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Do I push out the air bubble?

Updated | Posted

Specializes in CEN. Has 4 years experience.

As a new nurse, I remember an argument on my unit questioning whether or not to inject lovenox whith the air bubble. My nurse educator at the time put an end to the question and explained that the air bubble remains in the syringe to be injected after the medication so that lovenox is pushed deeper into the tissue and would prevent bruising.

Recently, this issue was brought up again. Apparently, all the nurses at another hospital get rid of the air bubbles because all air bubbles are dangerous. It made me wonder if I have been giving lovenox the wrong way. Do I push out the air bubble or not?

Is lovenox the auto injectable syringe? I don't think a tiny air bubble in the subcutaneous tissue would cause any harm. We have patients with mass subcutaneous emphysema and the physicians will just have us monitor and wait. I believe the air is reabsorbed. I wouldn't worry about it

Sour Lemon

Has 11 years experience.

Pixie.RN said:
Read the medication insert that comes with Lovenox - that explains the presence of the bubble. https://www.lovenox.com/hcp_default.aspx

No, no, no ...it's much better to do casual survey on the internet than read the manufacturer's instructions.

missmollie, ADN, BSN, RN

Specializes in Neuroscience. Has 4 years experience.

I didn't see any information about the air bubble in what pixie posted, but they definitely did not say to get rid of the bubble.

The air bubble helps to trap the medication in the subcutaneous layer, thus preventing the medication to leak to the epidermis layer. This helps to prevent severe bruising on the skin and keeps the medication where it is supposed to stay. I do this with heparin as well,

Lunah, MSN, RN

Specializes in EMS, ED, Trauma, CNE, CEN, CPEN, TCRN. Has 13 years experience.

missmollie said:
I didn't see any information about the air bubble in what pixie posted, but they definitely did not say to get rid of the bubble.

The air bubble helps to trap the medication in the subcutaneous layer, thus preventing the medication to leak to the epidermis layer. This helps to prevent severe bruising on the skin and keeps the medication where it is supposed to stay. I do this with heparin as well,

That page from the manufacturer does indeed mention the air bubble. It recommends to NOT expel the air bubble prior to administration.

TriciaJ, RN

Specializes in Psych, Corrections, Med-Surg, Ambulatory. Has 40 years experience.

Pixie.RN said:
That page from the manufacturer does indeed mention the air bubble. It recommends to NOT expel the air bubble prior to administration.

My understanding was to let the bubble float to the plunger end of the barrel, then inject it last. It will help clear the last bit of medication from the syringe so the patient gets the whole dose.

evastone, BSN, RN

Specializes in CEN. Has 4 years experience.

Sour Lemon said:
No, no, no ...it's much better to do casual survey on the internet than read the manufacturer's instructions.

Actually, I did look at the instructions before coming here. I couldn't find it in the instructions it came with. I figured I missed it somewhere which is why I was asking. Figured someone had seen what I hadn't. Instructions are much clearer online.

Sarcasm is always appreciated though. It makes for an interesting thread.

Lunah, MSN, RN

Specializes in EMS, ED, Trauma, CNE, CEN, CPEN, TCRN. Has 13 years experience.

evastone said:
Actually, I did look at the instructions before coming here. I couldn't find it in the instructions it came with. I figured I missed it somewhere which is why I was asking. Figured someone had seen what I hadn't. Instructions are much clearer online.

It is in there, but on paper you don't have the benefit of using a "find" function! Here is the insert online. ­čÖé Lovenox┬« (enoxaparin sodium injection) for subcutaneous and intravenous use Prescribing Information

evastone, BSN, RN

Specializes in CEN. Has 4 years experience.

Thank you all!

People do that all the time, and it grinds my gears. That along with the little flip green hanger for IVP infusion sets...one side has the raised dots, the other side has the indentation where the raised dot clicks onto when you flip the thing. And when you do it wrong side, the two raised arrows are at odds with each other and you get that weird angled thing.

Like everyone said, definitely just insert with the bubble. Random tip, I started putting ice on the area I was about to inject for just like 30 seconds or so (had to do it for 9 months) and I barely had any bruising at all the whole time (may not have been the ice but made it feel a little better too!).