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!

[TazziRN, RN]

I've never seen Lovenox come in multidose vials! I've only seen them preloaded in 30's and 40's.

[truern]

Just today I had a patient with Lovenox ordered 1 mg/kg...she weighed 157 pounds. Therefore, I wasted 9 mg from a prefilled 80 mg syringe before giving her 71 mg.

Certainly wasn't a problem. :)

[rjflyn, ASN, RN]

From the Lovenox web site:

Lovenox Injection is available in two concentrations:

1.

100 mg per mL

-Prefilled Syringes

30 mg / 0.3 mL, 40 mg / 0.4 mL

-Graduated Prefilled Syringes

60 mg / 0.6 mL, 80 mg / 0.8 mL, 100 mg / 1 mL

-Multiple-Dose Vials

300 mg / 3.0 mL

Lovenox Injection 100 mg/mL Concentration contains 10 mg enoxaparin sodium (approximate anti-Factor Xa activity of 1000 IU [with reference to the W.H.O. First International Low Molecular Weight Heparin Reference Standard]) per 0.1 mL Water for Injection.

2.

150 mg per mL

-Graduated Prefilled Syringes

120 mg / 0.8 mL, 150 mg / 1 mL

Generally I see the doses get rounded to the 10mg and always down by the pharmacy on the printed MAR. Its safer to under dose slightly and ideally we would be dosing the patient based on lean muscle mass and not total body wt which would bring the dose down anyway.

Rj

[INnurse]

Where I work the cardiologists order it all the time that way. The syringe is marked, just expel the unneeded portion. It is weight based, one mg per kg. and usually ordered BID. The 30-40mg dose daily is for DVT prophylaxis.

[rehab nurse]

Just today I had a patient with Lovenox ordered 1 mg/kg...she weighed 157 pounds. Therefore, I wasted 9 mg from a prefilled 80 mg syringe before giving her 71 mg.

Certainly wasn't a problem. :)

well, it seems in my area that the nurses are writing people (read=me) up for med errors for doing that. no amount of showing them the drug guide, or telling them how i came up with the dose on the syringe would convince them that i was not making an error. i believe they are thinking that because of the drilling into our heads of not to waste the "air bubble" out of the 30mg and 40mg syringes since it could lead to loss of medication.

i am glad i am not the only one who has given an odd amount. thanks for your reply.

[rehab nurse]

I've never seen Lovenox come in multidose vials! I've only seen them preloaded in 30's and 40's.

i have never seen the vials either, only read about their availability. however, we get all kinds of the prefilled syringes, every dose available, usually a 40mg or 80mg syringe. thanks for your reply!

[Tweety, BSN, RN]

Our ortho docs usually order 30 to 40 mg for prophylaxis.

However, for DVT or PE patients, they are usually weight based and we give some strange amounts. Fortunately the pharmacist calcuates it and it's the med sheet how much to give, for example .84 cc. They send the nearist dose and we expell what we don't need. I don't see any other way of doing it. I'm really not understanding the controversy.

[rehab nurse]

Generally I see the doses get rounded to the 10mg and always down by the pharmacy on the printed MAR. Its safer to under dose slightly and ideally we would be dosing the patient based on lean muscle mass and not total body wt which would bring the dose down anyway.

Rj

we usually get a rounded amount too, but recently i have seen more and more of the unusual doses. don't know why, just know thats what we get orders for. and all of our doses are handwritten orders, no computers where i work. only if out pts are there more than a month do they get preprinted MARs, and usual pt stay is about week and a half. thanks for replying!

[rehab nurse]

Our ortho docs usually order 30 to 40 mg for prophylaxis.

However, for DVT or PE patients, they are usually weight based and we give some strange amounts. Fortunately the pharmacist calcuates it and it's the med sheet how much to give, for example .84 cc. They send the nearist dose and we expell what we don't need. I don't see any other way of doing

it. I'm really not understanding the controversy.

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!

[rehab nurse]

Where I work the cardiologists order it all the time that way. The syringe is marked, just expel the unneeded portion. It is weight based, one mg per kg. and usually ordered BID. The 30-40mg dose daily is for DVT prophylaxis.

thanks for your reply! i am glad i have yet another nurse who has given the lovenox in an unusual amount. and yes, for another poster's remark about different dosing for different reasons; the unusual doses ordered are usually pt's who have prior history of PE and are now undergoing elective surgery for hip/knee, etc. again, thanks everyone for your quick and intelligent replies! you are all so great!

[catlady, BSN, RN]

Just today I had a patient with Lovenox ordered 1 mg/kg...she weighed 157 pounds. Therefore, I wasted 9 mg from a prefilled 80 mg syringe before giving her 71 mg.

Certainly wasn't a problem. :)

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.