| Objectives: To explore the most effective injection duration and pressing duration associated with subcutaneous injection of low-molecular-weight heparin by using the best injection techniques, which were based on Evidence-based Nursing.Methods: The relevant literature about subcutaneous heparin injection techniques were searched in the databases of Pub Med, Highwire, Science Direct, Chinese Cochrane Library, CNKI, Wanfang database and Google. The quality of the included studies was assessed using JBI-developed 2010 Grades of effectiveness and levels of evidence, then put the best injection technique, which was based on the evidence into the two part experiments. Part 1: From May 2013 to August 2013, 109 patients [male: 63, female 46, 57.31±11.09 years old on average, family history of cardiovascular disease: 7,hypertension: 53, hyperlipemia: 29, diabetes: 18, smoking: 39, BMI:(24.82±2.50)kg/m2 on average, platelet count:(206.62±42.61)×109/L on average, APTT:(31.80±3.29) s on average] with subcutaneous injection of low-molecular-weight heparin were included in the study. According to the table of random digit, those patients were divided into three groups: non-pressing group(n=36), 5-minute-pressing group(n=39), 10-minute-pressing group(n=34). The first ten injections were included in the study for each individual. The diameters of bruising areas were assessed at 48 hours after each injection using transparent millimetric measuring paper. The incidence of bruising and the extension of bruising were analyzed by using χ2 test and Kruskal-Wallis rank test. Part 2: using the conclusion of part 1. From August 2013 to October 2013, 71 patients [male: 39, female 32, 59.25±9.38 years old on average, family history of cardiovascular disease: 2, hypertension: 36, hyperlipemia: 21, diabetes: 18, smoking: 31, platelet count:(204.44±49.71)×109/L on average, APTT: 32.70(6.10) s] with subcutaneous heparin were included in the study. According to the table of random digit, the first ten heparin injections for each individual were randomly divided into two groups: the control group(10-second injection) and the experimental group(30-second injection). The visual analog scale(VAS) was used to measure pain intensity the moment after injection. The diameters of bruising areas were assessed at 48 hours after each injection using transparent millimetric measuring paper. Data were analyzed using Wilcoxon signed rank test.Results:Part 1:1 The incidence of bruising occurrence was 63.61%(non-pressing group), 32.56%(5-minute-pressing group), 35.88%(10-minute-pressing group), with statistical significance among the three groups(χ2=86.036, P<0.01).However, there is no difference between 5-minute-pressing group and 10-minute-pressing group(χ2=0.890, P=0.346).2 The extension of bruising in 5-minute-pressing group and 10-minute-pressing group were lower than that in non-pressing group, showed statistic differences(χ2=21.756, P<0.01). However, there is no difference between 5-minute-pressing group and 10-minute-pressing group(Z=-1.424, P=0.154).Part 2:1 The bruising diameter was [3.00(2.80) mm] in the experimental group and [4.20(2.80) mm] in the control group, with statistical significance between the two groups(Z=-5.923, P<0.01).2 The pain intensity was [1.08(0.84) point] in the experimental group and [1.16(0.94) point] in the control group, with statistical significance between the two groups(Z=-3.935, P<0.01).Conclusions:1 5 minutes of pressing after injection proved to be more effective to reduce the incidence and extension of bruising after injection low molecular weight heparin.2 The injection duration of 30 seconds proved to be more effective to reduce bruising and pain.3 Using the best injection technique which based on evidence, hold a fold of skin, introduce the needle at an angle of 90°, prolong the injecting time to 30 seconds, waiting for 5 seconds before withdrawing the needle, pressing 5 proved to be more effective to reduce the side effects after subcutaneous injection of low molecular weight heparin. |
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