Elsevier

Journal of Vascular Nursing

Volume 36, Issue 4, December 2018, Pages 208-215
Journal of Vascular Nursing

Article
Comparison of abdominal and arm areas in patients receiving subcutaneous heparin in terms of development of pain, hematoma, and ecchymosis

https://doi.org/10.1016/j.jvn.2018.06.003Get rights and content

Highlights

  • The abdominal area should be preferred in patients who are pain sensitive.

  • No difference between areas in terms of the development of ecchymosis and hematoma.

  • Both areas could be used in terms of the development of ecchymosis and hematoma.

  • This study provides the choice of the appropriate area to prevent complication development.

The purpose of this study was to compare the abdominal and arm areas in the patients using subcutaneous heparin in terms of pain, hematoma, and ecchymosis development. As a result of subcutaneous heparin injections, complications such as pain, ecchymosis, and hematoma may develop in the injection site. The injection site chosen for injection is one of the factors that are effective on complications. This quasi-experimental study was conducted with 54 patients at orthopedics–traumatology and cardiothoracic surgery clinics of a university hospital. The data were collected using a patient description and follow-up form, visual analog scale, transparent film, and a chronometer. Ecchymosis and hematoma were evaluated at the 48th hour after injection, whereas the pain level was evaluated right after the injection, and the pain duration was evaluated during the injection. The rate of pain in the arm area was statistically higher. Differences between the areas in terms of level and duration of pain and development and size of ecchymosis and hematoma were not significant. More pain developed due to heparin injection in the arm area than in the abdominal area. No differences were observed between the areas in terms of level and duration of pain, development and size of ecchymosis, or development and size of hematoma.

Section snippets

Design

This study was conducted on one group with a quasi-experimental method. Conditions such as pain, ecchymosis, and hematomas that may develop due to injection may vary among individuals. For this reason, each patient formed his/her own control group in the study. The complications developed due to the injections applied to the arm area of each patient were compared with the complications developed due to the injections applied to their abdominal area. Thus, the characteristics of the patient

Results

It was observed that 51.9% of the patients were in the age range of 39–59 years, 61.1% of them were male, 37% were overweight, 46.2% were treated due to vascular diseases, and 57.4% underwent nadroparin calcium treatment (Table 1).

During the administration of injections to abdominal areas, 40.7% of the patients felt no pain, whereas this rate was 31.5% for injections administered to arm areas (P < .01; Table 2).

Ecchymosis developed at the rate of 48.1% in the abdominal area and at 66.7% in the

Discussion

In this study, a statistically significant difference was found between areas only in terms of pain development. The differences observed between the areas in terms of level and duration of pain, as well as the development of ecchymosis and hematoma, were not statistically significant.

The patients experienced very mild pain in both the abdominal and arm areas, but this rate was higher in the arm area. In addition, the mean scores of pain levels were higher in the arm area.

Zeraatkari et al9

Conclusion

Pain developed in significantly more patients in the arm area than in the abdominal area. The mean pain level and the mean pain duration were statistically insignificant. There were no significant differences between the areas in terms of the development of ecchymosis and hematoma.

Acknowledgments

The authors would like to thank directors of hospital, nurses, and the participants. Also they thank the Scientific Research Projects Unit of Inonu University.

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  • Cited by (9)

    • Effectiveness of mechano-analgesia and cold application on ecchymosis, pain, and patient satisfaction associated with subcutaneous heparin injection

      2020, Journal of Vascular Nursing
      Citation Excerpt :

      Some studies emphasizes slow injection time, as it causes less trauma and pain.10,11,13,15,19,20,22,24 Preferring the abdominal region, which has thicker SC tissue than the other areas of the body, is also found effective for reducing pain.13,25 In addition, cold application is recommended to reduce pain, as it prevents pain perception through its effect on sensory nociceptors.12,15

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    Conflicts of interest: The authors declare that there is no conflict of interest.

    Authors' contributions: Both the authors contributed equally to the study design, data collection and analysis, and manuscript writing.

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