Do I push out the air bubble?

Nurses General Nursing

Updated:   Published

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?

I was taught to keep the bubble.

1 Votes

"My nurse educator at the time put an end to the question ". Well now, there was your answer.

You have much bigger fish to fry. Use your critical thinking skills. That small of an air bubble will not be significant , even if it given through the IV route.

Pick your battles. Many more to come.

1 Votes
evastone said:
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?

I would stay I away from anything that starts with "I was always taught", or "From what I hear..".

Even a simple Google search of "Lovenox air bubble" beets that. Actually, it gets you exactly what you want without even following a link.

"*NOTE: Patients should be lying down and LOVENOX® administered by deep subcutaneous (SC) injection. To avoid the loss of drug when using the 30 mg and 40 mg prefilled syringes, do not expel the air bubble from the syringe before the injection."

3 Votes
Specializes in Critical Care.

I remember being so freaked out by the air bubble in the Lovenox syringe the first time I gave it - but when I was researching the med prior to giving it the manufacturer's instructions said to keep the bubble, and my clinical instructor confirmed that for me so now I don't worry about it :)

1 Votes

I never thought of these things when I was a bedside nurse lol, how exactly would a tiny air bubble being injected into the subq layer cause any harm?

2 Votes
Specializes in Emergency Department.
TriciaJ said:
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.

This was recently emphasized to us in NS, and aligns with the mfr recommendations.

I don't think much, if any, of the air bubble escapes the needle tip, it's probably calibrated to fully empty the syringe and needle of medication (expensive drug).

1 Votes

Medication question: has anyone ever been told that identifying meds is not within nursing scope of practice?

1 Votes

I inject with the air bubble. The air bubble is there to ensure the lovenox is correctly administered into the subcutaneous tissue. If you read the instructions that come with lovenox it clearly indicates this.

2 Votes
Specializes in Mental Health, Gerontology, Palliative.
evastone said:
....

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?

Using logic, how much damage do you think a tiny air bubble is going to cause going into subcut layer?

The bubble helps ensure that all the medication is given

1 Votes
ambrosepr said:
Medication question: has anyone ever been told that identifying meds is not within nursing scope of practice?

Well, I am pretty sure that identifying your medication is kind of important.

On the other hand, if you have the right patient, time, dose, and route, that is 80%.

I am guessing I don't understand the question.

1 Votes

Tricia M. RN, M/S 22 years, IMCU 4 years, ED 2 years, education 4 years. 

Don't let the sarcasm get to you. There are nurses out there who can't remember what is was like to ask questions or worse, that thought they didn't have to ask questions. 

The bubble in the enoxeparin (Lovenox) syringe IS to be injected last to push the medication in fully and prevent bruising of the patient. I have used this technique for over 30 years and I can't remember bruising any patient. Also, there are many nurses who don't know this that have been practicing for years and years. 

We are conditioned to avoid injecting bubbles in any route but like everything else, every rule has it's exception. In this instance, injecting a bubble is advantageous to your patient. 

2 Votes
Specializes in Rehab/Nurse Manager.
On 12/3/2017 at 11:43 AM, 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

I keep getting "ERROR 404
Sorry we couldn't find this page for you" with the link provided.  Wondering if I am doing something wrong? I'm actually interested in this information 

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