anyone use lovenox in odd doses? i.e. 76mg?

[rehab nurse]

Hi everyone,

this is a question for those who work often with Lovenox. I know it is available in 30 and 40mg syringes that are not to be messed with or the air bubble expelled due to possible loss of drug. However, I was under the assumption that the higher dose syringes, i.e. 60mg, 80mg and 100mg are all able to be calibrated to the ordered dose. those syringes are calibrated on the side like a regular syringe. i am asking because we have an issue at our work and the nurses are fighting about whether other places use unusual doses of the med, such as 54 mg for example. i saw on the website that lovenox is also available in multidose vials. several of our pts have come with unusual dose orders from the hospital, and i know the docs usually dose it based on weight in kilogram, usually 1mg per kg. so if someone weighs 76 kg, usually the dose will be written for 76mg of lovenox, which would mean expelling just a small amount out of a 80mg syringe.

does anyone else out there have experience with unusual doses of lovenox? if so, i would love to know that other people have done the same as our place. i am tired of people writting "error reports" out on something that is not an error. it says in the drug guide, and per pharmacy that the higher dose prefilled syringes are able to be adjusted, so i don't know why this has caused such a problem.

thank you for your input and answers!

[babiesX2]

I've always had Lovenox in the prefilled syringes and the dose would be for prophylaxis. I'm in the nursery now so I don't see it anymore.

[INnurse]

Insulin syringes are small volume, do you round up insulin? No. The syringe is calibrated. It is possible to be precise.

[Tweety, BSN, RN]

thanks tweety, the controversy is just some evil nurses who would rather get to write a coworker up than learn something new about WHY lovenox is given for a particular reason and that things don't always stay the same. exactly why i am leaving the unit as soon as school is over in three months. but that's a whole other thread entirely, lol. i am just glad other nurses have seen unusual doses and have given them. thanks for your reply!

Nursing and medicine is constantly evolving and changing. Tell them to get with the program and joint the 2000's! Nursing is an evidence-based practice. Sheesh.

[twinmommy+2, ADN, BSN, MSN]

There doesn't need to be a med error with odd lovenox injections. When wasting a small amount from a graduated lovenox syringe, just point the needle down and waste. This saves the bubble and waste from the top of the liquid in the syringe

[Tweety, BSN, RN]

Not to knock you, but how on earth do you waste 9 mg, when the 80 mg is in a 1 ml syringe? I don't think you could be that precise. Seems like you'd have to round off somewhere.

At that does Lovenox is supplied in a 1:100 concentration and has .8 cc of medication in the vile.

But you are right, it is very difficult to be precise and waste .09 of a cc, more than likely you'd waste .1 cc. Still that's more precise than rounding 71 mg up to 80.

Weight-based Lovenox doesn't would not be a standard, if it wasn't important. Nurses don't have license to change MDs orders with clarification. (As we know we don't go blinding following orders either.)

[santhony44, MSN, RN, NP]

i am tired of people writting "error reports" out on something that is not an error. it says in the drug guide, and per pharmacy that the higher dose prefilled syringes are able to be adjusted, so i don't know why this has caused such a problem.

Why has your management not corrected this problem? I suppose that is part of the reason you're leaving! That, and people doing petty stuff like writing up med errors when you can prove that what was done was not an error. You could also ask the prescribing physician about it: "Dr. Jones, you wrote for Mrs. Smith to get 76 milligrams of Lovenox. The syringe has 80 milligrams, is it OK if we give all that?" You should get an answer along the lines of "No, I wrote 76 milligrams, I meant 76 milligrams, not 80!" That might get management to move on the issue, but of course would escalate the game-playing.

Many years ago I worked under a head nurse who delighted in writing people up. One of the RN's on the floor (I was an LPN at the time) had a patient going to surgery the next morning. She went in to give the sleeping pill ordered by the anesthesiologist and found the patient sound asleep. Well, as she said, waking people up to give sleeping pills is the stuff jokes are made of, so she decided to hold the pill. She was a semi-retired, very experienced nurse, the last one I knew who still wore her cap to work. Anyway, she got written up for not giving the sleeping pill. The write-up made its way back to the anesthesiologist who'd ordered the med. He said that holding a sleeping pill for a patient who was sound asleep sounded like good nursing judgement to him. That was the end of the write-up, but it was also the last straw for the RN. She completely retired after that, which was sad, because she was kind to the patients, lovely to work with, and still totally competent to do her job.

