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.