A Word of Caution to the Unaware and Uninformed: Unusual Complication from Subcutaneous Heparin Injection

OBJECTIVES: We report two cases of subcutaneous infection and abscess formation resulting from subcutaneous heparin injections.
METHODS: Single dose vials with pop tops are used for subcutaneous heparin injections. These vials are tamper resistant but are not sterile per the manufacturer. Two cases of subcutaneous infection and abscess formation are reported that resulted from the nurses’ assuming the single dose vials are sterile. Both cases needed drainage procedures, however one case was actually a necrotizing fascitis with MRSA that required multiple incisions and drainage procedures.
RESULTS: Manufacturer’s pop tops are “tamper resistant” but not considered sterile. A survey of young nursing staff, however, did not reveal this same understanding. Similar lack of understanding was found in the anesthesiology department.
CONCLUSIONS: Maintenance of sterile technique is recommended. This issue is raised to increase awareness of product manufacturing specifications and their application for clinical use and patient safety.