Lovenox Injections: SC, But Where?

Nurses Medications Nursing Q/A

I was told by a seasoned nurse that Lovenox (enoxaparin) is never given anywhere but in the abdomen, especially not in the arm. My drug book simply says give only in abdomen (but doesn't say why not elsewhere), but my pharmacology text does not specify location, just that it is given SC. I have done a search on the web and find reputable journal articles showing that it is given SC in abdomen and arms.

I am trying to determine the pathophysiology against using the fatty tissue over the triceps. I need to understand why the arm is no good for Lovenox. I saw a patient with extensive bleeding in the arm from a Lovenox injection, but by his description of how much the injection hurt, I would guess it was not a SC but an IM injection.

I would appreciate being pointed in the direction of a source with the answer to this question. I'm trying to develop my practice based on evidence. Thanks!

I guess we know how it got ist's name now- makes more sense than love an ox

Specializes in ICU, Mother/Baby.

I just got home from the hospital with a blood clot in my lungs ...well the ER Dr said I did but later after several Lovenox shots they said no I didn't.

I was getting the shot twice a day and always in the abdomen. Only had one nurse ask me where the last one was given at and then she went low almost in my hip area. All the nurses except one grabbed the skin while injecting and the one that did not do it is where I have a bruise. Plus that one hurt the most!

The hurt is a stinging that is felt after the shot is given and it last for several minutes. So please remember to pinch the skin together when you give it it helps with the stinging for some reason.

I was also taught to always give Lovenox in the abdomen, at least 2 inches away from the belly button. My patients have told me that it does indeed hurt like the dickens, but that the pinching trick seems to help a little.

Saw a pt that got a sterile abscess in her upper arm. She says the nurses gave it there, but they denied it and said she must have given herself the injections there. She was pregnant and had to be re-admitted to the hospital. Who knows who caused it...her or the nurses??

I am a nursing student..My text book says that SQ injections can be given in a variety of places such as in the upper arm region close to the deltoid..I know that insulin is an SQ injection and my instructor told me to give it there..What makes lovenox different from other SQ injections , where the pharmacy writes specifically, SQ injections..

Never mind, I read in the internet, that lovenox can be given in the upper arm region

SQ is simply the route of administration as is PO, IM, etc... Some meds given IM specify "deep" IM or the package insert recommends deltoid, just depending on how aggravating to the tissues it is. I know Rocephin burns and really hurts. I wouldn't give it IM in the deltoid, because I know I wouldn't be able to move my arm after rec'ing it and the pt probably wouldn't either! Knowing which site to use comes from your education, experience and looking up the med or calling the pharmacy if you've never given it. When you are unfamiliar with a drug, it is best to ask seasoned nurses about the med and look it up. If you don't get all the info you want, call pharmacy for more and they should be a good resource.

Specializes in Adult ER.
pedi-er-RN said:
Saw a pt that got a sterile abscess in her upper arm. she says the nurses gave it there, but they denied it and said she must have given herself the injections there. She was pregnant and had to be re-admitted to the hospital. Who knows who caused it...her or the nurses??

Well when I was prego, and had to give myself this medication, I gave it in the thigh. yes the abdomen is the best place for it to go, however because I was pregnant I could not give it there. I was informed to go with either the thigh or the fatty tissue in my arms.

I have a question for you, where would you have placed the injection (in the arm thigh or abdomen)?

Specializes in LTC, Home Health.

I have a pt in LTC who receives Lovenox injections 60mg bid. I always give it in the abd. She told me one day that the first shift nurse had given it in her arm and it hurt really bad. She does have bruising on her abd, but they turn yellow and fade rather fast. I've had no complaints from her about pain, during or after the injection. BTW, this pt told me she never wanted another Lovenox injection in her arm, so it must have been a really bad experience for her. We also document on the MAR the site of injection right under our initial when we sign that the drug was given. This helps to rotate the injection.

Specializes in Adult ER.

I can imagine, from experience I know that the drug hurts it has a sting like you couldn't imagine. there were many times where I wish that they would have just put me back on heparin rather then this one, even if it meant that I had to inject it twice in the am and pm.

Specializes in Education, Acute, Med/Surg, Tele, etc.

I give in the abdomen....that is about it...

Can still be given in the abdomen as long as you still have some SQ tissue, also can be given in the "love handles" as someone stated.

I was taught to ice the site for a few minutes before and after injection to minimize bruising and post injection bleeding. I've always given in the ABD.

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