Heparin Administration Techniques

Heparin is a blood-thinning medication whose aim is to prevent blood clot formation in the circulatory system. Blood clots are responsible for strokes, heart attacks and venous thrombosis in a patient. Heparin is administered by injection into the subcutaneous layer of the skin, requiring a technique similar to an insulin injection, but only on the abdomen.

Check the Order

• Check the physician's medication order against the medication on hand. Some heparin in low concentration is used for flushing intravenous lines and should not be confused with heparin for injection. Differences between the doctor's order and the medication vial on hand must be corrected before continuing with the preparations for injection. Check the patient record for any additional orders, any pertinent lab results and the time and site of the last heparin dose.

Prepare the Dose

• Gather the necessary equipment - the insulin or tuberculin syringe, needle, several alcohol swabs and a pair of disposable gloves. Check the medication vial's expiration date. Label the vial with today's date; open vials should be discarded if not used within 30 days (follow facility policy). Draw the ordered amount of heparin into the syringe, triple checking for correct medication, correct dose and correct time. The dosage that can be given subcutaneously (SC, SQ) is less than 1 ml.

Patient Preparation

• Identify the patient and explain what you are about to do. Assess the skin for potential sites of administration. The lower, anterior abdominal area, at least 2 inches away from the umbilicus, is the preferred site for the SC injection of heparin. Avoid scar tissue, wounds and bruised areas. Don gloves. Wipe the area to be injected with the alcohol swab.

Mechanics of Administration

• Administer heparin ensuring that the medication is not injected into the patient's muscle tissue. The amount of fatty tissue present determines the needle length and angle of insertion. In general, a 25-gauge, 5/8-inch needle (as is common in insulin and tuberculin syringes) is inserted at a 45- to 90-degree angle. The needle length should be half the skinfold depth (a roll of skin held between the index finger and thumb). If the skinfold depth is 2 inches, inject using a 90-degree angle; if the depth is 1 inch, inject using a 45-degree angle.

Inject the Medicine

• Create a skinfold (use your thumb and forefinger spread 3 inches apart then draw the fingers together while holding the skin between them). Inject the heparin into the apex of the skinfold. Do not move the needle once it is in the skin; this causes bruising. Depress the plunger on the syringe to dispense the medication. Loosen your hold on the skin as you withdraw the needle. Do not massage or rub the area, but do pat the area with a clean alcohol swab, holding for up to three minutes if bleeding occurs.

Complete the Task

• Dispose of used needles in the sharps container. Remove the gloves and wash your hands. Assess the patient for any reactions to the medication. Note any symptoms of bruising or bleeding. Instruct the patient to report any unusual bleeding right away. Document the procedure in the patient record. Notify the physician of any problems noted or encountered during and after the procedure.