Annotated Bibliography of 3 Articles on Subcutaneous Injection Administration

This annotated bibliography includes 3 articles on subcutaneous injection administration, covering topics such as injection site reactions, physical and physiological properties of injection sites, and the effect of injection duration and site on pain and bruising.

Running head: NURSING ASSIGNMENT
Annotated bibliography of 3 articles
Name of the Student
Name of the University
Author Note

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Article 1:
Kamimura, T., Miyamoto, T., Yokota, N., Takashima, S., Chong, Y., Ito, Y., & Akashi, K.
(2013). Higher incidence of injection site reactions after subcutaneous bortezomib
administration on the thigh compared with the abdomen. European journal of
haematology, 90(2), 157-161.
The currency of the article is relevant and it is up-to-date, thereby facilitating the purpose
of the research. It was published in the year 2013. Relevancy of the study can be established by
the fact that it focuses on the importance of rotating he injection site for subcutaneous
administration of bortezomib (Bor) for treating multiple myeloma. The article was presented
well and met the needs of understanding the importance of correct site selection for subcutaneous
injection administration. This is particularly essential, as injection site reaction caused due to
scBor administration has been found tolerable among several patients, when the site is rotated
between the lower and upper quadrants of the abdomen and proximal and distal region on both
thighs. The author’s viewpoint was based on the fact that injecting scBor at incorrect regions in
the thigh can result in severity. The result findings suggested that scBor injection in the thigh
was associated with moderate to severe form of ISR, when compared to injection at abdominal
regions. This was attributed to computed tomography findings that provided evidence for the
presence of more subcutaneous adipose tissue in the abdomen, than the thighs. This low fat
content in wrong injection sites resulted in less dilution of scBor that increased ISR incidence
and severity. Accuracy of the results are supported by figures that showed pictures of skin
erythema after subcutaneous injection at different sites, and tables showing ISR severity. Major
usefulness of the article is its role in recognizing that local subcutaneous fat distribution at
injection sites are related with scBor induced ISR. One major limitation is small sample size (15

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patients) for the study. Larger sample size and further studies are required to support the
findings. Thus, administration of scBor at regions with low fat content (thigh) might lead to
severe ISR.
Article 2:
Kinnunen, H. M., & Mrsny, R. J. (2014). Improving the outcomes of biopharmaceutical delivery
via the subcutaneous route by understanding the chemical, physical and physiological
properties of the subcutaneous injection site. Journal of Controlled Release, 182, 22-32.
The article was published in 2014. The article’s relevance is related to the fact that the
authors tried to understand the physical, chemical, and physiological properties of subcutaneous
injection sites for improving outcomes of delivery of biopharmaceuticals through intravenous
routes. The article involved an exhaustive study of the subcutaneous injection sites that was of
extreme importance for the present research. The article helped in gaining an understanding of
the appropriate sites where subcutaneous injections should be generally administered for
injecting biopharmaceuticals. The author’s viewpoint was based on the fact that most
biopharmaceuticals are formulated at acidic pH with several stabilizing agents. The authors also
suggested that the extracellular matrix are made up of collagen protein and provide mechanical
stability. Furthermore, the article also stated that collagen fibrils, hyaluronic acid, and
chondroitin sulphate are major compounds that present in subcutaneous tissues. Findings of the
article also stated that interstitial pressure of subcutaneous tissue is regulated by colloid osmotic
pressure and interstitial hydrostatic pressure. Findings of the article suggested that
biopharmaceuticals experience a range of potential stressors on being injected at subcutaneous
locations. The most common stressors were identified to be steric exclusion, extracellular matrix

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binding interaction, electrostatic interaction and excipient-API interactions, among others.
Accuracy of the results are supported by relevant tables and diagrams that depict the interaction.
Major usefulness of the article can be correlated with the fact that it helped in indentifying
essential physical, chemical and physiological properties of subcutaneous tissues present at
injection sites and illustrated the influence of these factors in affecting stability and absorption of
an injected biopharmaceutical. Recognising significance of the interactions also enabled protein
formulation tailoring for providing optimal stability upon subcutaneous administration. One
major limitation is lack of in-vitro laboratory models that would predict stability outcomes or
potential events after subcutaneous administration.
Article 3:
Pourghaznein, T., Azimi, A. V., & Jafarabadi, M. A. (2014). The effect of injection duration and
injection site on pain and bruising of subcutaneous injection of heparin. Journal of
clinical nursing, 23(7-8), 1105-1113.
The currency of the article is relevant since it was published in the year 2014. The
information presented in the article determines the impact of subcutaneous injection site, in
addition to duration of injection administration on bruising and pain. The viewpoint of the
authors is that subcutaneous injection of heparin is an essential nursing intervention and often
results in several complications such as, hematoma, bruising, and pain at the injection site.
Moreover, the authors also stated that injection site, needle size, heparin amount and aspiration
before injection play an important role in development of injection site reactions. Relevance of
the research article can be established by the fact that the authors demonstrated effects of these
factors by selecting two injection sites, namely, the thigh and the abdomen, in addition to

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changing the duration of administration. Major findings of the research stated that there was no
significant difference in the size and number of bruising in injection methods in the thigh and
abdominal regions. In addition, the findings also illustrated that slower subcutaneous injection of
heparin in the thigh or abdomen results in smaller and less number of bruises. Reliability of the
findings can be confirmed by tables that display statistical results for bruise and pain occurrence
with regards to both injection sites. The article covered the research topic to a certain extent due
to the fact that it failed to demonstrate significant differences in pain and bruises upon
subcutaneous injection of heparin at different sites. Major usefulness of the article was related to
the fact that greater bruising due to subcutaneous heparin injection occurs among females, than
males. Moreover, severity of pain was found to be low in the abdomen than the thighs. However,
small number of COPD patients who formed the sample and the simple random schedule were
the major limitations.

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References
Kamimura, T., Miyamoto, T., Yokota, N., Takashima, S., Chong, Y., Ito, Y., & Akashi, K.
(2013). Higher incidence of injection site reactions after subcutaneous bortezomib
administration on the thigh compared with the abdomen. European journal of
haematology, 90(2), 157-161.
Kinnunen, H. M., & Mrsny, R. J. (2014). Improving the outcomes of biopharmaceutical delivery
via the subcutaneous route by understanding the chemical, physical and physiological
properties of the subcutaneous injection site. Journal of Controlled Release, 182, 22-32.
Pourghaznein, T., Azimi, A. V., & Jafarabadi, M. A. (2014). The effect of injection duration and
injection site on pain and bruising of subcutaneous injection of heparin. Journal of
clinical nursing, 23(7-8), 1105-1113.