How do you break with tradition and make low molecular calcium painless and bleed-free?
- Date：2020-12-09
- Click：11329Times
Two nurses injected the same patient with low molecular heparin, the injection methods were different and the bleeding at the injection site was different, how to inject can reduce the occurrence of subcutaneous bleeding, see below~
A patient was admitted to the hospital with normal coagulation six results, knee arthroplasty after the implementation of medical advice: low molecular heparin calcium 6000iu q12h, after two days of injection found that the patient's two needle eye (nurse A injection) around the subcutaneous bruising, the needle eye at the formation of a blood crust; the other two needle eye (nurse B injection) is no abnormality, the patient complains of previous skin injuries are easy to bruise.
Then the nurse in charge should think about it: the same drug, the same patient, where is the difference?
After review, Nurse A used the traditional injection method, and Nurse B used the improved injection method.
As an antithrombotic agent, low molecular heparin calcium can inhibit the formation of thrombus and arterial and venous thrombus in vivo and outside the body, and is widely used clinically because of its long duration of subcutaneous injection in the abdomen and few side effects.
However, when applying low molecular heparin calcium, both the injection process and the absorption process can damage the local capillary wall, causing the capillary wall to rupture and bleed, forming local petechiae and hard knots after deep petechial hemorrhage, leading to pain and discomfort for patients, increasing the psychological burden of the patients, and affecting the absorption of drugs.
The following are a few points of improved injection techniques to avoid bleeding caused by subcutaneous injection:
1. Reasonable choice of injection site
The high concentration of low molecular calcium subcutaneous injection has a destructive effect on local capillaries, which is easy to cause bleeding, so it is necessary to reasonably choose the injection site.
It is best to take turns to inject, the distance between two injection points is more than 2cm, and the skin around the umbilicus is relatively low sensitivity, easy to pinch up to form folds, so it is appropriate to choose the umbilicus around the 10cm alternating injection.
2. Massage before injection
Massage the local area for 2 minutes before injection, and then inject subcutaneously when the skin is reddened, so as to accelerate the local blood circulation, which is conducive to the absorption of the drug, and can reduce the concentration of the local drug, and significantly reduce the incidence of subcutaneous haemorrhage.
3. Reduce the residue of drug solution
Before injection, disinfected dry cotton swabs should be used to dry the suspension at the tip of the needle to reduce the residual drug solution.
At present, the low molecular heparin used in the clinic is mostly pre-filled with needle, and it is not necessary to exhaust the air when injecting, there is 0.1ml of air in the syringe, the air will be popped up to the top of the drug solution before injection, and the air in the syringe will be filled with the syringe nipple and the cavity of the needle just after the injection is finished, which not only makes the drug solution fully utilised, but also avoids the residual liquid stimulation leading to the formation of local skin ecchymosis.
4. Mastering the skill of needle insertion
When operating according to the patient's fat and thin to choose the depth of the needle, generally about 1cm, so that the fat layer is appropriate.
Fix the needle, draw no blood, vertical fold method of injection: that is, when injecting the left thumb and forefinger pinch up the abdominal wall skin to form a fold, in the highest point of the skin fold the needle vertically pierce a little fast push injection, the injection stays for 5-6 seconds, so that all the needle liquid dripping into the subcutaneous.
As the pushing time is shortened, the patient's nervousness and fear can be reduced, and the skin is kept in a folded state during the whole injection process, and the vertical fold method always keeps the medicine injected into the subcutaneous adipose tissue uniformly and reduces the damage of the local tissues.
If the needle is inserted into the skin obliquely or the hand that pinches the skin is loosened during the injection process, the area damaged by the needle will be enlarged, thus intensifying the pain, and at the same time, because the internal and external puncture points are not in the same position, it is easy to appear subcutaneous bruising.
5. No pressure after needle removal
The traditional method of removing the needle needs to be pressed with a cotton swab, and some research results have proved that pressing after removing the needle increases the stimulation and extrusion of the drug on the injection site, and is prone to form local bruising.
When injecting, the skin is pinched up into folds to make the capillaries bend, so that they are not easy to be damaged, and the vertical needle can reduce tissue damage, coupled with the disposable pre-filled injections of the needle is very thin, after pulling out the needle will not cause bleeding on the surface of the skin, so there is no need for cotton swabs to press.
After injection, it is only necessary to stay for 5-6 seconds, so that all the liquid in the needle can be dripped into the subcutaneous, avoiding bleeding caused by reflux of the liquid.
It can be seen that the injection of low molecular heparin calcium needs to be careful. As a responsible nurse, you, using a favourable method of subcutaneous injection of low molecular heparin calcium, can effectively avoid subcutaneous bleeding, bruising and subcutaneous haematoma.
In the clinical nursing work we should observe more, accumulate experience in many aspects, and summarise more techniques and methods to avoid these adverse reactions, in order to reduce the pain of patients, improve the efficacy, increase patient satisfaction, and improve self level at the same time.
References:
[1] Lu Li. Improvement and application of low molecular heparin subcutaneous injection method[J]. Combined Chinese and Western medicine nursing: in English, 2015,1(2):99-100.
[2]Li YH. Research on the effect of different injection methods of low molecular heparin[J]. World Clinical Medicine,2017,11(23):46.
[3] Low molecular heparin calcium drug insert.
(Huamei Hospital District, Li Fangfang)
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