Nuray TURAN, Gülsün ÖZDEMİR AYDIN, Nurten KAYA

Subkütan Enjeksiyon Uygulamasında Güncel Yaklaşımlar

DOI: 10.17681/hsp.449018Subkütan 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 900’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

Current Approaches to Subcutaneous Injection

DOI: 10.17681/hsp.449018Subcutaneous 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.

Keywords:

Nursing care, subcutaneous injection, current approaches,

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