Prophylactic SubQ heparin injections

[0.adamantite]

Many of our patients have subQ heparin injections q8 or q12 hours for DVT prophylaxis while hospitalized. In nursing school I was always taught to give heparin injections in the abdomen and no where else. However, I have come across patients who are so distended or so malnourished that they have almost no fat to "pinch an inch." I don't feel safe giving them the injection (I know this is not correct, but I'm paranoid that I will pierce their peritoneum for whatever reason - that's how thin some of our patients are). Some of our frequent fliers have had dozens of abdominal surgeries and are riddled with scar tissue.

Other patients just request the injection somewhere else. Is it safe to give the SubQ heparin in the inner thigh, back of the arm, etc? Should I give the injection at a 45 degree angle? I give almost all injections at a 90 degree angle.

[dexm]

Abdomen is the preferred injection site, however, you can inject it anywhere else a regular SQ shot can be given. I usually give it in the back of the arm if my pt has thin skin and not much fat in the abdominal area.

I was also taught that the angle you inject is based on how much fat you can pinch up - i.e., a 45 degree angle is used for pts who don't have much subcutaneous tissue and 90 degrees if you can "pinch an inch."