Background: Subcutaneous enoxaparin administration often causes problems such as pain;
bruise and hematoma at the injection sites. In terms of these problems, cold application has been
found to have various therapeutic benefits as relieve pain by produce localized anesthetic effect and
controls bleeding by causing vasoconstriction. Aim of the study: To investigate the effect of cold
application on local problems among patients receiving subcutaneous enoxaparin. Design: Self
controlled trial design was utilized. Setting: The study was carried out in general surgery
department, orthopedic surgery department, and chest Intensive Care Unit at Beni-seuf University
Hospital. Study subjects: A purposive sample of 60 patients was included in the study. Data
collection tools: Data were obtained through Patient assessment tool, Bruising Category Scale,
Visual Analogue Scale for pain and Hematoma Formation Scale. Results: All studied patients had
pain and more than half developed bruise at injection site when they received enoxaparin without
cold application but more than three quarter of studied patients had pain and less than one quarter
developed bruise when they received injection with cold application. Meanwhile, the majority of the
studied patient did not develop hematoma whether cold applied at injection site or not. Conclusion:
The pre-injection cold application at enoxaparin injection site was effective in reducing the
occurrence of pain and bruising. Moreover, there was statistically significant relation between the
patients' pain intensity, the size of bruising and their demographic characteristics; age and gender.
Recommendations: Cold application should be included in standard protocol for the administration
of SC enoxaparin and providing on-going and regular in-service educational programs about it for
nurses.