lovenox injections: SC, but where?

The literature that is with the actual injection from the company states the abdomen and SC. It never once mentions the arms as being an approved site for the injections.

If it is not listed by the actual company, then it would not be considered an approved site to use.

We use an insuflon sub Q catheter to deliver Lovenox/enoxaparin into the subcutanous tissue on our babies anterior thighs. I've also seen it ordered/given IV in some cases.

Couple of years ago they started the recommendation that lovenox be given in the love handles. We even had to sign a statement at work that we had been educated on where to give it, and had to keep a chart with MAR that showed a picture of the love handles with sites to use and label which one we used with our initials.

Lovenox is a Low Molecular Weight Heparin. It should only be given in the abdomen, and only subcutaneously. I take care of alot of postop patients in my subacute rehab unit, and administer this drug daily.You cannot give it IV, but I do not know why.

I've had multiple very thin pts. refuse the injection if it could not be given in another location than abd. By the description of the events, it would seem that when they were given the injection it was IM not SQ....hence extremely painful and they refused it ever again. I have had some of the emergency physicians state that it can be given in the upper arm SQ (ie: as you would with allergy shots). My father happens to be one of those such pts and refuses to even let me give him an injection in his abd. He has had it in his arm without any complications. With a very thin pt you must must pinch up the skin to ensure you do not give the injection IM. I too questioned the manufacturer but got no reply. I have never given an injection that someone told me it was painful or bruised. I gave them to my mother after knee replacement for at least a month, none of which bruised. However, some of the ones given in rehab left enormous bruises. I always pinch up the skin.

EmergRN: TY for the info that it can be given in the arm, if necessary. The facility I work in forbids it through policy, though. Have you heard anything of this affecting the PT/PTT and INR? It may be the nurse giving the injections that caused the bruising- with this particular drug I have heard from several patients that certian nurses give it so you do not feel it and it does not bruise, and other nurses give it and it hurts bad and bruises. I have had one woman who would only let me give her lovenox after her knee replacements. I could see in very thin patients where you could inadvertently give it IM.

Hello all,

Reading this made me smile. Back when Lovenox was first being trialed in the hospitals (back in 1994) during a double blind study comparing its efficacy with heparin and coumadin, we were instructed by the drug reps doing the study, to inject in the "love handles" , which was why they named it lovenox in the first place. Most literature states abdomen (anterolateral) - which when looking at the charts posted in my hospital - clearly are the "love handles". Personally I know it stings - as I was given it when I had an episode of SVT that wouldn't quit....

Anyhow, also thought I would share this story. As a traveler I was working on a tele unit that handled patients 1 day post CABG and post cath and post angioplasty/stenting. I had a patient who was in A. Fib with RVR, and was scheduled to have cardioversion in the morning. When I assessed her I noticed a very large "lump" in her abdomen. She was pale and "not feeling very well". The lump was a huge, football sized hematoma, which necessitated that the woman get three units of blood transfused (can't remember her H/H, but that evening was a 6 point drop in her Hgb from the am draw). She also could not be cardioverted because of the huge hematoma, and had to stay on IV amiodarone for a few more days, then on po amiodarone... All that from a Lovenox injection given approximately 3 inches from the umbilicus on a fairly large woman with lots of subcutaneous tissue.

Anyhow, thought I would share. I never give Lovenox anywhere but the love handles. I have never had a problem (other than burning at the site) with this site for injection. I have seen multiple hematomas in the abdomen from Lovenox over the years - just none as dramatic as the lady I just mentioned.

NY nurse at heart

Ugh. I am patient (who is considering going into nursing). I was *never* instructed to use my abdomen, just told it was subQ. I am currently using my thighs and running out of 'room' due to bruising. I am malnourished and on TPN and thus have very little subq fat on my abdomen. I 'save' my lovehandles for glucose sensors, and also use my thighs for infusion sets. Arms are thin, but saved for picc's and iv's.

In patients like me (oh, also have a 10" ab surgical scar that is only six weeks old), I can't fathom using the abdomen. It's skin, no fat...

Recommended to inject AT LEAST 2 inches from umbilicus rotating between L & R anterolateral and posterolater sites. Aventis considers this the "love handles". It would appear to be a problem of semantics with regard to using "love handles" vs. "abdomen". SC injections of a LMWH in this area makes more sense with regard to absorption and a reduction of bruising. Remember, this is an extremely exacting anticoagulant. Giving it anywhere else where more frequent movement increases blood flow; i.e. arms or legs may increase incidence of bruising. Also the "air" bubble is actually a nitrogen bubble which prevents oxidation of the drug. It is also used to ensure that when injected, THE ENTIRE AMOUNT OF LOVENOX is administered into the SC tissue. It should never be expelled. Again, this is a very exacting drug and all of it must be administered. I apologize for the excessive use of caps, but I don't have the italics icon present. It seems so much more gentle to use italics then the caps! I think it has been interesting to read the postings from nurses on this subject. I think it really helps to see how information and misinformation is passed along. My information came from a very thorough inservice years ago by a very knowledgeable and wickedly bright nurse who was our drug rep for Aventis. Really, the inservicing is only as good as the person giving it. Always look for the rationale behind the instruction.