doi: 10.1046/j.1365-2648.2001.01925. PMID: 11555036.
Zaybak A, Khorshid L. A study on the effect of the duration of subcutaneous heparin injection on bruising
and pain. J Clin Nurs. 2008; 17(3): 378-85. doi: 10.1111/j.1365-2702.2006.01933. PMID: 17931375.
Akpinar RB, Celebioglu A. Effect of injection duration on bruising associated with subcutaneous heparin: a
quasi-experimental within-subject design. Int J Nurs Stud. 2008; 45(6): 812-7. doi:
1016/j.ijnurstu.2007.02.005. PMID: 17399715.
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