Heparin SubQ administration? - page 3

by Hellostudentnurssee 23,560 Views | 28 Comments

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... Read More


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    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.
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    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
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    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.
    tyvin likes this.
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    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!!
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    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.
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    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.
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    Oh. And... All you can do when a clinical instructor tells you something is agree with them, thank them, and then double check it later. Maybe they're right. HOPEFULLY they are right. But you should be polite and cooperative either way if you ever want to receive your diploma (and because being polite and cooperative with your instructors is typically the right thing to do - barring some extreme and bizarre circumstance).
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    I am not a nurse. I am getting my prerequisite now for my bsn but I do know about heparin. I have incompetent cervix. My cerclage was failing with my last pregnancy and I had to be on strict bedrest in the hospital. Was there from 20 weeks gestation to 29 weeks when my cerclage finally gave out. Well that whole time I had to take heparin twice a day since I was not able to get up. I had many different nurses give it to me and sometimes it did not hurt and sometimes it did. The fatter the area the better. Never hurt in the fatty area of my stomach. Also some gave it above my umbilacus. It hurt a lot above my belly button. After a few times of that I always told them to do it below. Now from reading this post they should have not done it that way anyway. Also never touch the injection site after giving the injection. A few times after getting the heparin shot I had some bleeding at the site. One nurse gently layed gauze on top of the site without ever touching it. She told me not to touch it. Before she walked out of my room she took it off and it was fine. When the same thing happened another time a different nurse wiped off the blood and put some pressure on it. It was light pressure. I got a huge bruise that lasted for a week. Hope this helps from a person who got heparin for 2 months.
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    Excellent advice about the clinical instructors! Thank you everyone. Yes I have been and will continue to be polite and just internalize any criticism from the instructors. I do want my diploma one day. And yes, how true that the book did say go slow to cause less trauma for patient but she wanted it quick as possible. I know what I read and I would choose to cause less trauma to patient and no bruising to the sites in my future practice as a nurse one day. Perhaps in my instructor's mind, doing it quick and getting it over with was less traumatic for the patient.


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