Enoxaprin and bruises

[brownbook]

I rarely give enoxaprin but had an out patient who came in once a day for the injection. He nor his family could manage to do it at home!

I studied up, watched how to videos, asked co- workers, but every site left a big bruise? He was over weight and wore tight fitting Levi's. Some co - workers said that was probably why? His INR was low?

Is bruising so unavoidable? He was always sitting up in a recliner chair and zipped up his pants and left as soon as I was done?

[Okami_CCRN, BSN, RN]

Unfortunately, this is a side effect of lovenox and heparin SQ. In the ICU we may give Lovenox q12 or q24h and by the end of the ICU stay they have this row of bruising along their pannus. With Lovenox it is important to not expel the air bubble that is within the syringe prior to administration.

[brownbook]

Thanks, I tried not to intentionally expel the air bubble, but it took me a few days just to get used to pinching the skin with one hand and holding the syringe and depressing the plunger with the other hand.....then the way it automatically retracted the needle after the injection, as soon as the med was injected, was kind of "whoa....how did that happen"!

As usual everyone said...oh it's easy.....still even 30 plus year nurses run into things that they need help and advise with as much as a new grad!

[KatieMI, BSN, MSN, RN]

Lovenox has nothing to do with INR, to begin with. It has different mechanism of action, and bruises at the point of injection is an expected side effect. It is not about being overweight and tight-fitting clothing.

Some people just can't push a needle into a human flesh. Also, the injector's needle and the releasing mechanism are poorly designed; in fact, so poorly that I saw patients paying OOP for compound pharmacy to re-dose enoxaparin in insulin syringes.

I wouldn't bother if daily visits are ok with everyone. If not, there is home care. After all, patient can bring a relative to do shots in your presence for a few times.

[brownbook]

Thanks, I reviewed INR, coumadin, enoxaprin, etc., prior to the injections. But I was so concerned about the bruises that that was all I focused on. I knew lovenox and INR weren't related....I was just in a hurry to ask Allnurses if something was wrong with my injection technique.

The daily visits were okay with Dr's, insurance, etc.

Yes the release mechanism took some getting used to....sometimes I wasn't sure if I had finished depressing the plunger prior to the release mechanism engaging!

[TheCommuter, BSN, RN]

Moved to the Nursing & Patient Medications forum.