Giving Lovenox to emaciated patients

[cardiacqueen]

So we've all been there...you have a 30-some kilo very ill lady to whom you need to administer Lovenox..

This seems like a dumb question, but is it possible to puncture/damage the intestines or other underlying organs of a very emaciated patient by administering Lovenox at the recommended 90-degree angle? I know the needle is only 1/2 inch...but it scares me because pinching up the skin on these patients is just that, only skin. Doing that would result in an intradermal injection and likely a needle stick for the me. I want to give these injections properly in the proper tissue but I also don't want to put myself at high risk for needle stick injuries...I have tried introducing the needle only about half way into the tissue (without pinching skin) to prevent the medication from being injected too deep and hitting musculature. Several of my coworkers say that hitting organs is impossible and it's actually not necessary to pinch up fat as the needle is so short.

I have heard of a few rare cases of muscular hematomas resulting from lovenox but never any organ damage? What do you guys think? Any tips for giving Lovenox to very very emaciated patients? This has always bothered me.

[FineAgain]

With a very thin or emaciated patient, instead of pinching the skin, I hold it taut so the needle goes in more easily. I find that this way I hit the fat pad instead of just injecting into skin. More comfortable for the patient...

As far as hitting an organ? No way, not possible.

[cardiacqueen]

thanks so much! Makes sense!

[KelRN215, BSN, RN]

I always hear adult nurses say that you must give lovenox in the abdomen but I can tell you in pediatrics we never do that. I've never met a kid who will let you anywhere near his belly with a needle. Thighs and backs of the arms work just fine. We check levels so we know they're therapeutic with injections at these sites.

[cardiacqueen]

KelRN, do drug companies manufacture a different syringe device for peds...like one with a smaller needle and appropriately smaller doses? Or do you draw your Lovenox up from a vial and give in a short sub-q needle? Just curious.

[KelRN215, BSN, RN]

KelRN, do drug companies manufacture a different syringe device for peds...like one with a smaller needle and appropriately smaller doses? Or do you draw your Lovenox up from a vial and give in a short sub-q needle? Just curious.

No they come in the same pre-filled syringes that you see in the adult world. If the dose in the pre-filled syringe isn't the dose the child needs, the parents are taught to waste a portion of the pre-filled syringe. Subq needles are short whether they're being used for adults or children. I've never seen a specific pediatric sized subq needle, though the IM needles we use for kids are significantly smaller than the ones you'd use for an adult.

[anon456, BSN, RN]

I work peds and we sometimes use this device on older/mature patients who would not mess with it, or those who neurologically are incapable of messing with it. It seems to be less traumatic to the patient. It is especially useful for those patients who have very little body fat. We need a doctor order to use it but most docs are happy to order it.

Intrapump » insuflon™

[blondy2061h, MSN, RN]

I work peds and we sometimes use this device on older/mature patients who would not mess with it, or those who neurologically are incapable of messing with it. It seems to be less traumatic to the patient. It is especially useful for those patients who have very little body fat. We need a doctor order to use it but most docs are happy to order it.

Intrapump » insuflon™

We don't need an order for them, but use them rarely. The Lovenox causes so much bruising all in one area. We prefer to save them for other subq shots. If the patient really has fear, we'll use it. I doubt it really helps, since most of the pain with Lovenox is the burning as it's injected.

[0.adamantite]

I asked a similar question in the past. How about those patients with like no body fat who have big, bloated bellies too? I hate giving the shots to these people. I am talking about people who are extremely malnourished. Do they even have any body fat?

[loriangel14, RN]

I have given it in the thigh to underweight patients.

[madwife2002, BSN, RN]

Move to Nursing and Patient Medications

[KelRN215, BSN, RN]

I work peds and we sometimes use this device on older/mature patients who would not mess with it, or those who neurologically are incapable of messing with it. It seems to be less traumatic to the patient. It is especially useful for those patients who have very little body fat. We need a doctor order to use it but most docs are happy to order it.

Intrapump » insuflon™

I hate these, especially for lovenox. The kids have huge bruises after 7 days. I've actually never met an older kid who wants one, they'd all rather get the shot daily or BID. We never needed an order for one though. In the home, most insurances won't cover them so we don't use them.