| Objective:Subcutaneous injection of low molecular weight heparin(LMWH)can cause common complications such as pain,ecchymosis and sclerosis at the injection site.The purpose of this study was to compare the effects of different injection duration and pressing time of LMWH on pain and ecchymosis in patients with high risk of deep venous thrombosis(DVT)after gastrointestinal cancer surgery,in order to find out the suitable injection duration and pressing time of LMWH,reduce the adverse reactions after subcutaneous injection of LMWH,and alleviate the pain of patients.Enhance trust and dependence between nurses and patients,improve nursing satisfaction,and provide basis for clinical treatment.Methods:From December 2017 to August 2018,patients with high risk of DVT and LMWH in gastrointestinal surgery of a third-class A general hospital in our city were selected as the subjects of study.According to the inclusion criteria and exclusion criteria,240 cases were finally included.Factorial design was adopted.The first factor was the duration of injection.The four levels were as follows: 10 s continuous injection,immediately withdrawal after injection,30 s continuous injection,immediately withdrawal after injection,10 s continuous injection,10 s continuous withdrawal after injection,10 s continuous injection,10 s continuous withdrawal after injection,30 s continuous injection and 10 s withdrawal after injection.The second factor was the pressing time,and the two levels were 5 minutes and 10 minutes respectively.The patients were randomly divided into A1 ~ A8 groups with 30 cases in each group.A1 group: continuous injection for 10 seconds,needle extraction immediately after injection and pressing for 5 minutes;A2 group: continuous injection for 30 seconds,needle extraction immediately after injection and pressing for 5 minutes;A3 group:continuous injection for 10 seconds,needle extraction for 10 seconds after injection and pressing for 5 minutes;A4 group: continuous injection for 30 seconds,needle extraction for10 seconds after injection and pressing for 5 minutes;A5 group: continuous injection for 10 seconds,needle extraction immediately after injection.Acupuncture,pressing for 10 minutes;A6 group: continuous injection for 30 seconds,immediately pull out the needle after injection,pressing for 10 minutes;A7 group: continuous injection for 10 seconds,pull out the needle after injection,pressing for 10 minutes;A8 group: continuous injection for 30 seconds,pull out the needle after injection for 10 seconds,pressing for 10 minutes.The lower edge of deltoid muscle of upper arm was selected as the injection site for each patient.The first LMWH subcutaneous injection was observed at each injection site.Visual Analogue Scale(VAS)was used to evaluate the pain intensity at the injection site.The maximum diameter of ecchymosis was measured with a digital soft ruler with accuracy of 1mm 48 hours after injection.The effects of different injection duration and pressing time on pain and ecchymosis of LMWH were compared.IBM SPSS24.0 statistical software package was used for data analysis.Results:1.The degree of pain at the injection site:(1)Different injection duration and pressing time had an interactive effect on the degree of pain at the injection site(P < 0.05).(2)The main effect of different injection duration on the degree of pain at the injection site was significant(P < 0.05);the main effect of different pressing time on the degree of pain at the injection site was not significant(P > 0.05).Under different pressing time,the mean pain scores of 10 seconds continuous injection,30 seconds continuous injection,30 seconds continuous injection,10 seconds continuous injection,10 seconds continuous injection,10 seconds withdrawal after injection,30 seconds continuous injection and 10 seconds withdrawal after injection were 2.32,2.42,2.05 and 1.97,respectively;30 seconds continuous injection,10 seconds withdrawal after injection and other three injections continued.There was significant difference in the degree of pain at the injection site betweenthe two groups(P < 0.05).Under different injection duration,there was no significant difference in the degree of pain between 5 minutes and 10 minutes of pressing(P > 0.05).2.Stasis at injection site:(1)There was no interaction between different injection duration and pressing time on the diameter of ecchymosis at injection site(P > 0.05).(2)The main effect of different injection duration on the diameter of ecchymosis was significant(P < 0.05).The main effect of different pressing time on the diameter of ecchymosis at injection site was significant(P < 0.05).The mean diameters of stasis at the injection sites of 10 s continuous injection,30 s continuous injection,10 s continuous injection,10 s continuous injection,10 s continuous injection,30 s continuous injection,10 s continuous injection and 10 s withdrawal after injection were 5.96,4.29,3.48 and 2.33,respectively;the mean diameters of stasis at the injection sites of 30 s continuous injection,10 s continuous injection and other three injection durations were 5.96,4.29,3.48 and 2.33,respectively.The multiple comparison of spot diameter showed significant difference(P < 0.05).The mean diameter of ecchymosis at injection site was 4.95 and 3.08 respectively after 5 minutes and10 minutes of pressing,and there was significant difference in the diameter of ecchymosis at injection site under different pressing time(P < 0.05).3.Comparisons of pain degree and diameter of ecchymosis between patients' sex and injection site:(1)There was no significant difference in pain between male and female injection sites(P > 0.05).(2)There was no significant difference in the diameter of ecchymosis between males and females(P > 0.05).4.The correlation between age,body mass index(BMI)and the degree of pain at injection site and the size of ecchymosis(1)Age and BMI were not correlated with the degree of pain at the injection site.(2)There was no correlation between age and BMI and the diameter of ecchymosis at the injection site.Conclusion:(1)Different injection duration has a significant effect on the degree of pain and the diameter of ecchymosis at the injection site.Continuous injection for 30 seconds and staying for 10 seconds after injection can effectively relieve pain at injection site and reduce the diameter of ecchymosis.(2)Different pressing time had no effect on the degree of pain at the injection site,but on the diameter of ecchymosis.After LMWH injection,pressing the injection site for 10 minutes can effectively reduce the diameter of ecchymosis.(3)There was no correlation between gender,age,BMI and the degree of pain at the injection site and the size of ecchymosis after LMWH subcutaneous injection. |
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