護理師正準備皮下注射依諾肝素（Enoxaparin）。下列哪項操作正確？
A nurse is administering a dose of subcutaneous enoxaparin. Which action is correct?
- AMassage the injection site vigorously after administration注射後用力按摩注射部位
- BAspirate before injecting to ensure no blood return注射前回抽以確認無血液回流
- CExpel the air bubble from the syringe before injection注射前排出針筒內的空氣泡
- DInject the medication into the abdominal wall✓ 正解將藥物注入腹部壁
Enoxaparin 是一種低分子量肝素（LMWH），常以預充式針筒（pre-filled syringe）提供。臨床操作重點在於避免皮下血腫與組織損傷。正確的注射部位為腹壁（肚臍周圍約 5 公分以外），注射前不需排出氣泡，因為該氣泡設計用於確保藥物完全進入皮下組織，並在針頭拔出後封住藥液，減少藥液外漏。此外，注射後嚴禁按摩，以免造成局部血管破裂與血腫。
Enoxaparin is a low-molecular-weight heparin (LMWH) often supplied in a pre-filled syringe. The clinical priority is to avoid subcutaneous hematoma and tissue damage. The correct injection site is the abdominal wall (at least about 5 cm away from the umbilicus). The air bubble in the syringe should not be expelled, because it is designed to ensure the entire dose enters the subcutaneous tissue and to seal the medication after withdrawal, reducing leakage. Massaging the injection site after administration is also strictly contraindicated, as it can rupture local vessels and cause hematoma.
台灣部分臨床單位針對預充式針筒是否保留氣泡仍有爭議，但美國 NCLEX 標準明確要求不應排出氣泡（Air-lock technique），並強調嚴禁按摩。