How to avoid subcutaneous cyanosis after injection of low molecular weight heparin

As a commonly used anticoagulant, low molecular weight heparin calcium has many advantages, remarkable curative effect, wide clinical application, long half-life and little side effects.

But there is a headache, which is easy to cause subcutaneous hemorrhage, even subcutaneous hematoma at the injection site and around it.

Because of this, the compliance of this drug is seriously affected, and once subcutaneous bleeding occurs, the injection range will be limited again, which will affect the recovery of the disease.

What is the cause of subcutaneous hemorrhage?

When injecting, the pillow is not perpendicular to the skin, and the inner and outer puncture points are not in the same position. When pulling out the needle, only press the outer eye of the needle, resulting in subcutaneous bleeding.

Because the liquid medicine attached to the needle tip and needle bar is brought into the needle eye of the punctured blood vessel, subcutaneous hemorrhage occurs.

Therefore, now we only need to solve the above two problems to reduce subcutaneous bleeding.

Because of this, many clinical nurses began to study how to reduce subcutaneous bleeding (it is recommended to check the patient's coagulation function before injection):

First, the pressing method

1. When the needle is pulled out one minute after the injection of stop, the needle is still full of liquid medicine, and the liquid medicine overflows and leaks into the subcutaneous tissue and enters the damaged blood vessels, which changes the permeability of the blood vessels, thus causing subcutaneous bleeding. Therefore, after the injection, stay for 10 second, pull out the needle plug with your right hand, pull out the needle, and press it with a dry cotton swab to make all the liquid medicine at the needle tip drip into the skin, so as to avoid bleeding due to backflow of the liquid medicine during needle pulling. Need to press: 5- 10 minutes.

2. Some scholars' research results show that pressing with a cotton swab after pulling out the needle increases the stimulation and extrusion of the drug on the injection site. If the force is large, it is easy to cause capillary wall rupture and bleeding, resulting in local congestion. Pinch the skin into wrinkles during injection, so that the capillary is not easy to be damaged, and vertical needle insertion can reduce tissue damage. In addition, the disposable pre-injection needle is very thin, which will not cause bleeding on the skin surface after pulling out the needle, so there is no need for cotton swab compression.

Second, rotate the injection site.

Someone specially made this card rotary injection, and the circle in the middle is facing the navel.

Third, an injection needs to pinch the skin.

Fourth, inject air together (the effect is good at present)

The traditional injection of exhaust gas should be injected after exhaust, and at this time, the needle is attached with liquid medicine. Low molecular weight heparin has anticoagulant effect. When the exhausted liquid medicine attached to the needle tip is injected into the puncture point, the blood vessels at the puncture point ooze blood, which easily leads to local skin fatigue.

Most of the low molecular weight heparin used in clinic is pre-injected, and there is no need to exhaust when injecting. There is 0. 1 ml air in the syringe. When injecting, the needle is facing down and the air bounces above the liquid medicine. At this time, the air in the syringe just injects all the liquid medicine into the human body, which ensures the accuracy of the dosage, avoids the local stimulation of the liquid medicine to the needle tip, and can reduce the local congestion.

There is air

Verb (abbreviation for verb) goes straight into the needle.

Traditional needle feeding method and vertical needle feeding method The traditional needle feeding method is that the left hand tightens the abdominal skin, and the right hand holds the syringe, and the inclined plane of the needle tip is 30-40 degrees upward with the skin. Quickly stab people's skin. The improved method is to lift the abdominal skin with the thumb and forefinger of the left hand to form wrinkles, and fix the needle to vertically insert the needle about 0.8~ 1.2cm (the injection depth depends on the patient's fat and thin). Compared with the traditional needle insertion method, the vertical needle insertion method causes less skin congestion.

The traditional needle insertion method involves many parts. If the needle accidentally pricks a blood vessel, pressing the puncture point alone cannot effectively stop bleeding. Because low molecular weight heparin is an anticoagulant, it is easy to cause bleeding by damaging small blood vessels, and the subcutaneous tissue of abdominal wall will form congestion and plaque. However, if the abdominal wall skin is lifted vertically during injection, the damage to local subcutaneous tissue is small and it is not easy to cause bleeding. Moreover, compared with the traditional needle insertion method, the vertical needle insertion method can obviously alleviate the pain of patients. When the needle is inserted vertically, the needle insertion speed is fast, the needle travel in the skin is short, the tissue damage is small, and the nerve endings are not easy to be damaged or damaged. In the traditional needle insertion, the needle has a long stroke in the skin, and the inclined plane of the needle cuts a large area of tissue, resulting in more tissue damage, so that the needle accidentally damages nerve endings, indicating that the patient's pain is more obvious, because collagen fibers in the dermis are thinner, cell components are more, and capillaries and nerve endings are rich.

Pull out the needle plug with thumb and forefinger, and push the needle plug with thumb after there is no blood return. After the liquid medicine is pushed, a small amount of bubbles enter the needle cavity to block the liquid medicine from flowing out, and the needle is pulled vertically. For pressing, please refer to the first part of this article (pressing).

What if there is subcutaneous congestion?

Subcutaneous injection of low molecular weight heparin sodium leads to blood stasis and ecchymosis at the injection site, which is very common in clinic and will be absorbed by itself without special treatment. Some colleagues also think that wet compress with magnesium sulfate will recover quickly.