such as enoxaparin. There is some low certainty evidence that administering the injection more slowly may decrease the pain from heparin injections, but not the risk of or extent of bruising. Subcutaneous heparin-based anticoagulation may also lead to necrosis of the surrounding skin or lesions, most commonly when injected in the abdomen. Many medications have the potential to cause local lesions or swelling due to the irritating effect the medications have on the skin and subcutaneous tissues. This includes medications such as apomorphine and hyaluronic acid injected as a filler, which may cause the area to appear bruised. Hyaluronic acid "bruising" may be treated using injections of hyaluronidase enzyme around the location. Other common medication-specific side effects include pain, burning or stinging, warmth, rash, flushing, or multiple of these reactions at the injection site, collectively termed "injection site reactions". This is seen with the subcutaneous injection of triptans for migraine headache, medroxyprogesterone acetate for contraception, as well as many monoclonal antibodies. In most cases, injection site reactions are self-limiting and resolve on their own after a short time without treatment, and do not require the medication to be discontinued. The administration of vaccines subcutaneously is also associated with injection site reactions. This includes the BCG vaccine which is associated with a specific scar appearance which can be used as evidence of prior vaccination. Other subcutaneous vaccines, many of which are live vaccines including the MMR vaccine and the varicella vaccine, which may cause fever and rash, as well as a feeling of general malaise for a day or two following the vaccination. Technique Subcutaneous injections are performed by cleaning the area to be injected followed by an injection, usually at a 45-degree angle to the skin when using a syringe and needle, or at a 90-degree angle (perpendicular) if using an injector pen. The appropriate injection angle is based on the length of needle used, and the depth of the subcutaneous fat in the skin of the specific person. A 90-degree angle is always used for medications such as heparin. If administered at an angle, the skin and underlying tissue may be pinched upwards prior to injection. The injection is administered slowly, lasting about 10 seconds per milliliter of fluid injected, and the needle may be left in place for 10 seconds following injection to ensure the medicine is fully injected. Equipment The gauge of the needle used can range