Heparin: to pinch or stretch?

[Tink87, BSN, LPN, RN]

I'm a senior nursing student and an LPN of 8 years (worked in offices and clinics). I have a question about subq heparin that has been driving me crazy. So, in both my LPN and my RN programs we have been taught to NEVER pinch the skin when giving heparin. We were taught to instead use your non-dominant hand to stretch the skin taught with the thumb and forefinger. We pinch with insulin but not heparin. However, every single nurse I see in the hospital pinches. Additionally, when I googled the topic, almost everything comes up saying to pinch. I wanted to do a QI assignment about why nurses don't do what they are taught (i.e. stretch the skin) but now I'm not even sure that this practice is evidence based. If it is, I can't seem to find the research. What is everyone else being taught? Is this just the schools in my region? I really don't get it.

[smf0903]

Pinch. You want the med to go in the subcut fat. Stretching is for IM injections. Stretching the skin, especially in a patient with little subcut fat, can end up with heparin in the muscle...which you absolutely do not want.

[Here.I.Stand, BSN, RN]

I was never taught to stretch...so I actually am doing what I was taught. I would think too, that on a lean body stretching would also flatten out the SQ tissue even further. Also anecdotally, I have had several pts tell me it hurts less with the pinch

[Tink87, BSN, LPN, RN]

I was told by my instructor that pinching with heparin is an old school thing and that there shouldn't be an issue going into muscle due to the length of the needle (unless someone is like, wasting away thin). I just find this all very confusing because I have now been taught the same thing at two different schools but I can't seem to find a "right" answer when researching the issue.

edit: I did just find one article on NIH that advocates for no pinching for any subcut injections but that's all I have found. That helps me know that it didn't come out of nowhere but I would like more info from other people.

[smf0903]

I was told by my instructor that pinching with heparin is an old school thing and that there shouldn't be an issue going into muscle due to the length of the needle (unless someone is like, wasting away thin). I just find this all very confusing because I have now been taught the same thing at two different schools but I can't seem to find a "right" answer when researching the issue.

Here's from out of the current Davis Drug guide:

I find that pinching helps with darting the needle as well. Some people have some gnarly old chicken skin on their bellies and the tautness of the pinched skin helps the needle dart in easier.

[smf0903]

.....

[smf0903]

Good grief, sorry for the ginormous pic, but I don't know how to make it smaller

[ArrowRN, BSN, RN]

I'm a senior nursing student and an LPN of 8 years (worked in offices and clinics). I have a question about subq heparin that has been driving me crazy. So, in both my LPN and my RN programs we have been taught to NEVER pinch the skin when giving heparin. We were taught to instead use your non-dominant hand to stretch the skin taught with the thumb and forefinger. We pinch with insulin but not heparin. However, every single nurse I see in the hospital pinches. Additionally, when I googled the topic, almost everything comes up saying to pinch. I wanted to do a QI assignment about why nurses don't do what they are taught (i.e. stretch the skin) but now I'm not even sure that this practice is evidence based. If it is, I can't seem to find the research. What is everyone else being taught? Is this just the schools in my region? I really don't get it.

Never stretch for subq heparin,you would pinch but technically the most accurate answer is neither. The reason is the old school needles were made longer and hence the reason for pinching started. More modern needles made today very short and thin and do not require the pinch. This was done to reduce the number of "accidental" needle sticks, however the only reason I do it is because, 1: it helps me target the area I want better and 2: Pt satisfaction, most pt's reports there is little to no pain/sting using the pinch method.

Stretch and that pt is likely to punch you in the face because heparin going into muscle hurts very badly.

[AceOfHearts<3]

I was taught to pinch. Keeping a firm pinch and going slower and at an even rate (not super fast) with the injection reduces the burn the patient feels. I have many patients compliment me and tell me they didn't even feel it versus it burning when others give it.

I had a patient when I was a student that was leery of a student giving him his shot as it burned so bad when another student did it. After I gave it to him he told me it was the best one he had had- from a student or a nurse. My instructor then complimented me and told me it was because I kept a good pinch and went at a slower rate. That has stuck with me and something I always keep in mind.

[ThePsychWhisperer, BSN, MSN, APRN, NP]

Honestly, I do neither. I usually inject heparin into the abdomen, approximately two inches from the umbilicus, same as I would do for Lovenox. Most people have enough subcutaneous tissue in their abdomen to accommodate.

[Tink87, BSN, LPN, RN]

Maybe I should clarify. When I say stretch I mean simply enough to tighten the skin and not have the needle bounce off. I don't mean aggressively stretch and flatten out the underlying tissue. This is only for heparin and lovenox. All other subcut we still pinch a fold for.

[emmjayy, BSN, RN]

I was taught to pinch all the way through to make sure it goes into subcutaneous tissue instead of getting into muscle.