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Published on: April 21, 2023
Injection Techniques to Reduce Adverse Effects of Subcutaneous Low-Molecular-Weight Heparin Among Patients With
Arkers Kwan Ching Wong1, Rachel Yui Ki Chu1, Ying Nan2
1School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR.
Insights
Minimizing adverse effects from low-molecular-weight heparin injections involves specific techniques. Evidence suggests abdominal sites and slower injections may reduce complications, but optimal parameters require further research.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Nursing Practice
Background:
- Low-molecular-weight heparin (LMWH) is crucial for cardiovascular disease management.
- Accurate subcutaneous injection of LMWH is vital to prevent complications and reduce healthcare costs.
- Standardized injection techniques are essential for patient safety and treatment efficacy.
Purpose of the Study:
- To systematically review effective techniques for minimizing adverse effects of subcutaneous LMWH injections.
- To identify optimal injection parameters for patients with cardiovascular diseases.
Main Methods:
- A comprehensive scoping review of literature from February 2014 to January 2024.
- Searches conducted across CINAHL, PubMed, EMBASE, and Cochrane Library.
- Data analyzed using the Joanna Briggs Institute approach.
Main Results:
- Twenty studies were included, comprising RCTs, quasi-experimental studies, and best practice projects.
- Techniques investigated included injection site, duration, needle angle, withdrawal time, and pressure application.
- Preliminary findings suggest abdominal sites and slower injection rates may reduce adverse effects, but optimal parameters remain uncertain.
Conclusions:
- Accurate LMWH administration is critical for reducing mortality and healthcare costs.
- This review strengthens the evidence base for standardized subcutaneous injection techniques.
- Implementing standardized techniques can improve patient outcomes in cardiovascular disease management.
Aim(S):
To systematically review the existing literature and address the following research question: What are the most effective techniques used to minimise adverse effects resulting from subcutaneous injections of low-molecular-weight heparin among patients with cardiovascular diseases?
Design:
A scoping review.
Methods:
A comprehensive search was conducted across multiple databases, including CINAHL, PubMed, EMBASE and the Cochrane Library, from 1 February 2014 to 31 January 2024. Participants were aged 18 years or older, diagnosed with venous thromboembolism or arterial thromboembolism and had prescribed subcutaneous injections of low-molecular-weight heparin. The collected data were analysed following the Joanna Briggs Institute approach, and it was organised and categorised based on the main objectives of the review.
Results:
Twenty studies were eligible, including 1 best practice project, 7 randomised controlled trials and 9 quasi-experimental studies. The techniques under investigation encompassed various aspects, including the injection site, injection duration (e.g., 30 s vs. 10 s), injection method (e.g., needle insertion angle), duration of needle withdrawal after injection, pressure application time and cold pressure. Preliminary evidence suggests that techniques such as using the abdominal site and slower injection rates may help reduce adverse effects. However, the optimal parameters for injection duration, waiting time, pressure and cold application, including the duration of these applications, remain uncertain due to limitations in sample size and heterogeneity in interventions and outcome measures across the studies.
Conclusions:
Ensuring the accurate administration of low-molecular-weight heparin is of utmost importance as it plays a critical role in decreasing mortality rates and minimising substantial healthcare costs linked to complications arising from incorrect administration. The findings from the current review have significantly contributed to strengthening the evidence base in this field, providing more robust and reliable information.
Implications For The Profession:
This review emphasises the significance of implementing standardised subcutaneous injection techniques for low-molecular-weight heparin in patients with cardiovascular disease in order to reduce complications and enhance patient outcomes.
Reporting Method:
This study followed the applicable guidelines established by the PRISMA 2020 statement. The PRISMA checklist for systematic reviews was utilised for reporting purposes.
Patient Or Public Contribution:
There is no patient or public contribution to declare.
Trial Registration:
OSF registries: osf.io/phk72.
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