Heparin SubQ administration?

MI_student · Nov 7, 2011

I have personally been on a heparin regimen in the past; it does burn, and when giving it to myself, I went fast--like stick in, shove down plunger, pull out fast--which made for less burning, but crazy bruising. Still, I preferred black-and-blue to the slow burn. With that said, when I'm administering heparin in clinical under the watchful eye of my instructor, I go by the book and do it s-l-o-w.

akulahawkRN, ADN, RN, EMT-P · Nov 7, 2011

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.

iwanna · Nov 8, 2011

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.

ObtundedRN, BSN, RN · Nov 8, 2011

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.

emmbee · Nov 8, 2011

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;)

talaxandra · Nov 8, 2011

The only injection I ever give with the drawing up needle is insulin. Ouch!

Esme12, ASN, BSN, RN · Nov 8, 2011

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.... :rolleyes:

catlvr · Nov 8, 2011

I ask the pt if they prefer slow or fast...they usually are able to state which is more tolerable to them.

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mazy · Nov 8, 2011

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.

sassynerd · Mar 26, 2013

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

MN-Nurse, ASN, RN · Mar 27, 2013

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.

salvadordolly · Mar 28, 2013

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!!