Injecting heparin tricks and tips?
May 19, 2014 1:51 AM   Subscribe

I'm back on fraxiparine for a trial run before warfarin, and possibly because of my other medication changes, I'm noticing changes. Last time, I just did the clockface around belly button injections and got big bruises with very little bleeding. Now I have to inject twice as often, and the injection mark bleeds a lot. My doctor and nurse instructions are slightly conflicting and I have specific questions.

1. I know I'm not supposed to inject into a bruised site, but what happens when I run out of non-bruised areas on my stomach? How bruised is not okay?

2. Alcohol swabs - yes or no? Some of the literature says yes, some says normal clean skin as alcohol can toughen the skin.

3. Put the cap back on the needle before putting it in the disposal box, or no cap?

4. I've got blood on the waistband of my clothes. Can I put bandaids over all the tiny injection sites or is it better to leave them uncovered? It's a pinprick of blood, but it's hours of steadily bleeding (which yay, no clotting) Is there an alternative as the toddler looooves to pull off bandaids and they irritate my skin?

5. Did anyone inject other than the stomach area? I need an intra-muscular area to repeatedly puncture.
posted by viggorlijah to Health & Fitness (7 answers total) 2 users marked this as a favorite
Best answer: 1. Yellowish few-day-old bruises should be ok if no other options.

2. Depends how clean your skin is - the risk is pushing germs into your skin. More of a concern in hospital inpatients who may not be sparkling clean. If you've showered that is fine, use the alcohol wipe if you're worried. It is not going to make your skin so tough you can't get the needle through. You're getting conflicting information because there's no clear evidence either way, so it's down to personal preference/judgement.

3. Putting the cap back on puts you at risk of needlestick injuries and is discouraged. Now it's your own blood you'd be exposing yourself to, so if you do stab yourself you aren't going to pick up any exciting blood-borne viruses, but it's safer to just put it straight in the sharps bin. Have the sharps bin to hand when you inject yourself, don't wander round the house with an unsheathed needle (that risks stabbing somebody else). Don't overfill the sharps bin either.

4. Bandaids are fine. So is gauze and tape, or any other dressing. That's what we do in hospital.

5. LMWH is injected subcutaneously, not IM. You can in theory go for any roll of fat, but the stomach is preferred because it's quite a large surface area and there's no risk of pranging anything important. Are you really bruised from ribcage to pelvis? You could maybe go around to the sides a bit if you are totally running out of skin.

If you're bruising that badly can you chat to your doctor about expediting the switch to warfarin, or using a once-daily LMWH? It doesn't sound like this is working well for you.
posted by tinkletown at 3:00 AM on May 19, 2014

Having been on Fragmin before, I can only speak to my own experiences...

1. no idea
2. I was on fragmin for a year, and unless I was filthy, I never used alcohol. Just clean skin; washcloth is needed, but I injected myself in all kinds of weird places, and never got as much as a red/sore site. So, alcohol may be overkill, unless there is a specific reason for you.
3. Tinkletown has nailed it. But, it's your blood, so you're just going to catch your own diseases...With a toddler around, it may be safer to recap a needle unless it's going directly into the sharps bin. Recapping is just bad practice to get into...
4. What about a 'belly band' (like pregnant women wear once jeans don't quite fit, but not ready for maternity pants) under your regular clothes to keep little hands off bandaids, and maybe offer a bit of pressure on oozey sites? I did throw little bandaids on the odd leaky site.
5. What Tinkletown said...
posted by Northbysomewhatcrazy at 5:01 AM on May 19, 2014

4. Invest in some tegaderm bandages - they're like clear stretchy tape. Just let it keep the blood pooled in a little bubble til it clots, then replace, and it'll heal like there's a second layer of skin over it, without being as appealing as a band aid to pull off.
You can even get a big sheet and just cut little squares to fit, if you're good at peeling little squares of tape.

Also, if you have kids, they're amazing for grazes. Slap em on, and by the time they're peeling off (a couple of days), there's skin there. It's clear, so you can see if a wound needs cleaning, but otherwise leave it alone.

If you don't want to cut tegaderm bandages up, and really don't mind shelling out, the tiny round cold sore band aids (zovirax invisiseal), are just hugely overpriced circles of tegaderm. I haven't tried though, I'm just guessing they'd be about the right size for a needle puncture.
posted by Elysum at 5:13 AM on May 19, 2014

Nurse here who gives plenty of LMWH and heparin injections.

Fraxiparine is a subcutaneous injection, not intramuscular. You may want to clarify this with your provider. You should be able to use the upper/outer portions of your thighs for this injection. See the image on the right here. This image is showing all possible sites for sub-q injection, but my understanding from physicians I've spoken with is that LMWH should ideally be placed in the abdomen or thighs only. With that said:

1. Use your thighs. Rotate stomach/thighs. You may find one area bruises more easily than another.

2. Yes, alcohol swabs or "clean skin" - as in, you just washed it.

3. No, hold it upright (needle pointing up into the air), walk to the sharps box, and drop it in.

4. Tiny bandaids or tegaderms are fine.

5. The thigh site should be an acceptable alternative. Check with your doctor. You want to inject into a soft, fatty portion of your thigh. If you're very thin, pinch the tissue with your non-injecting hand and angle the needle slightly.
posted by pecanpies at 6:54 AM on May 19, 2014

Best answer: Get a good bunch of fat between your thumb and forefinger of your non-dominant hand. Use a larger barrel syringe if possible (5cc). Stick yourself quickly and inject very slowly. In theory the large syringe creates less pressure and the slow injection causes less tissue damage by allowing the tissue to absorb the medication.
posted by evalunatik at 10:10 AM on May 19, 2014

Just to emphasise something Pecanpie said, there are bits of thigh to avoid (nerves veins and arteries) as shown in Pecanpie's picture. Hitting your femoral nerve by accident could have serious and permanent consequences. You also need to make very sure you are going subcutaneously not intramuscularly (a big haematoma in your quads would also not be fun) so definitely have your doctor or nurse show you where and how to inject safely before leaping in.

That's my IANYD bit. Do not start injecting your thigh until your own team have demonstrated how to do it safely. It's not risky once you know where to avoid, but you currently don't and really you need to be shown in person.
posted by tinkletown at 10:21 AM on May 19, 2014

Response by poster: Thank you to everyone who replied! The fast jab/slow push leaves a much smaller bruise. I'm capping because of the toddler before disposing into a sharps bin, and using alcohol wipes if I'm not straight out of a shower. Next visit, I will ask about the safe areas on the thigh and where to get tegaderm - couldn't find a pharmacy with it in stock.

Now I just have to practice flicking expertly to get the air bubbles out like a TV Nurse!
posted by viggorlijah at 2:05 AM on May 25, 2014

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