Current Approaches to Subcutaneous Injection

Yıl 2019, Cilt: 6 Sayı: 2, 406 - 411, 01.06.2019

Nuray Turan , Gülsün Özdemir Aydın , Nurten Kaya

https://doi.org/10.17681/hsp.449018

Öz

DOI:
10.17681/hsp.449018

Subcutaneous injection (SC) is one of the most common
parenteral drug administration methods performed by nurses. For this reason,
the change in the manner of preparation of some medicines nowadays requires
learning new information about the application. Thus, it is aimed to
reduce/eliminate the problems related to implementation. However, common
problems in this method are drug leaking out of the skin, hematoma and pain.
Insulin, heparin, some narcotics and allergy drugs are frequently administered
by SC injection method. In the literature, it is seen that as the volume of the
drug increases, the amount of leakage increases, the application of the drug to
the abdominal region less leakage, the rate of drug administration does not
affect the amount of leakage, and the volume of the drug increases. While the
thickness of the tip of the needle used in the injection does not affect the
backlash, the inlet angle of 450 causes more backlash than the inlet
angle of 900. Insulin, heparin, some narcotics and allergy drugs are
frequently administered by subcutaneous injection. After the subcutaneous
injection, usually 10 seconds waiting period was suggested, but the current
information indicates that at least 3 seconds should be waited. One of the
drugs is heparin which is commonly applied as subcutaneous injection.  Heparin injections are now available for
application. Studies in
the literature of heparin injections are made with low molecular weight
heparins (LMWH), and studies show that the duration of the drug administration
is related to prevention of pain and ecchymosis after injection. LMWH is
usually applied to the abdominal region, and rotation is recommended between
other subcutaneous SC injection sites for prolonged use. When the injection
duration is more than 10 seconds, it is seen that the pain is less and the
hematoma size does not changed after 48 hours and beyond.  Although it is shown that ice application is
effective before injecting, there is no advanced evidence. Especially
aspiration is not recommended during insulin and heparin administration. As a
result, scientific researches about SC injection applications are emerging day
by day. Updating existing literature data in this context will contribute to
increase the quality of nursing care.
From this point, the literature and research findings related to SC
injection application were discussed, and the prominence of the subject was
discussed and proposals for application were presented.

Anahtar Kelimeler

Nursing care, subcutaneous injection, current approaches

Subkütan Enjeksiyon Uygulamasında Güncel Yaklaşımlar

Öz

DOI:
10.17681/hsp.449018

Subkütan enjeksiyon
(SC), hemşirelerin en sık uyguladığı parenteral ilaç uygulama yöntemlerinden biridir.
Günümüzde bazı ilaçların hazırlanma şekillerinin değişmesi uygulamaya ilişkin
yeni bilgileri öğrenmeyi gerektirmektedir. Böylece uygulamaya ilişkin
sorunların azaltılması/ortadan kaldırılması hedeflenmektedir. SC enjeksiyon
yöntemi ile sıklıkla insülin, heparin, bazı narkotik ve allerji ilaçları
uygulanmaktadır. Ancak bu yöntemde sık karşılaşılan sorunlar; ilacın deri
dışına geri sızması, hematom ve ağrıdır. Literatürde, insülin uygulaması için
ilacın volümü arttıkça sızıntı miktarının arttığı, karın bölgesine uygulamada
daha az sızıntı olduğu, ilacın verilme hızının sızıntı miktarını etkilemediği,
verilen ilacın hacmi arttıkça sızıntı miktarının da arttığı görülmektedir.
Enjeksiyonda kullanılan iğne ucunun kalınlığı geri sızmayı etkilemezken, 45⁰’lik
giriş açısı 90^0’lik giriş açısına göre daha fazla geri sızmaya neden
olmaktadır. Subkütan enjeksiyondan sonra, genellikle 10 sn. beklenmesi
önerilmekte iken güncel bilgiler en az 3 sn. beklenmesi gerektiğini ifade
etmektedir. Sıklıkla SC uygulanan ilaçlardan biri de heparindir. Heparin
enjeksiyonları günümüzde uygulamaya hazır bulunmaktadır. Literatürde heparin
enjeksiyonuna ilişkin çalışmaların düşük molekül ağırlıklı (DMAH) heparinlerle
yapıldığı, araştırmaların daha çok ilacın verilme süresi, sonrasında ağrı ve
ekimozun önlenmesine ilişkin olduğu görülmektedir. DMAH heparin, genellikle
abdominal bölgesine uygulanmakta, uzun süreli kullanımda diğer SC enjeksiyon
bölgeleri arasında rotasyon önerilmektedir. Enjeksiyon uygulama hızının 10
sn.’den fazla olduğu çalışmalarda 48 st. ve sonrasında ağrının daha az, hematom
büyüklüğünün ise değişiklik göstermediği görülmektedir. Enjeksiyon uygulaması
öncesi buz uygulamasının etkili olduğu gösterilmekle birlikte ileri düzey
kanıtlar mevcut değildir. Özellikle insülin ve heparin uygulamaları sırasında
ise aspirasyon önerilmemektedir. Sonuç olarak SC enjeksiyon uygulamalarına
ilişkin her geçen gün bilimsel araştırmalar ortaya çıkmaktadır. Bu kapsamda var
olan literatür bilgilerinin güncellenerek uygulamaya aktarılması hemşirelik
bakımının kalitesinin artmasına katkı sağlayacaktır. Bu noktadan hareketle,
makalede, SC enjeksiyon uygulamasına ilişkin literatür ve araştırma bulguları
incelenerek konunun önemi tartışıldı ve uygulamaya yönelik öneriler sunuldu.

Anahtar Kelimeler

Hemşirelik bakımı, subkütan enjeksiyon, güncel yaklaşımlar

Kaynakça

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