In fact, if 76 milligrams is ordered, then giving 80 milligrams is the error. You could get into a tit-for-tat with these nurses, but it probably would not be worth it. Just keep doing what you know is right.

[catlady, BSN, RN]

Insulin syringes are small volume, do you round up insulin? No. The syringe is calibrated. It is possible to be precise.

It's not calibrated to the degree of an insulin or TB syringe, is it? There aren't 100 markings on a Lovenox syringe, IIRC.

[rehab nurse]

Why has your management not corrected this problem? I suppose that is part of the reason you're leaving! That, and people doing petty stuff like writing up med errors when you can prove that what was done was not an error. You could also ask the prescribing physician about it: "Dr. Jones, you wrote for Mrs. Smith to get 76 milligrams of Lovenox. The syringe has 80 milligrams, is it OK if we give all that?" You should get an answer along the lines of "No, I wrote 76 milligrams, I meant 76 milligrams, not 80!" That might get management to move on the issue, but of course would escalate the game-playing.

Many years ago I worked under a head nurse who delighted in writing people up. One of the RN's on the floor (I was an LPN at the time) had a patient going to surgery the next morning. She went in to give the sleeping pill ordered by the anesthesiologist and found the patient sound asleep.

In fact, if 76 milligrams is ordered, then giving 80 milligrams is the error. You could get into a tit-for-tat with these nurses, but it probably would not be worth it. Just keep doing what you know is right.

thanks for your support. this was written up over the weekend, and i am off work this week because of medical reasons. i did write up a rebuttal to management, but they are not any brighter than the people working the floor. i'd be surprised if they even know what lovenox is. i'm not being mean, i'm only being honest as to their "inservices" on topics. they give outdated, completely wrong information, and they have made it clear that they are "RIGHT" and the peon floor nurses are "WRONG". i have given up trying to teach anybody anything. and in fact, i did call the physician about this order, and asked if i could just give the rounded up dose. i knew his answer was going to be "NO". but i did it anyway. this is a physician who will back me, as will the medical director, that i did the right thing. i am waiting to find out whether or not this will be officially "written up" by management or not. this all started because i caught a very dangerous med error when something was ordered in mcg, was transcribed to mg, and this nurse gave 10 pills of a potent antihypertensive to make up the dose. the patient suffered some ill effects, and because of that write up, the nurses are searching for an "error" to write me up for. i know, it's very petty, and management should put a stop to it, but they don't. it's all pretty sad really. i can't wait to get out of this stressful, hostile work environment. thanks again for everyone's help and for telling me how you have done things on your units. i really appreciate everyone's replies!

[Creamsoda, ASN, RN]

We dont usually use lovenox, usually heparin in our ICU, but when lovenox is ordered, we carry the multi dose vials in pyxis, so you can draw up how much you need.

Cher

[veegeern, BSN, RN]

Our Lovenox is rounded to the nearest 10 per the protocol established by the quality control committee (or somebody like that). It is stated on the EMAR.

We had a drug rep come and do education with us at a couple of our health fairs. Maybe your facility could do an "invite." :nuke:

For Lovenox, we were told to hold the needle pointed down while wasting the extra in the syringe to avoid having lovenox on the needle. This is to minimize bleeding at the site. We were also told to maintain the "air bubble" when possible. Seems like that the "air" is actually "nitrogen," but I wouldn't swear to that at this late date! Finally, we're being taught to pinch for the SC injection, and to inject at a 90 deg angle. I have to admit that this angle just goes against everything within me!

[HappyNurse2005, RN]

I get rid of say, 9cc of lovenox (91cc ordered, 100cc syringe) by pointing the needle down and squirting a little out. That way, teh air bubble is floated back and not being wasted.

[catlady, BSN, RN]

I get rid of say, 9cc of lovenox (91cc ordered, 100cc syringe) by pointing the needle down and squirting a little out. That way, teh air bubble is floated back and not being wasted.

100 cc syringe????