Development of Clinical Nursing Practice Guideline for Subcutaneous Anticoagulation Injection: the Cold-Time Technique - การพัฒนาแนวปฏิบัติการพยาบาลทางคลินิก ในการฉีดยาป้องกันการแข็งตัวของเลือดใต้ผิวหนัง: Cold-Time Technique

Abstract

                The objective of this study were to develop a clinical nursing practice guideline for subcutaneous anticoagulation injection and to investigate the occurrence of bruising, hematoma and pain at the injection site. It was conducted at Surin hospital during June 2013 to January 2015. There were 3 phases of study procedure including (1) development of a clinical nursing practice guideline, (2) implementation and (3) evaluation of the implementation. The samples were 60 acute coronary syndrome patients who had re-ceived enoxaparin (30 patients each in the study group and the control group) and 16 registered nurses who implemented the guideline. Data was collected by using assessment forms for treatment, knowledge and skills related to subcutaneous anticoagulation injection; and were analyzed using descriptive statistics and independent t-test. The clinical nursing practice guideline of subcutaneous anticoagulation injection (the cold-time technique) consisted of 3 components: (1) pre-injection, (2) injection by used cold-time technique, and (3) post-injection. It was found that there was a reduction of bruise (from 63.3% in the control group to 6.7% in the study group), and no hematoma at the injection site of any study subject. The size of bruise and pain score in 24 and 48 hrs was significantly reduced in the study group). In conclusion, the clinical nursing practice guideline of subcutaneous anticoagulation injection: the cold-time technique had reduced the occurrence of bruise, hematoma and pain at the injection site. Therefore, it is suggested that the clinical nursing practice guideline should be utilized in routine clinical care for acute coronary syndrome patients who need subcutaneous anticoagulation injection.

Key words: subcutaneous injection, low molecular weight heparin, cold-time technique, pain, bruise, hematoma