The Journal of Informed Pharmacotherapy 2001;4:407
Dawn Robb, BSc (Pharm), Zahra Kanji, BSc (Pharm), PharmD
Pharmacy Department, Lions Gate Hospital, North Shore Health Region, North Vancouver, British Columbia, Canada.
Canadian Society of Hospital Pharmacists (British Columbia Branch) Residency Research Presentation Night, Vancouver, British Columbia, Canada. May 10, 2000. (Supported by a grant from Rhone-Poulenc Rorer. This study was carried out solely under the direction of the authors.)
Nursing staff at our institution have reported frequent, large hematomas at subcutaneous injection sites when administering enoxaparin. Reports from the literature and the manufacturer suggest hematomas develop at subcutaneous injection sites in 5.1 to 19.3% of patients. Use of a smaller needle size has been anecdotally reported to limit injection site hematomas when administering enoxaparin.
To determine if using a 30-gauge, 5/16" insulin syringe versus a 26-gauge, 3/8" tuberculin syringe would significantly reduce the size of injection site hematomas and/or cause less pain on injection when patients were treated with enoxaparin (1mg/kg q12h) for unstable angina or non-Q-wave myocardial infarction.
The emergency department, intensive care unit, and cardiology ward of a 675-bed community hospital in Canada.
A prospective, randomized study. Patients presenting to the emergency department with unstable angina or non-Q-wave myocardial infarction and prescribed enoxaparin were randomized to receive subcutaneous injections by one of the two study needles. Every twelve hours, prior to the next administered dose, nurses inspected designated injection sites and measured any hematomas present. After the dose, nurses asked the patient to rate the pain on injection.
Size of largest hematoma formed, measured at the widest diameter in centimeters. Pain associated with injection, using a 10-point numerical pain scale.
There was no significant difference in the median size of the largest hematoma (3.5 cm with the insulin syringe group versus 2.3 cm with the tuberculin syringe group, p=0.68) and no significant difference in the average pain score (0.31 units with the insulin syringe group versus 0.53 units with the tuberculin syringe group, p=0.10).
Use of a 30-gauge, 5/16" insulin syringe versus a 26-gauge, 3/8" tuberculin syringe does not significantly reduce hematoma size nor does it significantly reduce pain on injection.
Copyright © 2000 by the Journal of Informed Pharmacotherapy. All rights reserved.