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Medication Administration - Subcutaneous Heparin Policy

Medication Administration - Subcutaneous Heparin Policy 

Purpose: To ensure safe and effective administration of subcutaneous heparin to residents in compliance with CMS guidelines and the State Operations Manual (SOM) for long-term care facilities. 

Procedure: 

I. Preparation: 

  • Refer to the Medication Administration Record (MAR) to determine the site of the last injection. 

  • Identify preferred sites: 

  • Abdomen: Avoid injecting within 2 inches of the umbilicus, scars, bruised, or broken areas. 

  • Thigh: Anterior lateral portion may be used if the abdomen is not suitable. 

II. Site Preparation: 

  • Swab the area with an alcohol prep pad gently; do not rub the site. 

  • Gently grasp the skin at the selected site to form a fat pad. Do not pinch the tissue. 

III. Injection: 

  • Expel any air bubbles from the syringe. 

  • Insert the needle into the fat pad at a 90-degree angle. 

  • Do not aspirate prior to injecting the medication to avoid damaging blood vessels and causing bleeding or hematoma, especially in the presence of high local concentrations of heparin. 

  • Maintain support on the tissue while slowly injecting heparin. Do not release the fat pad while injecting heparin. 

  • Withdraw the needle quickly while simultaneously releasing the tissue. 

  • Apply gentle pressure to the site with an alcohol prep pad for 5-10 seconds. Do not rub or massage the area. 

IV. Site Key: 

  • RUQ: Right Upper Quadrant 

  • LUQ: Left Upper Quadrant 

  • RMQ: Right Middle Quadrant 

  • MQ: Middle Quadrant 

  • LMQ: Left Middle Quadrant 

  • RLQ: Right Lower Quadrant 

  • MLQ: Middle Lower Quadrant 

  • LLQ: Left Lower Quadrant 

References: 

  • Centers for Medicare & Medicaid Services (CMS), Requirements of Participation for Long-Term Care Facilities. 

  • State Operations Manual (SOM), CMS. 

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