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Does the duration of subcutaneous low-molecular-weight heparin injection impact in the occurrence, extent of bruising and on site pain?

Rajani Shireen*, Batool Afeera, Domanog Marlene Tan, Manlapig Michelle, Rajpali Saima and Shaheen Uzma

Background: Subcutaneous injections often cause pain and bruising. It is noteworthy that the pain of the site causes the patient to experience physical and mental discomfort. A few ways to prevent bruise and pain under heparin injection have been extensively researched but duration of the pain and the extent of bruising is little documented.
Aim: The purpose of this study was to evaluate the duration of injecting heparin with a low molecular weight of 10 seconds compared to 20 seconds regarding the occurrence and level of bruise and pain at the Research Hospital in Kingdom of Saudi Arabia.
Method: Quasi Experimental design was used for successive patient admission to the Cardiovascular Division under services of post cardiovascular surgery, medical cardiology and vascular cases in King Faisal Specialist Hospital & Research Centre, Riyadh, KSA. The adjusted variable was the injection time of 10 seconds (treatment A) compared to 20 seconds (treatment B). Patients were followed up at 48 and 60 hours to evaluate the degree of bruising. Expert and trained nurses performed the Enoxaparin administration to the patient. The data analysis was performed in a blind fashion.
Result: Out of 194 patients, 6.2% (n=12) patients had bruises of 10-150 mm at 48 hours and 6.7% (n=13) patients had bruises of 20-150 mm at 60 hours with injection technique of 10 seconds. During the injection duration of 20 seconds, 3.1% (n=6) patients had bruises of 10-100 mm at 48 hours which was further observed until 60 hours. Out of 194 patients, 70.6% (n=137) patients had site pain (score of 1-6) with injection technique of 10 seconds and 37.6% (n=73) patients had site pain (score of 1-5) with injection technique of 20 seconds. Research finding showing that assessment of bruise at 60 hours with injection duration of 10 seconds is more than the injection duration of 20 seconds. Analysis of pain assessment reveals that majority of patient had increase in intensity of pain in 10 seconds and no significant changes found in the pain score from initial 10 seconds versus 20 seconds.
Conclusion: Our research study provides new knowledge regarding injecting subcutaneous low molecular weight heparin that in 20 seconds injection, it lowers the occurrence of bruise in comparison to 10 seconds injection with no subsequent difference in the pain level.