Heparin SubQ administration? - page 2

I gave a heparin injection sub Q to my patient during clinical last week. My instructor said I did it wrong because I showed go "really slow". I wasn't going really fast but just how you administer... Read More

  1. by   akulahawkRN
    I'd say to penetrate the dermis fast, thus you get that part of the whole thing done quickly and with less pain. I'm not saying to use the dart method and bury the needle, just a really quick stab that goes only about 1/4-1/2 inch deep, then advance less quickly to reach the appropriate depth. Then, inject slowly to decrease tissue trauma. I feel that you can cause a patient more discomfort by slowly puncturing the skin than by going quickly. The rate of actual injection is something entirely different.
  2. by   iwanna
    It has been awhile, but I believe that we used to change needles after we drew it up.

    Also, I have been on the receiving end of heparin shots. They are not that painful. Uncomfortable, yes, but not so painful.
  3. by   ObtundedRN
    Perhaps the OP just didn't give it the way the instructor prefers it be given? Slow or fast, you can't exactly say it was "wrong." Just not how that instructor believes it should be given. I don't know if my personal technique is considered fast or slow, maybe in between, but i've had patients actually tell me it doesn't hurt so much when I do it.
  4. by   emmbee
    I've been on heparin regiments as well... I found the dart method with a slow STEADY administration lead to NO bruising and little burning. And yes it can come prefilled like lovenox, but both are rather expensive.

    ensure more comfort to the patient by drawing up with one needle, replace with new needle that has not been dulled and then administer. For the HUNDREDS of heparin/lovenox injections I have given myself that is what worked best
  5. by   talaxandra
    The only injection I ever give with the drawing up needle is insulin. Ouch!
  6. by   Esme12
    Quote from psu_213
    I agree with everything except for this point...everywhere I have worked, subQ heparin comes in a vial and must be pulled up into a syringe for administration. Lovenox comes as a prefilled syringe--though in the ER we never seem to give the amount that is in the syringe.
    I have seen it at many facilities......I try to cover all the possibilities of packaging and sometimes I just get tired of typing all the possible packaging senarios....
  7. by   catlvr
    I ask the pt if they prefer slow or fast...they usually are able to state which is more tolerable to them.

  8. by   mazy
    Quote from Hellostudentnurssee
    I gave a heparin injection sub Q to my patient during clinical last week. My instructor said I did it wrong because I showed go "really slow". I wasn't going really fast but just how you administer any subQ injection. What's the reason for going "slow" with a heparin subQ injection?

    PS: A big reason to my stress/anxiety is my clinical instructor. She's a smart one but definitely the b*tchy teacher who lives "by the books" and uses negative reinforcement (and not constructive criticism). Constantly on egg shells with this instructor and believe me, I'm definitely adjusting MYSELF to fit to her needs so I can pass this damn class. *sigh*
    You have posted many many threads about your clinical instructor and seem to be questioning her at every turn. No one can really know the true situation you are living with.

    But your last statement is very accurate. You are learning to be a nurse. This is not just about a class, it is about your profession and how you choose to define yourself in that profession.

    You are not a nurse now, and so you do need to change or adjust yourself because you are in the process of becoming something new -- a person who was not a nurse who will soon be a completely different type of person: a nurse.

    It is a journey, a very difficult one. Becoming a new type of person always is. Stop fighting this so hard. If you allow this to unfold and allow yourself to be challenged and shaken up you might be surprised and pleased with the outcome.

    Best of luck.
  9. by   sassynerd
    I know this is an old post and I'm here reading this to pick everyone's brain. This very similar situation happened to me at clinical. I was taught in school during health assessment class to not aspirate or massage for heparin and to go slow as it would avoid bruising/tissue trauma. When I did it at clinical, I injected like a dart, quick, at a 45 degree angle, then pushed the heparin in slow. Not like super slow, but moderately slower than I would do an IM. Immediately my clinical instructor said I did it wrong and too slow, that I was hurting the patient with my method. I understand her rationale to do it as quick as possible to get it over with for the patient. But I get confused as to listen to the book way we are taught at school or to follow what the instructor says. Of course I didn't talk back and just nodded to my "mistakes", I was so upset she said that in front of the patient and I was hurting them that I tried to recap the needle before throwing it in the sharps and I know to never ever ever recap because I've done injections all the time at a flu clinic before. What a bad day that was...this post helped a little in understanding the rationales for heparin slow or fast. But still, unsure as to what I should've done different
  10. by   MN-Nurse
    Quote from sassynerd
    Immediately my clinical instructor said I did it wrong and too slow, that I was hurting the patient with my method. t
    The best way to do something in clinical is to ask the instructor or preceptor how they do it, then do it that way.
  11. by   salvadordolly
    Nursing instructors are anal retentive. They seldom do anything but criticize and they love to do it in front of people. I hate to say this, but get used to it - criticism is rampant in this profession filled with detail-oriented perfectionists!!
  12. by   Esme12
    It does seems to be a characteristic of nurses to be anal retentive and detail oriented....but I think one has to be when you have the life of someone at your finger tips and any slight error can have an untoward outcome.

    I'm glad a I have a venue for my OCD.
  13. by   Sadala
    A) I've had only FABULOUS and very patient clinical instructors when they are separate from the school. The nursing instructors with the school (who sometimes double as clinical instructors - God help us) are a toss-up. Some are WONDERFUL (in fact, the majority) but a couple are... to be avoided if at all possible.

    B) I think the technical answer on the subcut heparin is that you give it slowly because it hurts less and causes less tissue damage. (Having had my fair share of abdominal subcut injections, it hurts me less when I do it slowly). Also, have you SEEN the bruising on some of the heparin pts? Not pretty.

    That said, some people find fast injections to be less painful, just like some people like the bandage ripped off quickly. My personal feeling on bandages and injections is that the less trauma you inflict, the better for the patient. And I think slower is less traumatic (physically anyway), causes less tissue damage, etc. - and may well be better for absorption. Ok. I made that last bit up. But it makes SENSE in my brain.